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APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q L�
.i; � SCANNED
Permit Number: `.104-0 1
m- .,� f�y. RECEIVED
St Lucie rnQjnty
Building Permit Application AUG 23 2017
P11 nning and Development Services Permitting Department
Building and Code Regulation Division St, Lu€IP. Gounty
2300 Virginia Avenue, Fort Pierce FL 34982
PI%ne- (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PE , MIT APPLICATION FOR: Roof S lrho `
PROPOSED POSED IMPROVEMENT LOCATION':
Add' ess: 102 NE Carlisle Ln.
Leg
l�l Description: 16 36 40 S 125 FT OF SE 1/4 LYG E OF ST LUCIE RIV-LESS E 30 FT FOR RD R/W-(0.90 AC)
(Oqj 1146-1715; 3560-2953)
Pro lerty Tax ID #: 3416-444-0002-000-4 Lot No.
Site Plan Name: Block No.
Proj ct Name:
acks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
new
PON
shingles, renail plywood, install Tribuilt Sand self adhering shingle underlayment and install
salt shingles. Tear off flat roofs and apply two layers of Polyglass SAV and one layer of
SAP.
CONSTRUCTION' INFORMATION:
bona wor to ",ormed under this permit— check all that apply:
3 HVAC L_J Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Tot il
Sq. Ft of Construction: 6400 S . Ft. of First Floor:
Cosf Construction: $ 26,000.00 Utilities:Sewer E]Septic Building Height:
Ow''
ER/LESSEE:
CONTRACTOR:
Nam
Addr,Iss:102
Irene Parks
Carlisle Ln.
Name: David Packard
Company: Packard Roofing & Waterproofing, Inc.
Fort St. Lucie State:F�
City:
Address: 2182 NW Reserve Park Trace
Zip
ode: 34952 Fax:
City: Port St. Lucie State: FL
Phon
E-M�I:
Fill inl�
I No.772-785-9391
Zip Code: 34986 Fax: 772-468-9978
Phone No. 772-468-3723
E-Mail: ssmith@packardroofing.com
ee simple Title Holder on next page (if different
from
the Owner listed above)
State or County License: CCCA17517
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
I
DESIGNER/ENGINEER:
N
Not Applicable
3 me:
MORTGAGE COMPANY: Not Applicable
Name:
dress: 102NECetdisleLn.
State:
Phone
I�
A
Cqy:
Zi
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
N ' me:
BONDING COMPANY: ANot Applicable
Name:
A dress:
Address:
City:
City:
Zip: Phone:
II I
Zip: Phone:
O NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I c IrItify that no work or installation has commenced prior to the issuance of a permit.
St. Lcie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whi h is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
strt cture. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In c I nsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in a Icordance 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
commencine work or recordine vour Notice of Commencement.
_0Q_Q_ c)_(�_��
re of Owner/ Lessee/Contractor as Agent for Owner Signature of contractor/License Holder
TE OF FLORI A STATE OF FLORIDA
JNTY OF=, is LVC8 2 COUNTY OF 61-, w a'P—
forgoinpg instrument was acknowledged before me
elo
V^gay of [31,i�N. t 20 by
Name of person making statement
finally Known ✓ OR Produced Identification
of Identification
The forgoing instrument was acknowledged before me
this4Yday of 424 yS t 20 hr by
mn'.1 G{ -?4c-(c"
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
1
(S
gnature of
-
(Signature o
Co
missionN
;,••�pRr'a�'•., STEPHANIE P. MIT
o o ,
:2. oa Notal Public-StaC da
; 2Q°,", :;
,�.o:
Commission * =
. STEPH)NIE P. SMITH
Notary Public - State of��s@r� al�
sion9GG13957
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9 iF
Commission 0 GG 139524
My Comm. Expires Sep 2, 2021
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My Comm, Expires Sep 2, 2021
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Bonded through NationalNota Asn.
BordedthroughNatioralNotaryAssn.
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Rev. ;8/2/17