HomeMy WebLinkAboutSUBMITTED PAPPERSIn
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MAP NO.
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ZONING
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LAND USE
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LOT CVG%
TAZ NO.
FLOOD ZONE
FIRM MAP #
IsT FLR ELV
MAX HGT
CONST TYPE
OCCUPTYPE
MAX OCCUP
#OFFERS
"
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF RFC
LOT OF REC (after
LOT SPLIT
LOT SPLIT
before I/90)
1/90
REQUIRED
APPROVED
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i v. }s's"c' GYa1t
�.v�. • � i3at:�v
Y sh
: b
ADMINST
LIBRARY
PARKS
PERMIT
VARIANCE
IMPACT FEE
IMPACT FEE
FEE
REPORT
PUBLIC BLD
HABITABLE
RADON FEE
CODE
—\`•J
IMPACT FEE
AREA
(RADON)
(�
SCHOOL
�\1
GROSSROAD
CREDIT
-TOTAL ROAD
IMPACT FEE
�
IMPACT'FEE
IMPACT FEE.
`
j
,DUE •`-..
� , •..
-
SCHOOL
CREDIT
Y
N
TOTAL
IMPACT FEE
SCHOOL
IMPACT FEE
POLICE FEE
FIRE FEE
MISC FEE
TOTAL
POLICE/fII;E
MISC FEES
ADDITIONAL
Y
N
SPECIFY -
TOTAL
PERMITS
ofALL
REQUIRED
�
FEES
K P� '`� F.{
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REVIEWS
ZONING
ZONING
PLANS
MISC.
VEGETATION
SEA TURTLE
MANGROVE
REVIEWED BY
EXAMING
DATE
COMPLETE
INITTALS
DATE FILED.
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER: Cl3 I d -• Oy� J
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO.BE1
1. LOCATION/SITE ADDRESS: �®e�
2. S/D NAME: SITE PLAN NAME:
3. PROPERTY TAX ID#: 7.901t »+to/ 681—,po3p'Z— PJerO/a
4. LEGAL DESCRIPTION (attach extra sheets if necessa
h
CERTIFICATION:
OWNER INFORMATION
PHONE (DAYTIME):`( 4 email:
T.
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): �)
CONTRACTOR INFORMATION
ST. of FL REG./CERT #: _
BUSINESS NAME: C%G
QUALIFIERS NAME: _
CITY: ' ( �/ wc4or STATE:
PHONE (DAYTIME):. FAX NO
ADDRESS:/ r Ur
CITY:v STATE:
PHONE (DAYTIME):
BONDING COMPANY: /"e✓/✓1�
ADDRESS:
CITY:
MORTGAGE LENDER: 11 �od
FAA Rams
STATE:
ZIP
ST. LUCIE COUNTY CERT
r -
ZIP
email:
I —
ZIP
ZIP
CITY: STATE: ZIP
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF TIES
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
126_4'� ze,
OWNER/CONTRACTOR SIGNATURE CONTRACTOR SIGNA11URE
STATE OF FLO STATE OF FLORIDAf
COUNTY OF lAl 11e. COUNTY OF _-. I IlA.
The foregoing ment was acknowledged
b fore me this �fFuday of Nov , , 20D5 by
, who is personally
known to me or who has produced
17ylnllrr %a pr,o was identification.
lgnat y
a Nobky
Fli IW, M'ller
Type or Print Name of Notary �,�' Elva Miller
p My commission DD165847 y _
Commission No. (Seal) orM` Expires November zz, zoos
The foregoing ins iment was acknowledged
Gkrn,
e this day of �jL, 20t9by
who is personally
me orwho has produced
&Y,00n(lit l6iown as identification.
Signatur of Not
U1 12, IyrllPr
Type or Print Name of Notary
,",N Eliza Miller
GomrriissioI No: 6 . ,"GAmisslon DD165847
_ Expires November 22, 2oe6
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN_
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THE APPLICATION.
For specific instructions see appropriate permit checklist.
►(F°Jp� TERMITE, & PEST MANAGEMENT
cm e I
792 SW Grove Avenue, Suite 101
s Port St. Lucie, FL 34983
1-800-230-7378
Certificate of Preconstruction
(This is a partial treatment only and not a guarantee or warranty)
Builders Name:
Permit ih,r Legal Description: Section;,:, . {N Block:—
:
Customer Name:
Location of Property:
0'Ho ontal Treatment
r
Date: / , ,J/ /r / ,
Chemical Used;
Square / Linear Feet Treated: /
city: i i ,`
Treatment Information
-:
❑ Supplemental Treatment dS"Vertical Barrier
Time:
r
❑ Pool Deck
Notice:
FEU �I� S l�UU4
Lot:
Zip:
❑ Retreat
( Concentration: % L Gallons Used: �?
Method of Treatment: Name of Applicator:
1
OFFICE USE ONLY:
DATE FILED:Z�Ig'-V �6
REVISION FEE: 91Q
1
I
PERMIT NUMBER:xLG 0-,MR. . zlo3q
RECEIPT NO.: "� f -� lZ9
ST. LUCIE COUNTY
DEPARTMENT OF COMlMUNL
BUILDING & Z
2300 VIRGINIA
FORT PIERCE, F
561-462- 5
APPLICATION FOR BUILDING
PROJECT I\FOR IATION'
LOCATIO\!SITE
ADDRESS:
DETAILED DESCRIPTION'S OF PROJECT
REVISIONS: Ad 0 -s-"' 7"0 ,
3. CONTRACTOR INFORMATION:
ST. OF FL REG./CERTX c�t
BUSINESSNA.'%IE: :yJ -
Qualiriers Name:
ADDRESS:
CITY:
PHONE (DAYTIME): 46rr —�
4.
ARCHIT/E\GINEER:
NA —ME:
ADDRESS: _
CITY: _
PHONE (DAYTIME): _
S�
ST. LUCIE COUNTI' CERT.=
STA'
FAX
Nu
STATE: ZIP
y
/1
41
Y�
Y .{
Y
1.
I
F.� � a I ' "'� _�1$t4%f Ski.' .s! 4• y r
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a
Code Compliance Division
2300 Virginia Avenue
Ft Pierce, FL 34982
Phone: (772)462-1553 F= (772)462-1148
Date: 18 January 2006
Job Address: 4901 SEAGRAPE DR
Received By: counselb
Paid With: CK
Paid By: SOUTHEAST ALUM LLC
Building
Receipt
Receipt#: 0000031788
Pemnit Number. SLC- 0512-0037
Amount: $25.00
Credit Card Number:
Check Number: 13576
Sign:
7
Not Part of this Plat
I f0 OIIE
,nlm i i
puRCri
AOUNDARY SURVEY
GRAPHIC SCALE IN FEET
t�
—16.0
n
z
a�
r
S 00100
(OUNight-of-way)
i § MIN. SETBACKREQ.
1
i) i m. = FRONT a5
! 7'r 1 -, a•-; SIDES
I ' I CNR SIDES
REAR
2NG. '
eo I TECH., ALA C
h i i c I'"r�I of LE13AI nES_R!FnON: .9 Y
All of LOT 37 sand the South t y 35 .A; 27
t-T-�-�I rlre F7 ,L t0, !\
LuI AR�A: Ibwu
I I al E iF2 ° T W "F S ;3n1
' o SURVEYORS NOTES:
0
i L' -„' _ �`))- r• I. Survey of description as furnished by vl•cni.
2. Lends show' her ec., w2r. .
r Cl IS) n I right ,f way record.
r —4I 3. 'Flee ar: rI' 'bu%e glvund e a:::,r unI
Tei 1 I .. No underground Improvement we = local .
u 05 i o 5. B a rugs shown he -on a L i ! r,n I .eni=
nD•ro nu E.
1 S. Property lies in Flood Zone"Al I ,c d Ira. -
unity Ponnl Pl rnh.. I^Itlro?Rlr F ri e1
7 tJ / cur ch f t e
ly, Wry ,r.y„ u' M1L'h R tl. ,.rar .t:Sx: hcr.,on ur_ -nod
1 � ^
1l.'.'.JC? F '•J. II::. �\:14'�r ii IIV\ VVYu„�.� ,�, .,i;
- is rnlended only` (ur \u", veer le:l:
=� raliwl 01
c, with,ul icbj'ty,tc
Ad4ilruIi5 a de a !r: t u
r I l'rT
Cl
t•rvem Rnt
Seagrape rr;v,`.
0 v -R,41 rA E k U?IL. I, Ei1'
rt'.0 ^ FUIJYD bAi IP.Cir
Cr1E O\^ RHE/u Lr P 1 "• L
5/9 IRU"I R 9
R/W - RIGHT-CF-writ
UE - UTILITY EASEMENT
DE = DRAINAGE EASENEN r
l2L A
- nR� ECJ ire.•
R = RAC.
O a FIND 5/5" IRON REDAR
*�' = SPOT El EW.TION
06.73.9105 -
O,ie
.i.. ... _ ..�
Illl(illl � r'i r1;rc f)l 1 \ l f ti ! Ftlr having ivn
i PVEYIN(, 1kc. ;I SE r\GRAPE D.RO I
]a] N.1V AVFr S ET Scule: Date: -i
PORT SAINT LUCIF L 34Ra3 !•• - .50 f!5,23.2U05
PIrUNF 772528.2557 Drawn ly: Shaef
FAX 772 335 2804 er \, .
Cl
T '.y
THESE PLANS AND ALL PROPOSED WORT(
ARE SUBJECT TO ANY CORRECTIONS
REQUIRED BY FIELD INSPECTORS THAT
MAY DE NECESSARY IN ORDER TO
COMPLY WITH ,ALL APPUCABLE CODES,
\1
a
(,�d3`
LUCIE CoUNy�
LDING DIVISION
REVIEWED
C
i�
REVIEWS MPLI CE
[DATIJA
,.pe.EMI�_� H#�','=1:ii.'WI
I on
M DE
Not Part of this Plat
IV DUE
I N_
a C k
i
m I PORCH
M
7'6'
O
2'
a
O
o
9.11
29 6
on
I N
. •. ....
BOUNDARY SURVEY
0 0 30
GRAPHIC SCALE IN FEET
r-.
O
mzm
eIw C:
z8z
m,0
I
I
I
O
2 7
Ili, C
m
n
y
'o
o
m
Drew
s
f CARPORT r8fp I
i � r
C
I � J
I
I
i
S 00'00'00•' E
''
1T0�JO•
6l
I
�
of
or
S 00'OO'OU"E
ia.Ou'
i
I
t ,OOZes
(60_-_'Right-of-way)
20' Yavement
Seagrape
Drive
LEGEND
DUE = DRAINAGE & UIIL' iY EASEMENT
FIRC = FOUND 5/8 SON PC[; & CAR
OHE = OVERHEAD U1I1-ITY LIES
= 5/8 [RON ROD
SIRC = SET 5/8 IRON ROD a CAP
R/W = RIGHT -OF -'WAY
UE = UTILITY EASEMENT
DE = DRAINAGE EASEMENT
FND = FOUND
CL
= CEN TERRINE
EP
EDCE OF PAVEMENT
D
OEG"A ANGLE
L
- ARC LENTH
R
= RADIUS
a - FND 5/8"IRON REBAR
03p= SPOT ELEV%,-,ION
REG.
FRONT
SIDES . �
CNR SIDES
REAR 15
ZNG.
TECH. �Pr
Iyr
LEGAL DESCRIPTION:
All of LOT 37 and the South i Lot Y2gaLOCK 27,
rocorded in Plat Book 10, at PaME44
thi publi,
LOT AREA: 15000 Sq. Ft.; 0.34 Acres± _
STREET ADrAESS: 49C1 Seagrope Drive, Ft ^ ,
SURVEYORS' NOTES:
1. Survey of description as furnished by client.
2. Lands shown hereon were not abstracted or rea¢
rights -of -way record.
3. There are no above ground encroachments, unal
4. No underground Improvements were located.
5. Bearings shown hereon are based on the cenierl
00.00'00" E.
6. Property lies in Flood Zone "AH" as scaled from
Community Panel Number 12111CO281G, with an eff,
7. No search of the public records was performed
8. Elevation shown hereon are ASSUMED.
-- -"" _-- 9. This survey is not covered by yrofes'siono; liabilii
10. This document, together with the r^oncbpts and
is intended only for the specific purposo and client
reliance on this document Without written.authorize
without liability to Christopher D robing.
11. Additions or deletions to this map or report by
written con.00t the signing pwty.
CERTIFICATION 12. All values and measurements are -^• p:ot ,urro
I he...hy certify that the survey ^ ., ap-c�ot9d ne,eon was- -,,:r
crmolies v:th the minimum tttchnical ,Iondards, as set &rife 7y
M, app=rs in Chapter 6IG17 -6 of i� e 'onda AdrnWsLrutiv=
Florida Statutes, and further That there are no visible, above ground el
or noted.
06,23.2005 ��• c -�.� x
Date of Signature CFRISTOPHF.R U. GOLOING
Professional Surveyor & Mapper
Florian Certificate No. 6090
p HUGHES & ASSOCIATES
File &Drawing No.
I SURVEYING, INC.
SEAGRAPE DRIVE
782 N.W. AVENS S7.
Scale:
D.
PORT SAINT LUCIE, FL 34983
1" = 30
06.23.2005
PHONE 772.528.2557
Drawn By:
Sheet
FAX 772.336.2804
ALH
1 1 Qf 1
r ti
e�.
THESE PUNS AND ALL PROPOSED WORK
(1 ARE SUBJECT TO ANY CORRECTIONS
43 � REOUIRED BY PIELD INSPECTORS THAT
MAY BE NECESSARY IN ORDER TO.
corpbYWITH
ALL APPLICkaLi00D€B, �
ST. LUCIE CDUry7y
BUILDING DIVISION
MU&iT [JE RUT ON JOB on
NO INSPECTION WILL BE Mq[
s Y1GLl
Code Compliance Division
2300 Virginia Avenue
Ft Pierce, FL 34982
Phone: (772) 4624553 Fax: (772) 462-1148
Date: 10 January 2006
Job Address: 4901 SEAGRAPE DR
Received By: serranob
Paid With: CK
Paid By: SOUTHEAT ALUMINUM
Building
Receipt
Receipt #: 0000031338
Permit Number: SLC- 0512-0037
Amount: 5252.00
Credit Card Number:
Check Number: 13559
Sign:
ST. LUCIE COUNTY
y BUILDING & ZONING
- e 23WFORT
IA AVENUE
FORT PIERCE.
FL 74982-5652
��ORIOQ A624553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property:
for which I have applied to St. Lucie County for a Final Development Permit. In accepting
this Final Development Permit, BP Number , I acknowledge that as
owner of the above described property, and in accordance with Section 7.04.01(D), St.
Lucie County Land Development Code, I shall be responsible for assuring adequate
drainage so that the immediate community WILL NOT be adversely affected. I further
acknowledge that in granting this permit for the development of this property, St. Lucie
County is neither obliged nor liable to provide for, or maintain in any form, adequate
drainage off my property which will not adversely affect the immediate community.
Property Owner Name
WE N WROMOrl-
Property Owner Signature 'Date
STATE OF FLORIDA. COUNTY OF 3 I n,AAA ,. , ' I
ACKNOWLEDGED BEFORE ME THIS A� DAY OF I I oyem I,, Jer . 20Q
BY I f 10IN(AL, la , I Cx I h e_i''r WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
cS» nall! 1 lDWY) AS IDENTIFICATION.
ll'xa, fiddler
SIGNAT RE OF NOTARY TYPE OR PRINT NAME OF NOTARY
nor Eliza Miller
NOTARY PUBLIC TITLE � � COMMISSION NUMBER �i ,y y Cres November 7
E ti St. Lucie County
Ss `.
Building & Zoning Department
2300 Virginia Avenue
• F<OIiID Fort Pierce, FL 34982
561-462-1553
OWNER/BUILDER AFFIDAVIT
DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that
law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license.
You must supervise the construction yourself. You may build or improve farm buildings, a one -family or two-family residence or a
commercial building at a cost of under $25,000.00. The building must be for your own occupancy. It may not be built or improved for
sale or lease. If you sell or lease the building you have built or improved yourself within one year after construction is complete, the
law will presume that you built or improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed
person as your contractor. Your construction must be done according to building codes and zoning regulations. It is your responsibility
to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances.
Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet th mimum
code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and myself must be handle in.a civil
court with the advice of an attorney. This department will not mitigate any contract disputes. Initial
i
I understand that if I compensate any person or company for work performed they are required to have a business licenses in
this jurisdiction. If for some reason they do not posses a business licenses I will be responsible and liable for the cost of the,license.
Initial �
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -they are entitled to
workmen's compensation. I could be held liable for all doctor, lawyer and related medical cost, which could includyelpsp of wa es
during recovery from their injury. Initial _
To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit
application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further understand that any
violation of the terms of the owner/builder exemption shall be reported by the Build' g and Zoning Department to the Florida State
DOepment of Professional Regulation. Signed and acknowledged on this day of Idt)IIEn her of
•
STATE OF FLORIDA
Owner/Builder Signature
,
COUNTY OF �,
The f�going instrument w ackTnowledged before me this r'I day of �eyyl, 6 r , 20 O5 ,
by 1 11 f� 11'ILLS Ci[7C YJBt�I who is personally known tome or who has produced
PhD ils K ItOto h as identification. /
.4PaV+ ON
Elva Miller
i I!%✓� ►1 r 1. LI/I r' My Commission DD185847
Aignaturrf� Notary Type or Print Name of Notary �'( Expires November22.2006
Title: Notary Public Commission Number 15M
Common/MasterFonnsBuilding/Applications 11/08/02
Property Appraiser - St.Lucie Count( ,
Page 1 of 1
Thomas Talbert Record: 1 of 1
Property Identification
Site Address: 4901 SEAGRAPE DR
Secrrown/Range: 02 :36S :40E
Map ID: 34/02N
Zoning:
PROPERTY RECORD CARD
«Prev Next>>
Spec.Assmnt Taxes
Exemptions Permits Home Print
ParcellD:
Account#:
3402-608-0032-000-2
37166
OCIE p
��� 1 �Oy
y - s
Land Use:
SF Res
s,�.
City/Cnty:
ST. LUCIE COUNTY'.you'
Ownership and Mailing
Legal Description
Owner:
Thomas Talbert
INDIAN RIVER ESTATES-UNIT-07-
BLK 27
S 1/2 OF LOT 36 AND ALL
Address:
4901 Seagrape
or
LOT37 (MAP 34/02N) (OR
2287-642)
Fort Pierce FL 34982-7132
Sales Information
Assessment FV
Total Land and
Building
Date Price
Code
Deed
Book/Page
2005 Val: 127200
Land Value:
57600 Acres: 0.34
6/27/2005 225000
00
WD
2287 / 0642
Assessed: 75790
Building Value:
69600
8/911995 100
01
QC
0969 / 1457
Ag.Credit: 0
Finished Area:
1638 SgFt
911/1977 0
01
CV
0276 / 0709
Exempt: 25000
91111975 36500
00
CV
0243/2767
Taxable: 50790
TotalTax: 1081.41
BUILDING INFORMATION
Exterior Features
View:
-
RoofCover:
ExtType:
HD+ - HD+
YearBlt:
Grade:
D+ -D+
EffYrBIC
StoryHght:
0010-1 Story
No.Units:
Interior Features
BedRooms:
3
Electric:
FullBath:
HeatType:
1/2Bath:
1
HeatFuel:
%A/C:
100
%Heated:
Special Features and Yard Items
Type
Y/S Qty.
Units Qual. Cord. YrBit.
2CNT - 2CNT
S 1
1 AV AV 1977
SDSF - SITE DEV S-F
Y 1
1 AV AV 2001
TG - Tar 8 Gravel
1973
1977
1
MX - MAXIMUM
FHA - FrcdHotAir
ELEC - Electric
100
Land Information
No. Land Use
1 0100-SF Res
RoofStrucl:
Frame:
PrimeWall:
SecWall:
PrmintWall:
AvgHt/FI:
Prm.Flors:
%Sprinkled:
GA - Gable
BS - CB Stucco
DW - Drywall
STD
CU - Carpet
0
Type Measure Depth
BI-Front Ft 120 125
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://www.paslc.org/prc.asp?prelid=340260800320002 12/2/2005
EDWIN M. FRY, Jr., CLERK OF ' ' CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 2754500 OR HOOK 242, iGE 298, Recorded 12/02/2005 at 09:F7-j4
NOTICE OF COMMENCEMENT
Permit No. Property Tax ID No. �Z-,
State of Florida County of QOpz—
The Undersigned hereby gives notice that improvement will be made to certain real property, and
in accordance with Chapter 713, Florida Statutes, the following information is provided in this
Notice of Commencement.
General rdescrriiption
Ownersc
_;may l�
Owner's interest in site of improvemedt
Fee Simple Title holder (it other than own,
Address'
Contractor L'�4t•/H�f�-
Address��YN
Surety
phone
Fax 0
Phone to
Amount of Bond
s,.
Lender Ci"" PhoneM
Address'. ,. x= ts:.I'` Fax N
Persons within the State of Florida designated by Owner upon whom notices or other documents maybe served as provided
by Sectionn713.13 (a) 7., Florida Statues:
Name G Wti eqr Gi �WG�"E!� Phonetl
In addition to himself, owner designates .i�t. of
Phoaa n - Fax o
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. Expiration date ofnatice of
commencement is one year from the date of recording unless a different date is specified.
wner�e
State of Florida, County of I -
Acknowledged before methis , day of NDJo'N �fj 200S.by 1I'LLtI ,(]7FQIN,rj
w is ersonally known to me or who has produced as identification.
01'Zo miller
Signatuly of Notary Type or Print Name of Notary y" NN(9 a Mules
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Title: Nolary Public Commission Number �t4�aK'% �eo,.S exmx Nwemc, a2.loo0
STATE OF FLORIDA
ST. LUCIE COUNTY
THIS TO CERTIFY THAT THIS IS A
TRUE AND CORRECT COPY OF THE
ORIGINAL.
ST. LUCIE COUNTY
CLERK O CiRCUITCOURT
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