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Home My WebLink AboutSUBMITTED PAPERSUPS DATE-FILED.I'LANREVEEWFEE- q��G� 4�MCURRENCY FEE; RECEIPT NO.: - -`CERT. CAP. NO.: ALL WFO MUST BE COMPLETE & FILLED IN TO' BE ACCEPTED PLANNING & DEVELOPAfENT SERVICES DEPARTMENT SC4, BUILDING & CODE ]REGULATIONS DIVISION BY 2300 Vugkb AveAvenueNNED Ft. fleice� Fl, 349R-:5652 n2-40-1553 St. Lucie County APPLICATION for BUIELDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LocAnowsITEADDuss:-330i -e- 1, FL 2. PROJECT NAME:. SITE PLAN. : 3. PROPERTY TAX H) ' GO I Q T-`? - 00 0 1 4. LEGAL DESCRIPTION (at" extra sheets ifne'cessay): La{, C-le- L3 CAr.- C, it- 5. PLAT BOOK 6. PAGE NO. 4,L' 7. BLOCK NO. 2-3. 8. LOT NO. 1 0 9. PARCEL SIZE (ACRESISQ FT.)- LOT DBMNSIONS: 111' X 4.)ge 3r>oops, wj F 10. COMP IETEDESCMYnONOFCONSIRUCITONPROJECTS ORWORK ACTIVITY: 2.Y'XjJ' C.,c.,.J-e- rA c-. F- /X I .4 1r, o, 7-Y &ew 5;.X, lo'.x to' ll. SETBACKS �i Ola. BACK. tl = RIGHT SIDE: LEFT SIDE. I L 12. Ty11E OF C014STRUCITON (Check all aWOOate boxes) NEW CONSTRUCTION EXPANSION/AI)DITIOP [] INTERIOR RENOVATION RESIDENTIAL,-CONI�MCIAL J] -MUSTRIAL OTHER (SPECIFY) 13. Dnmmm OF PROPOSED USE: I IF Re- --5; X-9� s, --z- 14. SQ. FT OF CONSTRUCTION., I 57'1 t 15. SF. FT.lstFLOOR AP 16. VALUE OF CONSTRUCTION: - $ '550V The value of construction is used to determine the amount of permit fees to be assessed St Lucie the ftfit to question and/or modify the Indicated value of construction if itis demonstrated that dw submitted figum are not consistent with ==eft", construction activities. If the valuclis M500 or more, a RECORDED Notice orConancacement myst be mbaflftod- with this application. SLCCDV Form No.: 001-02 UPDATED 6125109 n OWNER INFORMATION NAME: 110 L, -n Y) 'A I ADDRESS: 3 3 0 ) 3--,1 cA,- i 0 YZA - CITY.. F + - Ps- -9-r L.0- . STATE: F L ZIP: -3 4q-rl PHONE (DAYTIME): (22 7.) 14 6,r - i.S-f S Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEAS ELL IN MAW AM ADDRESS BELOW. FEE SIMPLE TITLEHOLDER ADDRESS: CITY: PHONE (DAYTDvlE): C__D CONTRACTOR INFORMATION STATE: MAJ - . . . ST. ofFL REG.CERT ST. LUCIE COUNTY CERTM 11637-S- ...:.BUSMESS NAME: -Inq C'. QUALIFIERS NAME: 13 ADDRESS: S-3 J 0 iqrry-. F+- P. e r STATE: E L- 5 .PHONE (DAYMffi):C-)-7-L -70Q>-Z5-J-e- FAX NO. - Email A.RCHITILNGINMR, ADDRESS: PHONE (DAYTflvM): BONDING COMPANY: ADDRESS: CITY. MORTGAGE LENDER ADDRESS: CITY: STATE- STATE: STATE- mg FA-r-A VA VJ IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after i it wffl be voided and returned to you by mail.yo CERTITICATION: This application is hereby made to obtain a( "fit to do the work and installations as Indic atec` i to obtain a certificate of capad if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate perm may be required for ELECTRICAL, PLUMBING SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANS AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this budding permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject stru which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants_ that may restrict or prole'bit 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 coacucrency review:. room additions, acre structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another !residential use. NOTICE TO OWNER: - YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YI PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y( LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMNIENCEIIIENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTAC HNIENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE Il GOOD FAITH TO DELIVER COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. 'OWNER OR CbtTRACTOR SIGMA STATE OF FLORIDA I• COUNTY OF/��-- The foregoing Instrument was acknowledged before me this day f l�� 20� by C �U- s personally known - or has produced as identification. li CONTRACTOR STATE OF FLORID A, COUNTY OF The foregoing instrument was acknowledged before me day of 20� by , e-_ M is personally knq or has produced as _J ANGEtA M. HUFF '�`' , *. r MY,COM�I,SSION # Ef 083530 (s� V Y COMMESSION # EE 083530 (SesT)., ��li! • API 1' 2015 QAe `' Banded Thm Notary Public Underwriters Bonded Thm Notary Puhlle I Ina —if. NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING THIS BUILDING PERMIT AS AN OWNERMUILDER,- THE OWNER MUST PERSONALLY APPEAR TO THIS APPLICATION IN TM OFFICE LISTED ONTfMFRONT OF THIS APPLICATION. t OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERJBUILDERAPPLICANTS- For specific- instructions see apRropriate permit"c`ihecklist. OFFICE USE ONLY �-�} BP> SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE X FIRM MAP # Isr FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINJi LFRS STORMWATER LOT OF REC LOT OF REC LOT SPLlT LOT SPLIT Before 111990 After 111990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE. l� AREA FEE FEE RADON -LIBRARY PUBLIC BLD PUBIC BID PARKS JPACT IMPACT FEE DAPACT SEE CORRECTION FEE FEE �CHOOL ROAD CREDIT Y N LAW ENF .IMPACT IMPACT FEE FEE FEE FIREIEMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEB VARIANCE FEE SPECIFY MECHANIC ROOF NON -CONFORMING MISCELLANEOUS SUBS. ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: I / REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTIE MANGROV COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE ` RECEIVED -DATE COMPLETED � INITIALS .- 7 i 3 063) Fps 40R l•: _D A _ 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, (�oI-01 L7 - 00c) -I -L'S 1 -4 10 le- c s [Lc, of 91 Vj V Lo� (Parcel ld#AegaI descnption/Address) 3 - L�c� for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number — tV 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. r nj 4P Z76 wn Name (Please ' t) _ p`G-�G Prop Owner Signature Date STATE OF FLORIDA, COUNTY OF c± 1U�A -e ACKNOWLEDGED BEFORE ME THIS DAY OF 20�, BY \ I nn b,4191 A(V CA WHO IS PEI rSONALLY KNOWN TOME OR WHO HAS PRODUCED C SLCPDSD Revised 08242010 AS IDENTIFICATION. t601 NeKAt-N [C TYPE OR PRINT NOTARY NUMBER SEM¢FANY S. NIXON NOTARY PUBLIC STATE OF FLORIDA Comm# EES34576 Explres 10/1/2016 I 9 Win , 14c. UWjQUE CONCRETE PUM 5 10 PALM DRIVE FORT PIERCE, FL 34032 28 -7 r.)t An It"a F ZV vJf'cA,% ji . --EW 1 or C &.% ep f RECENED JUL 172014 Fort Pierce,, FL 34982 772-462-2172 Fax 772-462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #: L 6!0- 3� JOB ADDRESS: -336 / blwrm cx,- BUILDER/CONTRACTOR: Robbie- 0r to6r PEST CONTROL CONTRACTOR: �n PEST CONTROL LICENSE #:.� We, the undersigned, hereby certify that we,, ave pretreated' the above described construction for subterranean termites in accordance with t6 standards of the National Pest Control Association. Square feet if area treated: Percentage of solution: `C Date of Treatment: --_—Footing 1st Treatment Re -Treat Driveway 11t Treatment Re -Treat Other 1st TreatrK Re -Treat �TE E I V E D JUL 17 2014 Chemicals used: cqdA. Total gallons used: 2 5 Time of Treatment:. /S /q �b 1st Treatment Re -Treat Pools V Treatment Re -Treat rimete r Final nspection Signature of Exterminator Note: There must be a completed form for each required treatment or re -treatment and this form must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re -inspection fee charged. FBC104.2.6 Certificate of Protective Treatment for peevendori of termites: A weather resistant jobsite posting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed, providing a copy for the person the permit is Issued to and another copy for the building permit files The Treatment Certificate shall provide the product used, identity of the appllcator, time and date of the treatment, site location, area treated, chemical used, percent concentration and number ofgallons used, to establish a veritable record of protective treatment. rf the soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed pronto final building approval. St Lucie -County requires for _the final inspection for CO, a Permanent Sticker to be placed on UNIQUE CONCRETE i E PUMPING, IWO' 5310 PALM DRIVE L4i '3 . p 1 ioi :� "FORT PIERCE, FL4982 167.s0t) 162.91(P) 3� 5 r, poot vo LOT ®LOOK 23ti� � � .mot ••Q LOT � , Y';`� •-,fly' �: � � ` �� 'V3 v •LO'T r °rECHr. \� • � •.. it � ' SET 7.1 'a°.tom � •''� � s � •• N d�� 3 5� kn LOT lo @L= 23py :* 1142Vftt8rlower —0cad, Lake Pa* FL 33m .,.Ur.464.4994 I pat:561.844-7102 SouthSam. Halide Dhimm ClapiddA61 •B44-9994 1 Central Roqida DIVISIon Dispatch: 407-339-5311 Yes LOT 0 0 I mmim ILI u- 1i ilu2 WaterTow9r. r.Leke Pads FL3340 661-M 02 Central flodda D104M Dlsp&h,. 407-3.39-5311 ater Added at Cuelomera R.,.- CyLrlHers Taken 0 4!� gals. to full load gals. to 2/3 load comnefu pats, to Ira lead 07 REt1PON91eLE FOR WARNING IRRITATION TO THE SLAIN AND EYES ADDITIONAL WATER ADDED TO THIS VAR1ATIONINCOLOR OR i6emanipa"orminoWmixod c�bl"y cause skinkluY.Avadcontadwith I =Mud wh exposed W u REDUCE ITS STRENGTH skin wsm PMMM With water. ",00rd powder or SURFACE 07rod a ft.%= aATCH AND DURABILITY: ANY WATER ADDED IS AT CUST'ONER'8 OWN RISK. ow 'Fijimlx 3aft REG 5. `!'%—Jul�-14; L;2% l] w- 8 0 WaRGUE CONCRETE PUMPING P pdva cirl a Rd F-STUMIE PI&MM J urge .......... Moreno CYD FIBERR F ENV I IRO 3AL ARGE 1.4 10. SAT SAT W Connate T LOT d W Connate T LOT d wateradded at Custotnete Request gals. r gals. to tug lead Commentsgets 2/3 load . . . . . . ..... ..... ..... a. to V3 load NOT RESPONSIBLE IcOR • IN COLOR R WARNING IRRWAMON TO THE SKIN AW EYES ADDIIII)NAL WAIM ADOEI M, or &h?V robed concrete may cam skin hjviy,'Avdd omtW WM exposed so an arum Ismmpfly. wm water, If CONCRETE WILL R=Imaffxm" ON mcimom ii,, w1o, . awh gab hmsawy low oft P, ;� AND DURASUM. j 'MR 0066.16 deco evay from =*4r and all IV mbcad AT OWN RISK. ' V:, so vp, aamam pmdLft. 9 53;- V;') PUM3"i'D:a60 3WO REP 5. 0-14 CONCRETE PUMPING PAS 4EUAI 0E=r7jdt_ Rd I 98 °fN°rie Warehae LOAD (t-Al,"IVE 2,r9E"FO jPROF)U--T CODC PfIODUrT 7 u 0 r1i UNIT PRICL 'UNT I. ENV I FM ENVIRd-AXOPOSAL 2 FUEL'-8URCWRGE SAT SAT w wul r 4.nyvmpww 41,11110".9f my GU&TQYAL TAI X V z )ffzRs ON REVEme ig�& ... . . ..... .0 - -- - - - L. i 1 1142 Water Tower Road, Lake Perk FL W403 f U F24 # Wce:1-877-484-99% / F=561444-7102 i .!....... . .......� n.aa. nwt.inn nl.mrtek A07.939-5311 w 1 w... n........�...�.. Concrete T08� p yM LOT # Water Added ID CustomeYs bequest CyArdera Taken [3Yes No pale. to full load gals. to 2/3load gels. to 1/3load Comments CLWmars Rep • Water ARR NOT itESFONBIBLE FOR YMIATNTN IN COLOR OR WjUL1IIN6 IRRITATION ro THE SHIN AM EYES wM Ctmrm odwn.re��odlmeAy mlud" pmt. m.y cam.tln t any. cement cldn witlr rr.l.r. If any amud powder of AD ONAL WATER ADDED TO THIS CONCRETE WILL REDUCE ITS STRENGTH SURFAI DISCOLORATION my� ooy Hp ar.e' chi immediate in f6P1V1tDdV With wamr fre * prompt mb m mad ate and ea.ntlon. Keep csadren away llrom cement pmni0r eb am Im y mtrod ANY WATER ADDED IS AND OAT CUSTOMER'S AT CUSTOMER'S OWN RISK. JAPm.dcN ialn coi pmdua n"..3 n0547570 TFq%s LOAUM@ MIX -1000 REO swuv 3. 1i19-Jul-14 . CIONCRIEW PUKRIKU va.. 185£9 oEt i�'iiYdrio Rd LUCIE u6jfi88 uRwRike Baiardi °Y 01 p}�CfK7N9 1.0 Ft RR FIBERR 1, ENVIRO ENVIRO DISPOSAL 1. g FUEL SURCHARGE— S. S SAT S E N A ME OF 0 I M.riy for my ddliv.rl.. b.yond the wrb llnw NY Pm Bea•TOTK TAX TOTAL i t I ITI VAAA s a'• e s o 1142 Water Tower Road, Lake Park FL 33403 Office:1-877-484-9994 / Fax: 561-844-7102 South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311 Concrete Tested ❑ Yes F] No LOT # Water Added at Customer's Cylinders Taken ❑Yes �;N'o Request I. gals. to full load Comments j,.•:, t4 - gals. to 2/3 load P gals. to 1/3 load f Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS " VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with SURFACE DISCOLORATION skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH . mixture gets into eyes, rinse immediately and repeatedly with water and get prompt AND DURABILITY. ANY WATER ADDED IS BATCH TIME medical attention. Keep children away from cement powder and all freshly mixed AT CUSTOMER'S OWN RISK. cement products. b Begin Pour PLANT , TICKET#, ORDER # TRUCK # LOAD SIZE MIX p'2 1.. SLUMP DATE CUSTOMER# SOLDTO P.O.# PROJECT# DELIVERY ADDRESS ZONE# USE ]DRIVER INSTRUCTIONS TIME DUE PRODUCT CODE PRODUCT DESCRIP±10�N �117 NINE, .0" • ! ! SIGNATURE OR RECEIPT - CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING - asc meyer Concrete Company will not assume liability for any property damage or any SUB -TOTAL equipment damage for any deliveries beyond the curb line. TAXY AUTHORIZED B - SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL THIS DEI RY IS MADE SUBJECTY'Ovir- FOLL.0 3 CONDITIONS- ic provide a suitable ro�' ' way for our trucks from the street graver on to the, place of deliv ery -if 11e, zl; i t zLi i i sui table roadways are no' pro Of de d, v.i, , c,, �,�e P, *A th,:--; right to stop d e flive ri es until co nd ition s arc rn m e d iod and n s-k Jch ev3rkt. custon jer vji'J be hold responsible for any loss cau.-`ud thiq eby, \A!hen delivery is made ba-yond the curb line at the customer oro'J'814omet repre sentativa's reqoost, any dqrnages including. o",A not !LaWrid to, sidewalks, dri �vevmy.q buildings, treas, shrubbasetr tanks and septic systerns, inchicling the &akrt f *, e I d, a, re at the o w, i o, e s risk. i . fie custorrier agrees to reirnbivs-- �,aidl ',':�mparry for loss of lime and equiprnent, by reason of such delivery, and al-'sotQ :s' lena� l4and harniless sa�d C, �:f if', ,I,-iy from any and all dia!f ns, demands and suQs for or on account of or in any save "p�; ine, r amsed by or arising from private driveway delivery, 4 041. torinr acknowledges that all material and services shown have been received, that t"i ick timessticwn are correct. and zi tnat the amoum of water added at the customer's request is shown correctly. CAUTION: The acts of 5- Weare not responsible for fln4shed results obtained from this load of concrete.; many important factors Affeclinq tr'0 �n )fthc, comnlr�4).edJob are beyond our scope of,resp!��.nsiUilityad c- A, rnartj-, of charged alar 3 minutes per cubia yard �jrioading br-aa is e $ 1.00 per rninute, will be Xce Tito cu,,t,,ower agree ss to provide a suitable wash down facility for our trucks and tools at the plans cot delivery of miter il- The curtomor hereby agrees to pay all costs and expenses of collection, it a. reasonable aflorney's fee, if tie -,haz! fiti: to p;-v for the merchandise reflected in ' .,,is invoice, when due.* Past due accounts are subject to a 1 -1f2% serAce =,'harpthe unpaid past due balance. I ne customer herebij� acknowledges rpceipt of the complete -Of,*"yof 41''s contract. p ' j 1 1142 Water Tower Road, Lake Park FL 33403 + Office:1-877-484-9994 / Fax: 561-844-7102 South East Florida Division 'Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311 Concrete Tested ❑ Yes ❑ No LOT # Water Added at Customer's Cylinders Taken ❑ Yes � No Request f� gals. to full load Comments ,�- gals. to 2/3 load �,, � r>. ,-- p gals. to 1/3 load - ,,e`Customer's Rep Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. If any cement powder, or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION, mixture gets into eyes, rinse immediately and repeatedly with water and get prompt medical attention. Keep children away from cement powder and all freshly mixed AND DURABILITY. ANY WATER ADDED IS AT CUSTOMER'S OWN RISK. BATCH TIME cement products. in Wash To Plant ant 7TICKE1 T# ; ORDER # TRUOK # LOAD SIZE MIX SLUMP DATE, a CUST OMER # CUSTOMER# SOLD TO 7 P.O.# PROJECT# DELIVERY ADDRESS ZON€0,, i - USEt DRIVER ; _ INSTRUCTIONS TIME DUE 4 ' ILYA ORDERED PRODUCT CO PRODUCT DESCRIPTION U.O.M. UNIT PRICE AMOUNT EIAPUIA�111LW QUANTITY r 1 SIGNATURE OR RECEIPT -CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING . asc meyer Concrete Company will not assume liability for any property damage or any SUB -TOTAL equipment damage for any deliveries beyond the curb line. TAX AUTHORIZED BY SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL 'THIS DE RY IS MADE SUB,JEC-T TO THE FOLLC IG CONDITIONS; - , , 01 ", "us -toner a roadway for our t;rucks hom the street pavement the place of delivery of material. t gross to provide suitable i such -u'table roadways are not provided, we reserve the right to sto: . dellveries until conditions are remedied and, in such even , custol'ner will be held responsible for any loss caused "hereby 2. "U'Vher, de'tivery is made beyond the curb line at the customer or customer representative's r quest, any damages ii1cludi ing, but not limited to, sidewalks, driveways, b0ldings, trees, shrubberV, septic tanks and septic systems, inciudingthe dran -1 Vd, are at the owner's risk. 3. The customer agrees to reimburse said Company for loss of time and equipment by reason of such delivery, and also to indemnify and save harmless said Company from any and all claims, demands and suits for or on account of or in any niann(N caused by or arising from private d0veway delivery, �.,,storner acknowledges that, all material and services shown have been received, that truck iirnes shorwri are Correct, and that the amount of water added at the customer's request is shown correctly. CAUTION: The addition of water reduces concreto strength and durability. 5, We are not responsible for finished results obtained from this load of concrete,, many important factors affecting "IhG ultimate quaifty of the complets-d job are beyond our scope of responsibility and control. 3. A cha� gc Of S','I.00 per minute will bp charged after 8 roinuies per cut�ic yard unloading time is exceeded. 7, Thp rustomer agrees to provide a suitable wash down facility for cur trucks and tools at the place of deliVeri of material. The cusfor nkir hereby ?green to pay all costs and exoeno-es of collection, including a reasonable attorneys fee, if he shall f?ec ed in tl is 1 ,12% invoice, when due: Past due accounts are subjectto a -1service 1 ch.aiv on the unpaid past due balance, 1-fiecustomerhereby acknowledges receipt of the complete copy of this contrac y, 10 P142Water •.:. ------------ ' i. Tower Rtad, Lake Park FL 33403877-484-9994 / Faa,661-844-7102 AUG 01 ZO South East Florida Division Dsp3 h: 561-844-9994 / Central Florida Division Dispatch: 407-33 y! Concrete Tested ❑ Yes No LOT # Water Added at Customer's . Request Cylinders Taken ❑ Yes DNo ,r gals. to full load Comments OO gals. to 2/3 load ell Ali gals. to 1/3 load 1^' ''Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION wash mixture gets into eyes, rinseimmediately and repeatedly with water and get prompt AND DURABILITY. ANY WATER' ADDED IS BATCH TIME medical attention. Keep children away from cement powder and all freshly mixed AT CUSTOMER'S OWN RISK. -, cement, products. PLANT _ TICKET# ORDER # ]TRUCK # LOAD SIZE y MIX SLUMP DATE CUSTOMER # SOLDTO P.O. # ]"FPOJEC�T DELIVERY ADDRESS' ZONE# USE DRIVER TIME'DUE INSTRUCTIONS PRODUCT CODE PRODUCT DESCRIPTION AMOUNT SIGNATURE OR RECEIPT -CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING • asc meyer Concrete Company wi not assume Raoinly Tor any proper y c amage or any SUB -TOTAL equipment damage for any deliveries beyond the curblhte: TAX AUTHORIZER -BY TOTAL — 'SUBJECT TO CONDY IONS ON REVERSE SIPE. , y inii� cric iiirtns ar rubbery, septic tunks ar%d r,-Vi'� 'mclqdirng dra"i me and equipment bydi' t, Efelivary, and al'at to a! claims, de;mands "3S a156 sults trA of fc- have been received, ftittruc(dines sho,m are cormct, and shown correctlV CAUTION: e addil"on of water reduces rh We are not respornsCtj,-j ft)j' 'oqd of ("c"(4 many importantfactors affecling the u�tjmate Q u a c' if the C;cf r- 01 etk> t.' )or; and-om-nl. M' t -W I b c h a rg,--,,,; x, 1 PC '-�'L; Ya J unfoadi ng ii me is exc eded, inum e I] to cuslklrner agrp.Gs to provide a suitable wash down fa(.,11!y for cur trucKs and tools at '61eplact)oldeiivet'Yottyla,'Lerial- cu,;Toter horebl rees tot pay all costs and expe%(4,3 of colie-clJon, including a reasonable Varney's fee, 4 he shali rai I �M, -'ay for the rm, ff.4 andise ref', ected i n this i nvoi ce, �,vh c-1 du e. Past d ue a ccou ats a re sr ib! of"'T t" a 12,X, :t. a rVice C:Ior- ge on"hle unpaid past due baiance, The- customer fnpmbacknowledges receip� of the C-),