APP-R-24-217968ROOF / RE-ROOF PERMIT APPLICATION
100 NW 1st Avenue Delray Beach FL 33444
(561) 243-7200 Fax: (561) 243-7221
Website: www.delraybeachfl.gov
FOR OFFICE USE ONLY:
PROPERTY CONTROL #: ____-____-____-____-____-____-____
PLEASE PRINT
JOB SITE ADDRESS______________________________________________________________
PROPERTY OWNER NAME _______________________________________________________
HOME PHONE (_______) _________________________ CELL (____) _______________________
PROPERTY OWNER ADDRESS ____________________________________________________
ROOF CONT’R (COMPANY) NAME ________________________________________________
ROOF CONT’R ADDRESS _________________________________________________________
CITY ________________________ ________ST ____________ ZIP ________________________
BUS. PHONE (_______) _________________________ CELL (____) ________________________
E-MAIL ___________________________________________ FAX (____) _____________________
NOTE: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180-DAYS OR IF ACTIVITY LAPSES FOR 180 DAYS. PLANS MUST BE
ON THE JOB SITE FOR ALL INSPECTIONS. FINAL INSPECTION IS REQUIRED ON ALL PERMITS.
PROJECT COST (Labor and Material) $ ___________________
Check one: ___NEW CONSTRUCTION ___RECOVER OVER EXISTING __REMOVE EXISTING & REPLACE __R/R A/C UNITS
(Engineer’s Letter Required) (Mech. Permit Required)
___ SOLAR PANELS or SOLAR WATER HEATER required to be removed/replaced (Permits Required and Engineer’s certification for re-installation)
Check one: _____SINGLE-FAMILY _____MULTI-FAMILY _____COMMERCIAL
MITIGATION REQUIREMENTS IF SAWN LUMBER, WOOD PLANK, OR WOOD STRUCTURAL PANEL ROOF DECK - FBC EXISTING
CODE section 706.8 :
1.YEAR BUILT (check one): _____ BEFORE MARCH 2002 (Go To #2) _____ AFTER MARCH 2002
2.BUILDING VALUE: $__________________________ MUST PROVIDE: BUILDING INSURANCE SUMMARY SHEET OR
(IF $300,000, OR MORE, NOT INCLUDING LAND VALUE, COPY OF MOST RECENT TAX BILL OR
GO TO #3) PROPERTY APPRAISER OFFICE WEBPAGE
3.SUBMIT RE-ROOFING MITIGATION DOCUMENT PACKAGE and BUILDING APPLICATION
TYPE/COLOR OF ROOF MATERIAL REMOVED ___________________ TYPE/COLOR OF ROOF MATERIAL INSTALLED _________________________
ROOF TYPE (CIRCLE): MANUFACTURER: PRODUCT APPROVAL NUMBER:
FLAT ___________________________________ _________________________________
SLOPED _____: 12 ___________________________________
_________________________________ ________________________________ ___________________ OR ___________________
SIGNATURE OF QUALIFIER CONTR. REGISTRATION # WORKERS COMP# EXEMPTS (FID /FEIN) #
PLEASE WRITE LEGIBLY AND COMPLETE FULLY. ILLEGIBLE OR INCOMPLETE NOTARIZATIONS WILL NOT BE ACCEPTED.
STATE OF _______________________
COUNTY OF ___________________________
The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization
this __DAY_____ day of _____MONTH_____________, __YEAR___ by _______________________________________
(Printed Name of Above Signatory)
______________________________________
Signature of Notary Public – State of Florida (NOTARY SEAL)
BLDG PERMIT #: ________________
ROOF PERMIT #: ________________
PERMIT FEE: ________________
SURCHARGES: ________________
PLAN CHECK FEE: ______________
MCR #: _________________
********************************
APPROVALS:
PLAN: _________ DATE: _________
P & Z: _________ DATE: _________
Personally Known _____
OR
Produced Identification _____
Type of Identification Produced
_________________________________
REV 5/2023
12 42 46 25 16 000 2180
2031 Valencia Dr, Delray Beach, FL 33445
Levinson, Mindy
N/A N/A
2031 Valencia Dr Delray Beach FL 33445
Distinctive Roofing Inc
1940 NW 33rd Ct
Pompano Beach FL 33064
info@distinctiveroofing.net
954 846-7663
$35,781.00
X
X
313,175.00
Eagle
Capistrano -Terracambra RangeBeige Blend - Roll Tile
N/A
6
N/A N/A
Eagle Roofing Products
- N/A - See attached Mitigation ReportNo Mitigation retrofits required
870-040258 / 3FF3837CCC1327639
X
Year Built - 1999
Florida
Broward
X
X
DL
FL7473-R10____________