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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %0 11;ll � N-\ Permit Number:
n I Iiiiiii = M = 0 M=" i Building Permit ApplicatioRECEIVED
Planning and Development Services
Building and Code Regulation Division OCT 2 7 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax:(772) 462-1578 Commercial APWOV ent
PERMIT APPLICATION FOR: Roof - St. Lucie County, FL
P 0 M LOCATION A.' ObSED-IMMOVE 'ENT-LO ' ION�`P',,-
Address: 2119 NW GREENBRIAR LN
Legal Description- GREENBRIAR VILLAGE HARBOUR RIDGE -PLAT 2- UNIT 12
Property Tax ID #: 4425-70170048-000-7 Lot No.
Site Plan Name: Block No.
Project Name: DIETZ
Setbacks Fr ont Back: Right Side: Left Side:
DETAILED DESCRIPTION��OF,WORK:-,-,-,,- ,
TEAR OFF EXISTING TILE ROOF AND REPLACE WITH NEW TILE ROOF.
Additional work to be performed under this permit— check all th-at apply:
❑HVAC 0 Gas Tank E]Gas Piping E]Shutters
❑ Electric El Plumbing [:]Sprinklers ❑ Generator
Total Sq. Ft of Construction: 42 SQUARES
Cost of Construction: $ 26,960.00
S Ft of First Floor:
UtilitiesT] Sewer FISeptic
ElWindows/Doors
Roof Roof pitch
Building Height:
-,OWNER/LESSEE:',`,','-
CONTRACTOR:
Name DIETZ, WILLIAM
Name: JOHN TURNER
Company: STUART ROOFING
Address: 9200 SE RIVERFRONT TERR
City: TEQUESTA State: FL
Address: 140 NE DIXIE HWY
Zip Code: 33469 Fax:
City: STUART State: FL
Phone No. 561-309-2198
Zip Code: 34994 Fax:
E-Mail:
Phone No. 772-692-9854
Fill in fee simple Title Holder on next page (if different
E-Mail: stuartroofinginc@comcast.net
from the Owner listed above)
State or County License: CCCO24411
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Y,
x ENTAIL, CONSTRUCTION
,LIEN LAW
INFORMATION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: DIETZ, WILLIAM
Name: JOHN TURNER
Address: 2119 NW GREENBRIAR LN
Address: 9200 SE RIVERFRONTTERR
City: STUART State:
City: TEQUESTA State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: 140 NE DIXIE HWY
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-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of CommencementA ,
Sig ture of Owner/ Lessee/Contractor as Agent for Owner
Sig ture of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLUCIE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 14 day of OCTOBER , Zp_ by
this 14 day of OCTOBER , 2i)_ by
JOHN TURNER
JOHN TURNER
Name of person making statement
Name of person making statement
Personally Know x OR Produced Identification
Personally Known x 0 ro u Identification
Type of Ide ication
Type of Identi ' ation
Produced
Produced
(Signs ure of N Public- State of Florida)
(Signature of Notary Public- State of Florida )
,, ;;�Y ;EyB�, TAN ' N ER
Commission No. . a•��
Commission No. ,.•�" r ryfc,, 7At�@�yRNER
Commission # FF 922696
Commission # FF 922696
-�, Q; Expires September 30, 2019
;w:
Expires September 30, 2019
Bonded Tbm Troy Fein Insurance =485.7019
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4,F R • ¢a` Fein Imurartu 800.785.7019
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Rev.8/2/17