HomeMy WebLinkAboutSUBMITTED PAPERSr
OFFICE'JSE• ONLY:Dot: E F11;ED:
PLAN REVIEW FEE: _
CONCURRENCY FEE:
RECEIPT NO.: _
RECEIPT NO.:
PERMIT NUMBER:
CERT. CAP, NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553 SCANNED B
St.. Lucie County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: d't UU I e rA. r t it IwwzP.
2. PROJECT NAME: iR-SITE PLAN NAME:
3. PROPERTY TAX ID #: 3P 3 400�® f
4. LEGAL DESCRIPTION (a W ch extra sh pts if necessary): ;g 35- -1 so rolc C ��'0 6FS
3-`'7 F Df SW Y4of foW 7f Df50 /q-L&SS sassy For 2.D 1w 9 f t.Wflc((ee-,29�iG-(5f.5
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
E
10.
11.
PARCEL SIZE (ACRES/SQ FT.): t,.l eAC- LOT DIMENSIONS: -5 q j --7q t ! qq. q
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT ORNYORK ACTIVITY:
`Forir- $
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[4 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
f,11 RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
L 1 OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: 50/i-t Park I vi'e
14. SQ. FT OF CONSTRUCTION: j� % Q 15. SF. FT 1 st FLOOR:
16. VALUE OF CONSTRUCTION: $Q�a.
The value of construction is used to determine t amoo 'nut es to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that t cis ibm�ltcd i re c not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice ofCommcnecmcnt must 6ubmitted pplication.
SLCCDV Form No.: 001-02
V C/
UPDATED 6125109
OWNER INFORMATOGN
NAME: �- 6:5 L v O(OWC E 7-Alt-oR,
ADDRESS: -)'tO(5 08,06 Ab
CITY: foiZ r PiSRC A5 STATE: L, ZIP:
PHONE (DAYTIME): C) Lk 65- 9 aCt Email: CA P7 55 7'1 (y) Q, A-rT. N may'
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
PHONE (DAYTIME): (___)
STATE:
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: C43C 1955TV ST. LUCIE COUNTY CERT#.
BUSINESS NAME: CAACrev'
QUALIFIERS NAME: La 1 tj t Lt I C,--!3
ADDRESS: 531 9vvLr'-5vTr-
CITY: fl- Flw'--� STATE: 14w
PHONE (DAYTIME): (2 5 q55^S FAX NO. '/0' 1966' Email:
ARCI-HT/ENGINFER:
ADDRESS:
CITY:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ZIP:
ZIP: 3 L/ q 49-
ZIP:
ZIP:
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, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
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: 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 YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
AIR OR CO T CTO SIGNATURE ��
STATE OF FLORIDA
COUNTY OF 57 L UC, I f—
The foregoing. instrument was acknowledged before
me this (D day of S ,_gWPdLLY 20 i
by J_"e_5 It- 7IAAJC A-NL0&
who is personally known \/< or has produced
identification.
Signature of Notary
4,pY �PyB`, ARLENE RIGSBY
Commission No. F o,0 (a . ° 5eg) COMMISSION # FF Q27661
�•.,, EXPIRES: June 13, 2017
Bonded Thru Notary Public Underwriters
a
CONTRACTOR SIGNATURE
STATE OF FLO
COUNTY OF
The foregoing instrument was acknowled d before
me this day of ' l,�n 20�
by /% �
who is rs;
ally known or has produced
as identification.
Lrimr. wniir �/� n
Notary Public - State of F iid,4) , •i//y
flAy l;et rr E yes Dec B�4b V
Commission # EE 48013
Bonded Through National Notary Assn.
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR,TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS.
For specific in;tractions see appropriate permit hecllista
i
OFFICE USE ONLY EP '�..
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
(
V `
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1 IT FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORM WATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
C
HABITABLE
RADON
PERMIT
CODE
\
AREA
FEE
FEE
V
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMPACT
IMPACT
:FEE
CORRECTION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
.REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
CQUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS
s
1 3 i I
i
P_
5598026.,
Cs 2P
plant:
Begin Loading:
To Job:
Arrive Job:,
Start Unload.-
Finish Unload:...
Leave Job:
Return Plant:
customer Code: Custonier Name:
Customer Job Number: Order Code / Date:
C.-
DANNY WILLIA S 184 01114/14
1 Project Code: Project Name: Project P.O. Number.- •Order P.O. Number.
VEREAL
Ticket Date r De very
s Map P . age: Map/Row/Column:
Delivery hnstructions: Dispatcher:
"'N �BT PJORTH OF RELL r-IVE OFF-- 0 C,
HK(_J"Ic
Ticket Number:
715c'
l
'lo 0.,
Due On Job: Slump: Truck Numb T-Dn7e, Number: Driver Name: End Use:
I o 0 i!�"- 5 11) 20, R _tY MORRIS BLDNG: B _P
5.0 _3
F LOAD CUMULATIVE I ORDERED UOM UNIT PRICE
TIT, QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION AMOUNT
QUANTITY QUANTITY
C)
R E 0
F 12'.-L- t[fL.S
5. 25 13. 1,
J r-54 1A Aml,0:57
1. CIO 12 4, 183.8 FUEL 3URCHIPRGE
1 ("'0 tat) 2749 ENVIRONMENTAL CHARGE
Cash Check # Auth Code: Signature of Driver Receiving Cash: Cash Received:
1 Without
COD Order Amount to Collect
Check Standby Charges:
Charge
Comments:
WATER ADDED: GAL YARDS IN DROM:0 a
-/kDDVD,
WqEN
SIGNATURE
Cufm-LiN&CROSSED AT OWNER'S/AGE Q1 JES
flVff �v
SIGNATURE
U'LO`AD�WA� TESTjw,'�'
[�y
Notice: Our drivers will make ever�, eficit tipplacematerials'wh'ere the'cu9to T,d61,gr�.ter, Lt tb6i' -SOEfCIAI- TERMS: Any water MP . , T ter added is at customers own, risk. If water is added on job, concrete strength
COMPBIY.qssymps.ho'resp6nsibi[iiy for damages inside curb oij-property line. Custpmdr agreed,t� tfii'�e, guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material
agrees
0 "
�b out
*me be hazardous
,a 7'
'y 'and"n' nf'
"o r
to
terms! ale and delivery and accepts concrete,as_is:r-DU6�fo important factor�,W'fiic6 are out '0 i our inay-be—hazardous to your safety and health, Please refer to the backside of this ticket for important
c9t, C delivery, this Company "INO c I, or a I Company accept any responsibility for the finlshW�results."� �o cied ' f r safety handling Inkirmation, and to the material safety data sheets for additional information.
wn 'hg U No I
concrete. -6iio6s'.n4 claims shall be deemed waived madde to in AUTHORIZED SIGNATURE:
s Buyers
the receipt of materials.
-D NUM,.- a
'SAL P'R.EV A
1 '01
INVOI E.
set forth on this Delivery Ticket ("Agreed- : "). Seller will provide the Standard Term _a Conditions upon regr est. Buyer agref
that, unless otherwise noted on the front hereof, all quhhtities;and items were delivered as indicated and further expo y agrees t
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH -
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly ash, may contain more than 0.025% crystalline silica.
Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust from handling,
crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled.
If ingested,ke`ep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of arnmo-
nia. Moisture can cause the ammonia to be released. Inhalation of arrunonia can cause coughing and irritation
or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective
clothing. Wash hands thoroughly with mild soap and water after handling: Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact, immediately flush eyes *ith flowing water for 15 minutes. If dust is inhaled, move to fresh
air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900.
V7 combined Houston, Texas 77024
02/12 For more information please visit www.cemexusa.com.
Este ticket de entrega incluye como referencia at comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El ve.6dedor proveera los term.inos estdndares y cpn.diciones detal.-
.lados en caso de asf ser requeridos. Con este documento, el. comprador acrepta los mismos ya antes mencionad.os y que las cantidades
y materiales fueron entregados como se expresa co el mismo. Acepta pagan• el monto de acuerdo at contrato; at menos que se identi-
fique con una nota at frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, Brava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, roca volcdnica, arena, grava, yotros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) ]a cual puede
contener mds de 0.025% de silicio crystalino.
Peligros: - Mezela de cernento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en la peel. Concreto seco y pcfjvo de agregados, pueden causar irritaci6n en los Ojos, piel y/o en
- ]a zona respiratoria. Polvo del manejo en el trituramiento, pulido, cone y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonai y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seg�i ridad• La humedad puede causar. la liberaci6.n del amoniaco. La inhal.aci6n del amoniaco puede causar toser, irritaci6n o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el nivel de la exposici6-n.
- r,
Seguridad: Evite el contacto con ojos y contacto proloiigado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros , , adecuada para protecci6n. Lavese ]as mans con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos..Si se expone a-polvos mds de `los limites recoinendados, use protecc16n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase afire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenc16n medica inmediatamente'aii la irritation continua.
CEMEX, Memorial Hermann Tower''
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024 ,
02/12 Para mds informacion visiti Www.cemexusa corn.
Ae CMEX
p
559 6024
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
Customer Code: Customer Name:
Project Code: Project Name:
Ticket Date: Delivery Address:
Delivery Instructions:
Customer Job Number:
Project P.O. Number.
Order Code / Date:
Z,
Order P.O. Number.
Map Page: Map/Row/Column:
Dispatcher:
. 4,
_ `
Ticket Number:
Due On Job:
Slump: _
Truck Number:
Driver Number:
Driver Name:
End Use:
1t_i`.'l?15
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
_ -, (<?r-?
C_�•: t'�;.: r�P'1J!'V�
i
ri_it'it.�tl 'r; �_I;=.
-
i' GE
Cash Check # /Auth Code:
Signature of Receiving•\ash— -_�
Cash Received:
Total COD Order Amount to Collect
] Check
ter
� 1 --���
\
Without Standby Charges:
Charge
Comments:
x �� �✓
j
/
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
t
SIGNATURE
CURB LINE CROSSED AT OW ER'S/AGENT'S REQUEST:
SIGNATURE
❑ LOAD WAS. TESTED. -BY:
Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customers own risk. If water is added on job, concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING; Product may cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your. safety, and health. ' Please refer to the backside of this ticket for important
coPr"�'er delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling information, and to the material safety data sheets for additional information.
tincrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing ALgHORIZED SIGNATURE:
'usiness day after the receipt of materials. O
INVOICE
reset forth on this Delivery Ticket ("AgreemeW). Seller will provide the Standard Terms WConditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees to
pay in accordance with the Agreement. K.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly ash, may contain more than 0.025% crystalline silica.
Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust from handling,
crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled.
If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo-
nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation
or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective
clothing. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. If exposed to
dust above recommender) limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact, immediately flush eyes with flowing water for 15 minutes. If dust is inhaled, move to fresh
air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combined Houston, Texas 77024
02/12 For more information please visit www.cemexusa.com.
Este ticket de entrega incluye Como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estdndares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el. comprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados como se expresa en e] mismo. Acepta pagar el monto de acuerdo al contrato; al menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, Brava y otros
materiales silicios. Los productos. de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, roca volcanica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mds de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en Jos Ojos, quemaduras en piel y ojos, y
reacci.ones alergicas en .la pie!. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
]a zona respiratoria. Polvo del manejo en el tritura -lento, pulido, come y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Se uridad• La huniedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
g quemaduras en la nariz, garganta y pulmones.'Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el. contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para proteccion. Ldvese ]as manos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos mds de los limites recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente flu.ya agua en la parte afectada por 15 minutes.
Si se inhala polvo. exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900:
V7 combinado Houston, Texas 77024
02/12- Para mds informaci6n visita www.cemexusa.-com.
JOSEPH E. SMITH, CLERK OP THE CIRCUIT COURT — SAINT LUCIE COUNTY _
FILE # 3913086 OR BOOK PAGE 1509, Recorded 01/07/2014 at ' _';32 PM
NOTICE OF COMMENCEMENT
Permit No. Tax Fotlo No. 7 a� 3�3 !%00 y QQQ/0
State of Florida County of St. Lucie
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.
gs -� �fow �DfT`- -- "��OFJ'so' S 367Ffo12 star %yop A,W of'sw�y-C�ss
5 a5 sr /-�or /q-E /. IPgr. C er a�i9G- (SS I
Genvaldesoriptbno! esneM: wiwnrey Stab a* .3Ar�'
Owner IntormatbJr pr Lessee Infamy on if the LesseeEcOfflralcted for the Improvement:
Name JAM r$ F 014 nr Mt kr
Address ;L YOO Madle F.JFT rrerrp sy48a
Interest In property ewpr
Name and address of fee simple titleholder ofdifferent from Owner listed above):
Contractor's Name: n C +
Contractor Address:33 1 It:,0 a Df 1 I A. Al 3yQ4S Phone Number. AO 37
Surety (if applicable, a copy ofthe payment bond is attached): Amount of bond: S -+-
Name and address:
Phone number.
Lender Name: Phone Number:
Lender's address:
Persons within the state of Florida designated by Owner upon whom notices or other documents May served as provided by Section
7IMP (8)7, Florida Statutes:
Name: Phone Number:
_Address:
O /
In addition to himself or herself, Owner designates 12 N 4 r, Lti /(/ ®log�ORcrY
Uenor's Notice as provided in Section713,13(l) (b), Florida Statutes. to receive a copy of the
Phone number of person or entity designated by owner.
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date Is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that 1 have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowjVge and belief.
(Sign of Owner or Lessee, r Owner's or Lessee's Authorized Officer/Director/Partner/Manager
OWR �f'
(Signatory's Title/Office) 1
The foregoing instrument was acknowledged before me this 6 day of_a'II , 2011/
gy _j�Qstl d l as iy�1° r for
Nae'oy/fPerson
— Type of authority (e.g. officer, trustee) Party on behalf of whom Instrument was executed
(Signature of Notary public- S e c dda ARLENE RI098Y ersonally known,�or Produced identification_
��„1
(Print, Type, or Stamp Commissioned Name o is)MYCOMOSSIDN 1 FFUMI
of Identification produced
EXPIRES: June 13, 2017
Qq(„ •' Doodad TAmu Refry Pu* uronwMn
STATE OF I'MIDA
ST. LUCIE COUNTY
THIS T 0 CERTIFY THAT THIS IS A
TRUI 0 rORRECT CO°Y O JJE
ORI I A!.
P I !CLE
Y:
Date:
SW
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
�� O o a� 55" Scow rso� a � ��o o� -S 367 d
r/ (Parcel I#/Legal desgl�iption/Address) �w C
1 D$ lvw �q of
5 W Iq r Ll°!%:57 s a5s P :'vc
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.
P operty Owner Name (Please Print)
.�
roperty Owne ignature Date
STATE OF FLORIDA, COUNTY OF S-1- LV cl e—
ACKcN�OWLEDGED BEFORE ME THIS tD DAY OF _ J1q A)0 AM 20 ,
BY !/(/%AJ `�- �jQ'/Yi e s :1 ma- a- WHO IS PERSONALLY KNOWN TO ME )4,_ OR WHO HAS
PRODUCED
AS IDENTIFICATION.
AP-LeWe- P-IG56Y
SIGNNATURE OF NOTARY PUBLIM TYPE OR PRINT NOTARY
I' 1p COMMISSION NUMBER
?SAY ��° = ARLEi Y
+: t: MY COMMISSION # FF 027661
p :;�•, EXPIRES: June 13. 2017
y �'? 67 "j, Bonded Thru Notary Public Underwriters
SLCPDSD Revised 08/24/2010
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test 150 feet of the East 480 fket of the South 367 feet of the Southwest Quarter of the Northwest
er -of the Southwest Quarter of Section 28, Township 38 South, Range 40 -East, St. Lucie County,
i, less the South 25. feet thereof for road. right of way.
. ........