HomeMy WebLinkAboutSUBMITTED PAPERSWf
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:
CONCURRENCY FEE�-' RECEIPT NO.:
PERNUT NUMBER: 07- Dly
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
IBUMDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652
772-462-1553
_�"YOOTM' ( - I -rT-
APPLICATION for BUILDING PERMIT
GQ&RTIFICATE of CAPACITY/ZONING COMPLIANCE
'5C
rAvirlF.-I JUINrUMVIA11VIN
I
LOCATION/SITE ADDRESS: 100 tic* k_004 61CA)
rz�' Ttevee
, FI,3#V
2.
PROJECT NAME:V'00 1) SITEPLANNAME:
K�5qa+
3.
PROPERTY TAX ID #: '131-3,
4.
LEGAL DESCRIPTION (attach extra sheets if necessary)- +10
pit! g�
5'
PLAT BOOK 9-0 PAGE XO_. 7. BLOCK
NO.
8. LOT NO.
9.
PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
10.
CONPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
P�-Ro.
a -A N
%Co
716�
wile-,
11.
Avuly
SETBACKS (ACTUAL) FRONT:'Samiam BACK: RIGHT SIDE
LEFT SlDgw�
12.
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION
INTERIOR RENOVATION
RESIDENTIAL COMN[ERCIAL
INDUSTRIAL
OTBER(SPECIFY)
13.
DESCRIPTION OF PROPOSED USE:
14.
46.
SQ. FT OF CONSTRUCTION: -22? 15. SF. FT I st FLOOR:
VALUE OF CONSTRUCTION: $ 2-5- 17 .00
f
The value of construction is used to determine the amount of permit fees to be assessed. 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 activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
F_. - I
UPDATED 6/25/09
01 1
OWNER INFORMATION
NAME: 4
ADDRESS: oloulejc-
CITY: f4. S7
STATE: f�L ZIP:
PHONE (DAYTIME): C?—
A� 3 Z ( - 51 Email:
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): C___)
CONTRACTOR INFORMATION
ST.ofFLREG.CERT#:
BUSINESSNAME:
STATE:
ma
LF
ST. LUCIE COUNTY CERT c2 S-q -2
1, & et .
QUALIFIERSNAME: 040c*
ADDRE S S; 'q 3 4-�M 14 lip0jn
CITY: V40 'ge-"JI STATE: ZIP: 63
PHONE(DAYT1ME):(7A)z4?3,-c9-3'Z— FAxNo.772-55?'Q'C4S4? Email: MMjr?&e-L61.00N
Al2C'MT1PWMM-PP'P& 'hk.Sbjr-- 5m, y4Af\
ADDRESS: L fe) I
CITY: Ver-O 9
�r:A C,
PHONE (DAYTIME): (7M Sfrf - fj�,-70
13ONDINCTCOWAW:
--# 1c) -z—
STATE: 41�'L—
ADDRESS:
CITY: STATE:
MORTGAGE LENDER:
ADDRESS:
CITY: STATE:
ZIP: gp-q 6 Z-
Nz
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notiflication
it will be voided and returned to you by mail.
IMMICATION:`
il i . s applic ion is hereby made to obtain a permit to do the work and installations as indicated, 2
appli ble, for the permitted work. I certify that no work or installation has commenced prior t
ork performed to meet the standards of all laws regulating construction in this jurisdictic
May be re�q*ed for ELECTRICAL, PLUMBING, SIGNS9 WELLS, POOLS, FURNACES
AND AIR CON�NERS,FENCES, ETC., not otherwise included with this building permi,
St. Lucie County makes no representation that its granting of a permit will authorize the permit
which is in conflict with'any applicable Homeowner Association rules, bylaws or any c6venn
structure—Please..conguh-with.,your Homeowner's Associat I ion -and review your deed. fbf. any restri
The-, im ing a full c c . urrency.
permit app cations are exempt from , dergo
A_
resiaennai use.---------
7NOTIMTO OWNER:-
-..NOTICE TO APPLICANT:
PAYING TWICE -FOR IMPROVEMENTS TO YOUR PROI
COMMENCEMENT MUST-BE'RECORDED AND POSTE]
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINA
LENDER OR AN ATTORNEYBEFORE RECORDING YO
COMMENCEMENT.
id to obtain a certificate of capacity,
.the issuance of a permit and that all
i. I understand that separate permits
BOILERS, HEATERS, TANKS,
application. .
older to build the 'subject structure
that may restrict or prohibit such
ions which may apply.
review: room additions, accessory
7&=accessory�-usesto-another non-
NT MAY RESULT IN YOUR
RTY. A NOTICE OF
ON THE JOBSITE BEFORE THE
ICING, CONSULT WITH YOUR
R-NOTICE OF
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 TBE CONSTRUCTION LIEN LAW NOTICE TO
W ik qk.e9krhA<T_OR SIGNATURE
CONTRACTOR SIGNATURE
STATE OF FLORID�A*
8 5,
5 --
STATE OF FLORIDAdid
COUNTY OF
?
COUNTY OF
The foregoing instrument was acknowledged before
mw
Co M
The foregoing instrument
was acknowledged before
1)f
me this �& day of 20
me this --�-&day of
920
by A -
by
who is personally known %--or has produced
who is pe all known
or has produced
as identification.
vo�g - C
as identification.
!:Id U=%,t/ -
Sigaiture OFN�iry ry
AUDREYS.HUMPHREY
MY COMMISSION OW 061169.
(Seal)
Commission No. (Seal) WIRE .,qppissii n No.
Bonded Tliru Notaty Pubho Undo rwriters
ss.
�Tvt*uv I
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS DUIOLDING PERMIT AS AN OWNERIBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICA-11ON INTHE OFFICE LISTED -ON THE FFRONT'OF TMS-AIPPLI,CA —11ON.
OWNER BUILDER AFFIDAVIT WELL BE REQUIRED . FOR ALL OWNER/BUELPER APPLICANTS.
For specific instructions see appropriate permit checklist. -
CERTIFICATION:
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 TFUS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF TEE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMEN_T,----,_---,,
'O'VVNER O��CTOWSIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
4 2
me this day of 0
by
who is personally known "Or hasproduced
as identification.
Sivra-fure of Notary
N
k,
CHRISTHOMAS
Commission No.
MyCV")N#0D210685
REXPIRES: July 26, 204
-04 BorM Thru Bu* Notaq SeMcm
SIGNATURE
STATE OF FLORMA--
COUNTYOF 41-W.
The foregoing instrument was acknowledged before
me this ;/4 day of DK-1.1141 20 '1 ,
by ollcgz".
who is personally known --�or has produced
as identification.
Signatur-e-6—fNotary
CHRIST
Commission No.
— MMMISS1008000
EXPIRES: July 26,2013
y BWW Thm Bu* Wa1Y SWO
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERIBUILDER, 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 OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checki.ist.
OFFICE USE ONLY BP #: 107- 0
SECTION
lb
TOWNSHIP
RANGE
Lo
MAP NO.
ZONING
354
LAND USE
9m
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
IlT FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER.
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
A2
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACT FEE
IMEACT---
IMPACT
FEE
CORRECTION_
FEE
FEE
GENERAL
.SCHOOL
ROAD
CREDIT
Y
N
LAWENF
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
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
10
INITIALS
u m a 1
"Lo� c: �1:pilo Ey�'�afa &-,_p3lrj font"
DA�E
T E
IM
OUT
ACCOUNT NO.
ROUTE NO.
J61-IAJ
N
NAME
E
_.k_) J?t o r 12 6.6 L
F
ACCOUNT IE
Z
0"REGULAR RESIDENTIAL INDOOR
1-TIME COMMERCIAL AUTDOOR_
,A DRE�BS_lv
q It) 0 L00,11#�U7- 07,
CITY STATE, ZIP
7-,
rREOUENCY
Rf ANNUALLY El 6 MONTHS [:13 MONTHS
_1VJEEKLY
MONTHLY El BI-MONTHLY F
PHONE
El INSPECTION 0'r.R'EATIVIE'PT El
`�!_MWTARGET PEST YZAA�.
w SITETREATED
APPUCATION METHOD
APPLICATION RATE
F:o. 64 grc
L ------
.......... --------- .....
. ........
................. - ------------ . .................
------------ ------- ------ ----------
--------------------------- - ------- .........
, --------------- ---------
---- ---------- - ------ ------
CHEI ALS USED 7f*
AMOUNT
%
EPA NUMBER
20
65-
.......
2 25' - -/
............ ........... op- ------ ---------
............................................ ...... ---------- ----------------------------
..................... ........... ---------- ................ ..... ....................................
--------- ......
-------------------------------------------------------------
.........
.............................. ...............
DESCRIPTION REM �R
AMOUNT
op
rl
SUB -TOTAL
- ------------
....... .. - ---------- - ------
TAX
TOTAL
— - - — ------ - -----
ACCOUNT BALANCE
Cl'-CASH AM%UNT PAID
CHECK #
SERIACED BY
LICENSE NO.
CUSTOMER SIGNATURE,
BALANCE DUE
ERVICE �'ORDER VW010E AOO A
9+200
I T
P.]
PLANNING & DEVELOPMENT SERVICEs
Building & Code COInPliance Division
BUILDING PERMIT
SUB-CO-NTRACTOR AGREEMENT
St. Lucie County Contractor CertificationNumber:—.11— 6o01-7L?3&
State of Plorida Ccrtificaton Number (if applicub:
ovo
(Compa"Y -Ndmetindividual Name) have agreed to be the
w V r
e" -.1; Sub-contfactorfor -1,lic0l
(Type of Trade) (Prf mar i �J Q,�
. Y Contractor)
I
for the Project located at 44) 00 I-DDI<nt li,
Vro]ecl Strftt -Address Or Property Tax ID #)
It is understood that. ifth
ere is any change of status regarding our particiP'afion with the
abOvO Mentioned project.
1 Will 'mm'ediatelY advise the Building and Zoning Departinent
of St. Lucie COUntY bY personally filing a Change of Contractor notim (Form: SLccDv
No� 004-00)
OUALIOIER (Name of the Individual shown on the Contractor's License)
Unir�S ARE RFQUIRED
A
4SIGA4TUEZA���. rKIN I NAME
DATE
Business Name: S t
Ad&ess: -"�1,6� 50LA—Z
city/statelzip: -47Pr �-Lf, tt 64,
Phone: �W�
etna":
1-0�� 5VQtffrAAa-
OFFICE USR' ONTY.
��D,4&3 RIVA P5019
Ct 31 5 R/NCWP/Wl DOW
vg� ooioq, F4.3.� V>3
KSM
KELLER, SCHLEICHER & MacWILLIAM ENGI - N ERI NG AND TESTING, INC-
MARTIN (772) 337-7755 RQ. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712
PALM 5EAQH (561) 845-7445 wwwAumengineering.nat MELBOURNE (321) 768�8488
FAX (661) 846-8876 E-Mail: KSM@KSMENGINEERlNG,NFr ST. LUCIE (772) 220-9093
G.A.: 5693 - SOIL COMPACTION REPORT FAX (772) 589-6469
ASTIVI D 1557 and ASTM D 2922
DATE TESTED
September 6, 2011 JOB# ; 111023-1 pd/SH/km
(�P E R M �[T #
1107-0143
CONTRACTOR
Indian River Pools
JOB LOCATION
4100 Lookout Court
Fbrt Pierce, Florida
ITEM TESTED - Pool Rackfill
TEST LOCATION
DEPTH
* PEN
DRY
MAX. DRY
PERCENT
OF SAMPLE
READ
DENSITY
PROCTOR VALUE
COMPACTION
1
S.W.
01-it
27
107.4
111.3
99.5
2
V-2,
37
95,0+
3
21-31
36
96.04
4
31.4'
36
95,0+
5
North
01-11
37
107,2
111.3
96.3
6
11, 2'
.38
95.0+
7
2'- 3'
36
95.0+
8
3'- 4'
36
95.0+
9
S.E.
01-11
38
108.1
111.3
97.1
10
1',2'
38
95,0+
11
21.3,
37
95.0+
12
T - 4'
37
95.0+
Soil Description:
Brown Sand .
In Place Moisture:
9.9 -Percent
Optimum Moisture:
12.2 Percent
Max. Dry Density,
111.3 P-(�,F.
Test Locationj
t I P Density &
Penetromp_t �dlcate
z
the De Of ts
Minim Nq ir d.
pe Grade.
Julie
De0artment
112.01 1 1 1 1
W
G
H111.0 T
T T
P
110.0
C
D
R
y
10&0
9 10 11 12 13 14
Moisture - % of Dry Weight
Ronald G. Keller, PE-; 37293/Si Lio.No.�860 -Julie E. Keller, RE.: 613366
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE COMPLIANCE DIVISION
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
I . JIAA '?kVt%( will be using the following sub -contractors for the
(Company/Individual Name)
project located at Woo Lm�_&A e+ Rextsti 4L -SqffI- -
(Street address or Property Tax ED #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning Department of St. Lucie County.
Trade
Name of Company/Contractor
St. Lucie County/
State of Florida
License Number
Electrical
Plumbing
7ocl '&ys 00
-661.?q,
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:�
PERMIT nolLo> ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUIELDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: i�450
State of Florida Certification Number (If applicable):
have agreed to be the
(Company Name/Individual Name)
Aec,6 2-0, N sub-contractorfor 1 1 Lk (—I
(Type of Trad ) (Primary Contractor)
for the project located at q(6o LP _,57
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL SIGNATURES REQUIRED
N TURE PRINT NANM
Business Name:
Address:
City/State/Zip:
Phone:
OFFICE USE ONLY:
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Luc ie Co u n t y C ontractor Certification Number:
State of Florida Certification Number (If applicable): C-p,±
have agreed to be the
(Company Name/Individual 34ame)
tuVA 4 1 V, 5 sub -contractor for
(Type of Trade) (Primary Contractor)
f-t-
for the project located at 6 6 LOWVOV-� 64. fq- 'Ik'fce
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BURNES.$ OKALIFIER (Name of the Individual shown on the Contractor's License)
�ORIGV/CN:ATURES ARE, RE, QUIRED
TURE
Business Name:
Address:
City/State/Zip:
Phone:
OFFICE USE ONLY:
PRINT NAME
J\.k'6" r�00 Ie
r-C, ?,2-
email:
PERMIT # ISSUE DATE
.,Ar /I _/
DATE
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT
1, the undersigned, am the owner of the following described property,
1'313�5762�, 3 tc+ 575
(P crip
,prcel Id#/Leg des ' tion/Address) ff. Fier -,Fd-
(MkIF IL(7 19 tS' COR i1of Z-qs 7) j.41M toot
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.
0.4 ri m Ly R L6 &
Property Owner Name lease
(P prmt)
<--� (�/' , '?, 0, , ;-2
P�'operty Ownpp�e Date
.1 "*�
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS ;3(3 DAY OF 3Wk 120 1 �/
BY j1'A,510Wy& A04ZC4— WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
r - r.
NOTARY PUBLIC
lwow —COMMISSION NUMBER
AS IDENTIFICATION.
6*v 9*406
TYPE OR PRINT NOTARY
M mi SION# DD91M
Y COM 8
(SEMES: Ju� 26, 2013
aonded Thru B*et NotalY $Ww-
SLCPDSD Revised 08/24/20 10
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 3608461 OR 131�—�3307 PAGE 988, Recorded 07/12/2011 '�1.2:39 PM
AFWR RECORDING-REMRN TO,
I
NOTICE OF COMMENCEMENT
Ile undersigned hereby given 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
1. DESCRIPTION OF PROPERTY (Legal description and sftd address) TAX FOLIO NUMBER: d6?S-QM14j
+W& I 2ba es Wb - Tkst S
2. GENERAL DFSCRWnON OF IMPROVEMENT: 'aol P 4�1-n
3. OWNER INFORMATION: a. Name . " r -3 &;.�
b. Add ress q 100 1- 00 le-0 C-'r� O:L _ V T'S -f 4.r- r-L -3 145 5-' f c i merest in property-6-L-k�M-j
d. Name and addressof fee simple titleholder (if other than owner)
V%ky- 611f
4. CONTRACTOR'S NAME, ADDRESS AND PHONE NUMBER- 11-2(4 0
FC-3Z--i 63
5. SURFWIS �AME, ADDRESS AND PHONE NUMBER AND BOND AMOUNT: A) V.5 of? 11+
6. LENDER'S NAME, ADDRESS AND PHONE NUMBER: %azttj IF-1— -&
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13 (1)(a) 7., Florida Statutes:
NAME, ADDRESS AND PHONE NUMBER:
8. In addition to himself or herself, Owner designates the following to receive a copy of the Li enor's Notice as provided in Section
713.13 (1)(b), Florida Statutes:
NAME, ADDRESS AND PHONE NUMBER:
9. Expiration date of notice of commencement (the expiration date is I year from the date of recording unless a different date is
specified) , _ 20_.
- 6 r.,- 0, o &-,1 6 (, -j C,
Print Name and Provide Signatory's TitlefOillce
Officer/Director/Partner/Manager
StateofFlorida
County of Awww
The foregoing instrument was acknowledged before me this IVtl ay of 20-L�--.
By- e4�5,*fAFIC- Kgf—�- as — &t,&AI 4e
(Nameofperson) (Type of authority ... e.g. Owner, officer, trustee, attorney in fact)
(Name of party on behalf of whom instrument was exec ) Personally Known— or produced the following type oflI):*1'
zw-w-c 414
k MyCGMMW*9#0D9IVA5
j EXPIRES: JuV 26. 20113
(Printed Name ofNotary Public) ign of Notary Pub-1ir7-- Aov* Mai Thm Bwge' Ndm WAW
Under penalties of perjury, I declare that I have read the foregoing and that the facts in it are true to the best of my knowledge and
belief (section 92.525, Florida Statutes).
Signature(s) of Owner(s) or Owner(s)' Authorlud OfficerlDirector/Partner/Manager who signed above:
--�7
BY: 11.e� By
R-0==(R—U.&111� —
STATE Of FLORIDA
c,r i twirMINTY
P
Rq
B
7
06/29/2011 16:28 7724621148 ST LUClE COUNTY
-PLANNING & DFVELOPMXNT SERVIds
BUMDING & CODE REGULATIONS I)MST.ON
2300 VMG]NIA AVE
FORT PIERCS, FL 34982
(772)462-1553
AYVMAVIT OF REQUMEMENT COMPLIANCIE
Residential Swimming pools, Spa, and Hot Tub Safety Act
PERKIT 9
PAGE 01/01
I (We) scimowledge that a w swimming pool, spa, or hot tub will be constructed or installed at
and hereby aTArvi that Ong of the following methods
(please print street address)
W to . meet the requirements of Chapter 515, Florida Statutes: (please initial the method used for Pool.)
c pool wui be isolated from access to the horne by sr enclosure that meets the pool bmior requif=cnts Of Florida SWc 515-29-
The pool will be equipped with an approved 81fdty pool ;Uvcr "t complies with ASTM F1246-91(Standard Peffomencc Speciflestions 1br
Safety Covcnfat Swimming Pools, Spai, and Hot Tubs).
All doors wd windows providing direct acrcss ftm the home to the,pool will bc cquipped with OR 9xxt Aterm t11Rt has a minilmum sowd
premire r&tWg of 85decibdq at 10 ftct,
All doors providiAg dimut access from the home to the pool wit, be equipped with self clo.ging, self latching devices with release mechanisms
pl=d no lower then 54 inchcg above the floor or decIL
I understand that not having one of the above installed at the time of final inspection, Or when the pool is completed for contract
purposes, TAII constitute a violation of Chapter 515, F.&, and -will be considered as committing jL misdemeanor of the second degree,
punishable by fines up to SSOO-00 AindlOr up to 60 days in iRil as established in chapter 775, F.S.
es liability for the fimal inspection of one of the
I understand that the St. Locle County Building Inspections Department assurn no
above protective d ic 'or the lack of maintaInance, or the rem , oval of such after the swimming POGI has been finalized.
L tbi contr 9 eto* ruct the owner of the proper Use and maintenance Of -such safety device.
—4,R S,
OWNER SI
Coojj�oolf SIGNATURE
Tv OF, r, LORMA. COUNTY OF --Lw 14-(44,Z- STATE RIDA, COUNTY OV A 4;4,6
6��T �M. LIC -WO-TARYPUBLIC
The foregoing Instrument was acknowledged before Me The foregoing instrument was acknowledged before me
20&_, this .20
this /V day of day of
by /Oww,
by- 5� el-� Personally Known— or Produced ldentftation—��-
Personally Known_ or Produced identificStiOn
Type of IdentifiCatlon produced: cyp& / g!�
P% asSTHOW
MY COMMISSION# DD WN5
EXPIRES: July 26,2013
SLCPDS Revised BonwThru Budget Notary SaNim
Type of Identification produced: Zetalk Z111i
i�sy P% CHRIST14OW
C, My COMMISSION# DDOIO95
EXPIRES: July 26,2013
Bor4adi Thru Budget Notary SWW
z
Property Appraiser - St.Lucie C,,;-ollty, FL Page 1 of I
PROPERTY RECORD CARD
Casimer Kogut Record: I of 1 <<Prev Next >> Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
Site Address: 4100 LOOKOUT CT
Sec[Town/Range: 18:34S :40E
Map ID: 14/18N
Zoning: RS-4
Ownership and Mailing
Owner: Casimer Kogut Judith A Kogut
Address: 4100 LOOKOUT CT
Fort Pierce FL 34951-3316
.,,V\3clE 00
ParcelID: 1313-502-0096-000-4
A
Account#: 4981
Land Use: SF Res
City/Cnty: St Lucie County
Legal Description
HOLIDAY PINES S/D-PHASE ]I[- LOT519 (MAP 14/18N) (OR 1201-
2957)
Sales Information
Assessment 2010 Final
Total Land and Building
Date Price
Code
Deed
Book/Page
2010 Final:
126900
Land Value: 34700 Acres: 0.66
1/29/1999 29500
00
WD
1201/2957
Assessed:
126900
Building Value: 92200
5/31/1990 31700
00
WD
0694/0701
Ag.Credit:
0
Finished Area: 1906 SqFt
12/1/1987 19000
00
CV
0569/2138
Exempt:
50000
Taxable:
76900
Taxes:
1802.73
BUILDING INFORMATION
Exterior Features
View:
RoofCover:
FS - Fibrglss Shg
RoofStruct:
HP - Hip
ExtType:
HC+ - HC+
YearBlt:
1999
Frame:
Grade:
C+ - C+
EffYrBlt:
1999
PrimeWall:
BS - CB Stucco
StoryHght:
0010 - I Story
No.Units:
1
SecWall:
Interior Features
BedRooms:
0
Electric:
MX - MAXIMUM
PrmlntWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/Fl:
1/213ath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
QT - Tile -Quarry
%A/C:
100
%Heated:
100
%Sprinkled:
0
Special Features and Yard Items
Land Information
Type
Y/S Qty.
Units Qual. Cond.
YrBIt- No. Land Use
Type
Measure Depth
SDSF - SITE DEV S-F
y 1
1 AV AV
2001 1 0100-SF Res
230 -Front Ft
155.98 185
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
http://www.pasle.org/prc.asp?prclid= 13 13 5 0200960004
7/12/2011