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Roofpitch X 2756 BROCKSMITH RD SUBDIVISION OF MC NURLEN FARMS BLK 4 LOT 8-LESS W 76.23 FT- (8.81 AC) 2320-501-0060-000-5 8 4 2647 17,700.00 Richard Sampson 2170 SW Conant AVE LARRY NEESE, LLC Port St. Lucie 3401 S. US Hwy 1 34953 Fort Pierce FL. 34982 772-361-6580 larryneeseroofing@gmail.com CCC1330608 5/12 FL Roof Remove and replace existing roof covering Gulf Coast 5V Crimp FL 11651.13 R3 Titanium PSU 30 11602-R-9 DESIGNER/ENGINEER: XX Not App Name:_ Address: City: _ Zip: Phone State: MORTGAGE COMPANY: Name: Address: CitV: Fort Pierce Zip: Phone:. — Not Applicable State: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: 3401 S. US Hwy 1 Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-resi tial use WARNING TO OWNER: allure to Record a tice of Commencement may result in your p ing twice for improvements to r i�Z, ty. A Notice omrnencement must be rec nd pos d on the jobsite before the firs spectiou inte tc obtain financing, consult lende or an a orney before commencin ork or our otice of Commencement. Signature of wner/ Lessee /Con r r as Agent for Owner Signature of Co tractor/license Holde STATE F FLORIDA STATE OF FLORI COON Y OF St. Lucie COUNTY OF St Lucie The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 120_ by this day of 20_ by Larry C Neese Larry C Neese Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of NoVy Public- State of Florida) (Signature of ary Public- State of Florida COmmISSIOn NO. Public Stator fLPjSS* n NO. `✓�i✓ iN " Scete Of Ronda Amy °d Amy N Wood My Comm/ssion GG 241645 My Commaision GG24164 5 Expires 0712512022 Expires 07/25/2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17