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Permit Number:
Planning and Development Services
Building and Code Regulation Division
2]00Virginia Avenue, Fort Pierce B34983
Phone: (772)462'15S3 Fax. (77Z)4621578 (,OOODlerCialResidential X
| PERMIT APPLICATION FOR: Roof |
Address: 17O4Bar Harbor Road, Fort Pierce, FL34Q45
Legal Description: Golden Ponds - 170 .4 Bar Harbor Drive, Fort Pierce, FL 34945
pnopertyTax|D#: 012701
Site Plan Name:
______
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
F1HVAC
___ Windows/Doors
Electric 1
� —� �
Tota|Sq.RofConzLnumthon: 12OO S Ft � �
nfFi F| 120O
[oeLofConstruction: $ OOUO Utikties� � �5ewerSeptic 8ui|ding HeiQht- 1
L�Shu�eo
��Roof pitch
Name Greg Ley
Address: 17U4Bar Harbor Drive
Fort Pierce City:Stake: FL
Zip Code: 34945 Fax: NIA
Phone No. 410'569'3367
E -Mail. leygregg@yahoo.com
Fill infee simple Title Holder omnext page (ifdifferent
from the Owner listed above)
Name: Richard V. Colletti
Company: Leak Busters Roof Repairs, LLC
Address: 6101 Buchanan Drive
City: Fort Pierce State. ^
Zip Code. 34982 Fax: 772'284'0378
Phone No. 772'832'8450
E -Mail: richiecollefti@gmai1.com
State or County License: CCC1 330976
nmauecnconstruction m!�ZWonrmore, mRECORDED Notice o1Commencement iorequired.
Name: _
Address:
City: _
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
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Address:
Name: _
Address:
City:_____
Zip: —
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I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
State:
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, wails, signs, screen rooms and accessory uses to another non-residential use
WARNINGS 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 recordiniz your Notice of Commencement.
aa, �a� V . C CZ ��. cam - s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
•F C)�. � COUNTY OF i i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this —L(p- day of u 20 1'&by thisA& day of, 20 A— by
(Name of person acknowledging) (Name of person acknowledging )
LL ?\6u�C4 - n" olkbl�_-b
(Signatu of NotaryPublic- State of Florida } (Sign ature-151N ota ry P blic- State of Florida }
Personally Known _ _ OR Produced Identification
Type of Identification Produced
Commission No.
SALLY PORTES
r* My Commission Expires
Revised 07/15/20 'f 0kuaei+�`��� November 16, 2020
Personally Known V OR Produced Identification
Type of Identification Produced
mission No.
)I) SALLY PORTE
Commission # GG
My Commission E
November 15,
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