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HomeMy WebLinkAboutSUBMITTED PAPERSDate: Due: Permit #-r— G ❑ Electrical ❑ Shed Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SCANNED Lucie County SPECIALTY PERMIT APPLICATION G]4" 1umbing ❑ Demolition ❑ HVAC ❑ Fence ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: �- 3-Ll'r� �t vzct 2. Parcel ID Number: - d� a� Office Use Only Section Township Range Map Page Zoning Land Use Initials Ci 3. Complete Description of Project or Work: 4. Owners Information ti 5. Contractors Information Name: , JaN 1 Lt, ' AAL FL Reg/Cert #: Address: l ®-2� C laz , (2d' City: '- e State: Zip: �� `t 0 �— Phone:T2'�!` "I319 6. Value of Construction: $ SP d"ub`�� County Cert#: Business Name: Phone: Fax: OWNERS AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work wi compliance with all applicable laws regulating construction and zoning. PRINT OWNER 09 CONTRACT(IR NAME SIG TURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS WHO IS PERSONALLY KNOWN TO ME COMMISSION NUMBER 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. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 Revised 04/26/2010 NOTICE TO OWNER: FAILURE TO 1?FCORD'.A NOTICE OF CgNIWNCEMENT M'4v?. .ESULT IN YOUR PAYING TWICE FOR RAPROVEN `S TO YOUR PROPERTY. IF YOU INTEND' OBTAIN FINANCING, CONSULT WITH YOUR LENL: `OR AN ATTORNEY BEFORE RECORDING YGu., NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000. INSTRUCTIONS Please complete allinformation in'the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The information to be provided with this application includes: 1. Location/Site Address 2. Parcel ID Number 3. Description of Project or Work Activity 4. Owner Information 5. Contractor Information 6. Value of Construction Indicate the street address or general location of property where the building activity is taking place. Indicate the tax identification number of the property where the building activity is taking place. Fully describe the activity to take place. Indicate'the name and address of the owner of the property on which activity is.taking place. Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name of the business doing the work. Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the building/construction activity. Construction value is used to determine the permit fee. St. Lucie County .reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction. ❑ Gas Attach 2 piping schematics with tank size, location, and BTU of each appliance ❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications ❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for new system or full replacement This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982: All permit applications must be filled out completely before submission. No applications will be accepted for processing after 4:30 P.M. -For assistance in completing this application, please call (772) 462-1553, during°regular office`hours (8:00 AM "'5:100 PM), Monday through -Friday.'- NOTE. Emergency electric service change out inspections will not be performed after 3: 00 PM without special arrangements and additional fee paid. Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261. Planning & Development Services Department Building & Code Regulations 2300 Virginia Avenue Fort Pierce, Florida 34982 (772) 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 provide direct, on -site supervision of the construction yourself. You may build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a cost of under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within one year after the construction is complete, the law will presume that you built or substantially improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building; 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. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all appl}�able laws, ordinances, building codes, and zoning regulations. Initial �JhA`• I understand that the building official and inspectors are not there to design or give advice on how ttomeet the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled in a civil court with the advice of an attorney. This department will not mitigate any contract disputes Initi I understand that if I compensate any person or company for work performed they are required to be licensed in this jurisdiction. If for some reason they do not possess a license, I may 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 may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relqt4 medical cost, which could include loss of wages 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 owneribuilder exemption shall be reported by the Building and Zqning DepartrWt to ft Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20 ),-4, _ Owne B ilder Signature STATE OF FLORIDA A )) � r COUNTY OF d ,& � I egoing inJstrument was acknowledged before me this � day of 20 by : who is personally known to me, or who has pro as identification. TV 7'T Signature of #tary T or Print Name o of (Seal) Title: Notary ublic Commission Number SLCPDSD Revised 07/22/2010 0Y "yAl • AUOREY B. HUPti1PNREY =* MY COMMISSION # EE 061169 i =q• EXPIRES: March 6, 2016 %p Bonded Thru Notary Public Ur e, :,•mien T.vaw�trimP�fis:ows.:auaa�c�i�i�:.s3:Y�cc .. Property Appraiser - St.Lucie County, FL Ir Page 1 of 1 PROPERTY RECORD CARD Sidney T Milton III Record: 1 of 2 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification Site Address: 703 ULRICH RD Par6ellD:�0tF3'_007c8'000�6� G,y Sec/Town/Range: 10 :36S :40E Account #: 40581 Map ID: 34/10N Land Use: SF Res r r� Zoning: RS-3 City/Cnty: St Lucie County ' Ownership and Mailing Legal Description Owner: Sidney T Milton III Janice A Milton ULRICH'S S/D BLK C LOTS 12 AND 13 (0.30 AC) (OR 3249-812) Address: 703 Ulrich Rd Fort Pierce FL 34982-3906 Sales Information Assessment 2011 Final Total Land and Building Date Price Code Deed Book/Page 2011 Final: 79100 Land Value: 13300 Acres: 0.3 11/18/2010 125000 0330 WD 3249 / 0812 Assessed: 79100 Building Value: 65800 1/1/1900 0 / Ag.Credit: 0 Finished Area: 2681 SgFt Exempt: 50000 Taxable: 29100 Taxes: 789.01 BUILDING INFORMATION Exterior Features View: - RoofCover: SA - Asph Shingle RoofStruct: GA - Gable ExtType: HD -HD YearBlt: 1956 Frame: Grade: D - D EffYrBlt: 1970 PrimeWall: BS - CB Stucco StoryHght: 0010 - 1 Story No.Units: 1 SecWall: SB - Abs Shingle Interior Features BedRooms: 3 Electric: MX - MAXIMUM PrmintWall: PN - PN FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/FI: STD 1/2Bath: 0 HeatFuel: ELEC - Electric Prm.Flors: CU - Carpet %A/C: 100 %Heated: 100 %Sprinkled: 0 Special Features and Yard Items Land Information Type Y/S Qty. Units Qual. Cond. YrBlt. No. Land Use Type Measure SWAV - RES POOL AVG Y 1 405 AV AV 1986 1 0100-SF Res 235 -Front Ft 90 PA01 - POOL DK-AVG Y 1 375 AV AV 1986 ENC2 - POOL ENC-AVG Y 1 780 AV AV 1986 3CNT - 3CNT S 1 1 AV AV 1970 SDSF - SITE DEV S-F Y 1 1 AV AV 2001 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED Depth 145 http://www.paslc.org/pre.asp?prclid=341060300780006 4/26/2012 Property Appraiser - St.Lucie r-unty, FL Page 1 of 1 PROPERTY RECORD CARD Sidney T Milton III Record: 1 of 2 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification Site Address: 703 ULRICH RD ParceIID: 3410-603-0078-000-6 yam/ Sec/Town/Range: 10 :36S :40E Account #: 40581 Map ID: 34/10N Land Use: SF Res Zoning: RS-3 City/Cnty: St Lucie County ' Ownership and Mailing Legal Description Owner: Sidney T Milton III Janice A Milton ULRICH'S S/D BLK C LOTS 12 AND 13 (0.30 AC) (OR 3249-812) Address: 703 Ulrich Rd Fort Pierce FL 34982-3906 Sales Information Assessment 2011 Final Total Land and Building Date Price Code Deed Book/Page 2011 Final: 79100 Land Value: 13300 Acres: 0.3 11/18/2010 125000 0330 WD 3249 / 0812 Assessed: 79100 Building Value: 65800 1/1/1900 0 / Ag.Credit: 0 Finished Area: 2681 SgFt Exempt: 50000 Taxable: 29100 Taxes: 789.01 BUILDING INFORMATION u�d�o�maNuc m ra m Exterior Features View: - RoofCover: SA - Asph Shingle RoofStruct: GA - Gable ExtType: HD -HD YearBlt: 1956 Frame: - Grade: D - D EffYrBlt: 1970 PrimeWall: BS - CB Stucco StoryHght: 0010 - 1 Story No.Units: 1 SecWall: SB - Abs Shingle Interior Features BedRooms: 3 Electric: MX - MAXIMUM PrmintWall: PN - PN FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/FI: STD 1/2Bath: 0 HeatFuel: ELEC - Electric Prm.Flors: CU - Carpet %A/C: 100 %Heated: 100 %Sprinkled: 0 Special Features and Yard Items Land Information Type Y/S Qty. Units Qual. Cond. YrBlt. No. Land Use Type Measure SWAV - RES POOL AVG Y 1 405 AV AV 1986 1 0100-SF Res 235 -Front Ft 90 PA01 - POOL DK-AVG Y 1 375 AV AV 1986 ENC2 - POOL ENC-AVG Y 1 780 AV AV 1986 3CNT - 3CNT S 1 1 AV AV 1970 SDSF - SITE DEV S-F Y 1 1 AV AV 2001 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED Depth 145 http://www.paslc.org/prc.asp?prclid=341060300780006 4/26/2012 .ATTORNEY CLEARANCE This will confirm that the following customer has signed an annexation agreement and is therefore cleared for provision of utility services: Customer Name: Sidney T. Milton, III, and Janice A. Milton, his wife Site Address: 705 Ulrich Road, Fort Pierce, Florida 34982 Parcel ID No. 3410-603-0076-000-2 Date of Execution of Annexation Agreement: DATED this nCT4 day of APCL , , 2012. Joyce E. Easterday Key Account Specialist Fort Pierce Utilities Authority (772) 466-1600 Ext. 3011 206 South 6th Street (34950) Fax (772) 467-3115 P. O. Box 341 jeasterday@fpua.com Fort Pierce,' L 34948-3191 www.fpua.com R. N. KOBLEGARD, III, Attorney i ATTORNEY CLEARANCE This will confirm that the following customer has signed an annexation agreement and is therefore cleared for provision of utility services: DATED this 2Q0 day of 2012. R. N. KOBLEGARD, III, Attorney Fort Pierce Utilities Author�T_.r} "Committed To Quality" Key Accounts 206 S. 6th Street Nuaw Fort Pierce, FL 34984-3191 Phone (772)466-1600 Fax (772)465-6984 Job Location: 703 ULRICH RD Invoice Number: KA-56-12 Account Name: JANICE A MILTON PCN: 341060300780006 Contact Name: JANICE A MILTON FEI# Billing Address: 703 ULRICH RD FT PIERCE Phone: ( ) - Fax: ( ) - . Cell: (772)209-9303 Cust Type Residential FL 34982 City Limits Outside :5ry`Y,.M�tn f..-�iJ %� 1. y3.. N� " o. .. :., ('/.. tbcc�o f�arf fro a y.. i7 Y,3 $."' kra ,`, ( W.eLv yj+.S.. r w. t: . ,pe.,'ti W . M Iz y, s :W.f. . "„My µ -�. ., ,,-.. h v,.. y�. ,r..: rX $''P 1 't., r.'t " YZ - 11 P— x ,r .a..s 3'..i t �uw'.i` 4F'�.. ,. k.. d+i, F .l .4.�,. d,;. . �,. 1 7, i': :° ... ,x?, li 4 �k .S" E? - tr- 1 !•2 `k .N ., Ja f, �:, § aDe car tle ., n _ _. A {4r,4rt } ' ` i mi s i 1b. 6. Hyt M ��t.:. %::� ➢'!Y'� s,",PR rw w t J .. :- ai' �+''A h .' J.`i'�t t ,;,t.�+a1 5 �t, , g, 4 ,t. R , i, ?t. V n..{ t. :?`ydt t ¢ '"`"+i ' i iR i �' . r w^ .. < .a c....- �,.... u x:. �- .`' r:. t R .r,�i.. ..{ .IT. , e3 Y,rs A5. a'4v nis rr xt ... w" ef•. (( ,{ .t4+.d.Su`�$._.�!'N�I.f`i'.tv,.M:Y'� r. .i'. .vs?.�. a' M1,.F . 9 1¢ ":s7�r r .a'� .,i ;S}'.'i...*.1 $:".u!"...-i eF-pp� ri Nfa- mix:.:, 06-3-060-43701-0000 1 5/8 X 3/4" Water Meter and/or Service Installation $250.00 06-2-000=23500-0000 Water Security Deposit $60.00 06-3-060-48800-0000 Water New Account Setup Charge $40.00 06-3-060-43702-0000 Water Capital Improvement Charge W ERC's 1.00 $920.50 06-3-060-49525-0000 *Water Accrued Guaranteed Revenue Charge $0.00 Meter Verification Fees $0.00 08-2-000-23500-0000 Wastewater Security Deposit $0.00 08-3-080-48800-0000 Wastewater New Account Setup Charge $0.00 08-3-080-43702-0000 Wastewater Capital Improvement Charge WW ERC's 0.00 $0.00 08-3-080-49525-0000 *Wastewater Accrued Guaranteed Revenue Charge $0.00 Lien Fees 0.00 ,y�ArES '9"Y to, :: ,r' :... ,.;.:. n J y'..r 'i'- ,....x"i "„ / ,.�. .i, //��.�/s} ,} b. }r.,, ., _. 'VY l�'11 t .� " �. �,.. Y A ?r ; Y.: rd„'; lu 7W ;. .. h i" . '..'«. Y[�Tpia5't'k�'xw�x°ffi �;G.. r:. t..'2s `'v'?%9uY%, y t ?: t 1 ^'>` 'J' { t,�:.� ",— ,�)f JN, y,4,�.:< Mt 'k,tY':,�� ,,; : 't �,.r. '";� •Y�,rr."r...Ntsa w s :i� c�: t.W�tA',s; 7rr•�.�g r# f t .r,,,yT r'nrd 7 ? .. k rye}:*. 'i.'htF `"vr'.: �'' `� Q �/},�, /� r i.. it c ,jj, r� ti w ti �' f$ ,r�?. -3 t: . ;k. h. .i', t. ;Cr .,Yr., . ., :. ' .g. UVtiV ti«.. �St .. Sitt ate(.; $ F ;,. yl 0X 6�':.+:; �� t.{{ >ti7«W3.vx { y ti �.� .�t. }.. xS�' �' �. � � V� Y g t. 4� x 'S �`'' � i; k � �!^ t § �. ...k^ .0 E'rv_���±s;t`v?.�;;.� 4^,�,�i�, ...q .,,� ,�. ,i .E. rFi,4r .d ..3,.1'' i� n }4 1wJfi rirx':L';�iµF4"�er,,.[wxi}�+mac f' 0.00 0.00 "'1."`i:7 rn iR I•T{� ater and Wastes ¢te�A�RC fees ar godd antilythe endk the, t)lonth, Ifxno recelved�fyyf s E DOWn Payment: $0.00 the end of the knot new des wlil a I Plesae contact our o ide"16 060dated fees PP Y� � �', a� �J� uz� tf a }' J r ter;�e �...v v. u �'u, Invoice Total: $1.270.50 Description for service order: INSTALL 5/8 X 3/4" WATER METER ONLY Total Paid: Date Paid: Check Number: Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health Department must be obtained Prior to initiating a septic tank abandonment. Contact the Health Department at (772)873-4931. Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority. Reviewed By: Joyce Easterday Key Accounts Specialist Date: 04/26/2012 Customer's Signature: Printed Name: Date: RETURN TO: 'R.N. KOBLEGARD, III, l., COURTHOUSE BOX ANNEXATION AGR `,NT INDIVIDUAL — f This instrument prepared by: R. N. Koblegard, III, Esquire 200 S. Indian River Drive, Suite 201 Fort Pierce, FL 34950 Property Appraisers Parcel Identification (Folio) Number(s): 3410-603-0076-000-2 TO: WATER/WASTEWATER ENGINEERING 705 ULRICH ROAD, FORT PIERCE, FLORIDA 34982 FORT PIERCE UTILITIES AUTHORITY Location Address POST OFFICE BOX 3191 FORT PIERCE, FLORIDA 34948-3191 703 ULRICH ROAD, FORT PIERCE, FLORIDA 34982 Mailing Address (if different from location address) Dear Sir: The undersigned does hereby apply to Fort Pierce Utilities Authority for water service and/or sewer service outside the City limits of the City of Fort Pierce, Florida to the following -described property which I own, to wit: THE EAST 25 FEET OF LOT 10 AND ALL OF LOT 11, BLOCK C, ULRICH SUBDIVISION, AS PER PLAT THEREOF ON FILE IN PLAT BOOK 5 AT PAGE 530F THE PUBLIC RECORDS OF ST. LUCIE COUNTY, FLORIDA. THE ABOVE -DESCRIBED PROPERTY IS NOT THE HOMESTEAD OF THE GRANTORS. THE GRANTORS RESIDE AT 703 ULRICH ROAD, FORT PIERCE, FLORIDA 34982 I hereby agree that in consideration of my request for water service and/or sewer service to my property, that if my property either becomes contiguous to the City limits of the City of Fort Pierce, Florida, as such term is defined in the Laws of Florida, is subject to a Chapter 171 interlocal service boundary agreement where contiguity has been waived by the County, or may otherwise be lawfully annexed, that this application shall be considered as an application for the annexation of my property (above -described) into the City of Fort Pierce, Florida. I do also hereby for myself, my heirs, successors and assigns approve the annexation of my property into the City of Fort Pierce, Florida and consent thereto in the event that it, or any area including it, is proposed for annexation by election or otherwise. I waive any and all objections to annexation of the property and agree that this Agreement shall be construed to satisfy any requirements of law for consent.to, or approval of, such annexation now or hereafter required. I further confirm that this Agreement shall be binding upon my heirs, successors or assigns and that this document may be recorded in the Public Records of St. Lucie County, Florida for the purpose of serving as notice to all persons or entities. In Witness Whereof, we hereunto set our hand and seal this I S* day of �I 7' L , 2012. Signed, sealed and delivered in our presence as witnesses: Printed Witness Signature STATE OF FLORIDA COUNTY OF ST. LUCIE 141 Signatulw--�' Sidney T. Milton, III Printed Signature 703 Ulrich Road Address Fort Pierce, Florida 34982 City, State, Zip Q2k.LS-) C�- Sign t re Janice A. Milton, his wife Printed Signature 703 Ulrich Road Address Fort Pierce, Florida 34982 City, State, Zip I hereby certify that on this day before me, an officer duly authorized to administer oaths and take acknowledgments, personally appeared Sidney T. Milton, III, and Janice A. Milton, his wife, known to me to be the persons described in and who executed the foregoing instrument, who acknowledged before me that they executed the same, that I relied upon the following form of identification of the above -named persons: Driver's Licenses; and that an oath was not taken. RUBBER STAMP NOTARY SEAL Witness my hand an official Sea in the County and ate last NOTARYPCBLIC•STATE OF FLORIDA afore id this S day of r't l .2012. Da%vn Renee Dannenhauer 0"--Expires: Commission #DD95k89%,JAN. 25, 2014 Notary Sign ure soxnm eta nzz,nN-nc soNDlxo co, INC Susan M. B u r b a n \Q,-W h QLA-LV\ 14_�'h �,Cytls�tV' Notary Printed Signature Userver\cft Documents\Forms7PUMCompleted Annexation AgreementslMilton, Sidney - 705 Ulrich Road.docx- Milton Vacamt Lot AA Revised 7/9/04 per atty. RETURN TO: R.N. KOBLEGARD, III, I � COURTHOUSE ANNEXATION AGRf, �YT INDIVIDUAL This instrument prepared by: R. N. Koblegard, III, Esquire 200 S. Indian River Drive, Suite 201 Fort Pierce, FL 34950 Property Appraisers Parcel Identification (Folio) Number(s): 3410-603-0078-000-6 TO: WATER/WASTEWATER ENGINEERING 703 ULRICH ROAD, FORT PIERCE, FLORIDA 34982 FORT PIERCE UTILITIES AUTHORITY Location Address POST OFFICE Box 3191 FORT PIERCE, FLORIDA 34948-3191 703 ULRICH ROAD, FORT PIERCE, FLORIDA 34982 Mailing Address (if different from location address) Dear Sir: The undersigned does hereby apply to Fort Pierce Utilities Authority for water service and/or sewer service outside the City limits of the City of Fort Pierce, Florida to the following -described property which I own, to wit: LOTS 12 AND 13, BLOCK C, ULRICH SUBDIVISION, As PER PLAT THEREOF ON FILE IN PLAT BOOK 5 AT PAGE 53 OF THE PUBLIC RECORDS OF ST. LUCIE COUNTY, FLORIDA. THE ABOVE -DESCRIBED PROPERTY IS THE HOMESTEAD OF THE GRANTORS. I hereby agree that in consideration of my request for water service and/or sewer service to my property, that if my property either becomes contiguous to the City limits of the City of Fort Pierce, Florida, as such term is defined in the Laws of Florida, is subject to a Chapter 171 interlocal service boundary agreement where contiguity has been waived by the County, or may otherwise be lawfully annexed, that this application shall be considered as an application for the annexation of my property (above -described) into the City of Fort Pierce, Florida. I do also hereby for myself, my heirs, successors and assigns approve the annexation of my property into the City of Fort Pierce, Florida and consent thereto in the event that it, or any area including it, is proposed for annexation by election or otherwise. I waive any and all objections to annexation of the property and agree that this Agreement shall be construed to satisfy any requirements of law for consent to, or approval of, such annexation now or hereafter required. I further confirm that this Agreement shall be binding upon my heirs, successors or assigns and that this document may be recorded in the Public Records of St. Lucie County, Florida for the purpose of serving as notice to ail persons or entities. In Witness Whereof, we hereunto set our hand and seal this %*__ day of IY` L , 2012. Signed, sealed and delivered in our presence as witnesses: Witness Signa`tt u-rem Printed Witness Signature STATE OF FLORIDA COUNTY OF ST. LUCIE c Sign Sidney T. Milton, III Printed Signature 703 Ulrich Road Address Fort Pierce, Florida 34982 City, State, Zip C' t Signblure Janice A. Milton, his wife Printed Signature 703 Ulrich Road Address Fort Pierce, Florida 34982 City, State, Zip I hereby certify that on this day before me, an officer duly authorized to administer oaths and take acknowledgments, personally appeared Sidney T. Milton, III, and Janice A. Milton, his wife, known to me to be the persons described in and who executed the foregoing instrument, who acknowledged before me that they executed the same, that I relied upon the following form of identification of the. above -named persons: Driver's Licenses; and that an oath was not taken. NotAky pt'BLIC ST-ME OF FLORIDA . tilt, �,> ,r all*n k�6,iEO tiannenhauer { huiriijWoh #DD955189 a Jam'!, 2S, 2014 soxD W%mccl.ma Witnesss my hand and official Seal iy e County and + aforesaid this .--) Idav of l�7✓)d A' E Susan M. Burban 12. �er %%Serverlc\My DocumentsTormsTPUMCompleted Annexation Agreements\111ton, Sidney - 703 Uh-ich Road.docx— Milton Homestead AA Revised 7/9/04 per atty.