HomeMy WebLinkAboutSUBMITTED PAPERSDate: Due: Receipt# Permit #
Me
Planning & Development Services
Building & Code Regulations Division'.
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578 C'
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ PluelDemolition
ng ❑ HVAC ❑ Fence
❑ Shed* ❑ Gas ❑ Siding
Seepage 2 forr instructions and
and ad(ditiInallpra�pge�rw�o/rk equired for specialty permits
1. Location/Site Address: �"1 �� �,i I� 1 l 9V J�....rY"'
2. Parcel ID Number:
3. Complete Description of Prpject or Work:
4.
Owners I ormatio 5. Contractors Information
Name: Qs�'7 FL Reg/Cert #: ` U
Address: &'-V[JejY County Cert#: I.
City: State: Business Name: d C CAIVQ
Zip: ( W Phone:; P & pVI'lione• SM` / T ZFax• 1 /dl
6. Value of Construction: $ 3cm ,
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is c rrect and that all work will be done in
r,
compliance with all applicable laws regulating construct' zoning.
rues `eo nQ rJ
PRINT OWNER OR CONTRACTOR NAME, I I NTRACT0R
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS
WHO IS PERSONALLY KNOWN TO ME V OR WHO HAS
I I
I F RY
COMMISSION NUMBER
2014—,
TIdACEY W. McGHEE
NOTARY PUBLIC
ORIDA (seal)
TYPE Y7
V ��'+a Epires 5/10//2015
*ALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED TO MEET THE FLOOD ZONE
ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on
reverse side of this sheet)
Revised 03/18/2014
Jubi ie t N . bri i can r UJjz M UL'' '1 nz U1XUU11' UUUAW - bk" V'1' UUULZ UUU1VWX
FILE,# 3959667 OR BOOK 3636 PAGE 2506, Recorded 05/29/2014 at 01:14.PM
NOTICE OF COMMENCEMENT
To be completed when construction exceeds $2,500.00 (S7,500 Mechanical)
PERMIT NO.
TAX FOLIO N0.
STATE OF FLORIDA, j d
COUNTY OF GW C+
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 the Notice of
Commencement:
�� !i OMMM,
Interest In Site of Improvement: Fee Simple
Fee Simple Title Holder (If other than owner)
Contractor: A & G Concrete Pools 410 Saeger Avenue Fort Pierce, FL 34982 772-878-7752
Surety: (If applicable, a copy of the payment bond Is attached):
Name and Address: —
Phone Number_._______ Amount of Bond:
Lender:__ _
Address: ____Phone Number —
Persons within the State of Florida designated by the owner upon whom notices or other documents may be
served as provided by Florida Statutes Section 713.13(1)(a)(7):
Name—---
Address_—---Phone Number
In addition addition to himself, Owner designates of to receive a copy
of the Uenor's Notice as provided In Section 713.13 (1) (b ), Florida Statties:
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 bel 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 1, SECTION 713.13, FLORIDA STATUES 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 BIT
THE FIRST INSPECTION: IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
Cos LING WORK OR RECORDING YOUR' NOTICE OF COMMENCEMENT.
UU d p< airy of perjury, I declare that I have read the foregoing and that the facts In It are true to thI I K) Ll'i'e l }dge,�a¢ ballet (Secdon92.S25,
f!e . N,tea) / / / aT. LUCIE OORI�TY
n
OWNERS
I'HIS.ISTO RTIFYTILTTRISISA
`•RUEAND R'ECTCOPYOFT'W.
M AITNAMEAND"WOE711111
State of Florida, County of ! _
Ac wed ed before me this day of , 2014 by �_�A'LIJSs, i
personall known to me or has
provided _____as Identiflca110 TRACI-YW- E
NOTARYPUBLIC
STATEOFFUMDA
Care NEE120M
_ eyinNB/19 115
Notary Public Stamped, printed, or Typed Name of Notary
.J
COS S SAL 7 S rINO LASORAMIZY, LLC
- P 0fAc&13►op2423
PctvvC%ty, FL 34991-2023
772.220.6688
VArE:
JOB NuMBn2
PERMIT NUMBER
CLIENT:
CONrRACroR:
JOB LF(5AL'
JOB ADDRESS:
C0RP? t'C7l'01V 7 S rREP- 09 r
,4SrXr D 6938-10
ALg4mtlS, 2014
14-0825
1405 -0416 01417
A Er 0 Poai&
A & (i Pam
NIA
7980 Sa:dd%.ba� Dvw�
PovtSt: Lucter, FL
SOIL CLASSIFZCArION & REMARKS: A3 f6 rv.brawwsafudy soiV
rESr SAMPLE LOCATION: IS 02 CorneY- -- CeyTer of Pad/ - 10" IS RF Corner
.Iw 'Zace/VCy
1) 103.0 ' 104.0 99.0
2) 102.2 104.0 98.2
3) 103.4 104.0 99.4
Re�e�i�u.�y Sudiyvu�ec�L
CA)
rr tcrveZa�ra; P.F. ' RECEIVED AUG 19.2014
ZOOIn T69TL899LL XVd LE:TZ VTOZ/9T/80
13
D.
Post Offic iSaxI2023
.. L
.� Pai*wCi;ty, FL 34991-2023
772.220.6688
'DATE: A u ffuSt l8, 2014
CONrIZAcrOg: A 6r Q PaoL-
JOB NUMBER: 14-0825
PERM —Tr NUMBER: 1405 -0416
132
i 110
0
U
Z) 108
U
102
ASrM D 1557-09
8 10 .12 14
Moisturo — Percent of Dry Weight
T69TLRZZLL YVd LC:TZ PT09/9T/80'