HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.:Q%
CONCURRENCY FEE: RECEIPT NO.:
PERMIT NUMBER 0 O - 0 ! / t
CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIQN"IVISION
2300 Virginia Avenue �011
Ft. Pierce, FL 3����
2-5652 0
SCANNED 553
' / 1 A)®ll o
gy
-lucre County '�? oG .
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE 9ZAe621`-
c� PROJECT INFORMATIO
N
!�
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME: eS SITE PLAN NAME: /
3. PROPERTY TAX ID #: "\�c� — �JO\ —�� — O(-) ZF� {�
4. LEGAL DESCRIPTION (attach extra sheets ifnecessary): ��e \LeS �SL cbSNC. � CtDCN&Q
5. PLAT BOOKa t 6. PAGE NO. \ 1� 7. BLOCK NO.� 8. LOT NO. _
9. PARCEL SIZE (ACRES/SQ FT.)AI LOT DIMENSIONS: iC
10.
COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
SETBACKS (ACTUAL) FRONT BACK: RIGHT SIDE: y LEFT SIDE:
TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION
RESIDENTIAL
] OTHER (SPECIFY)
DESCRIPTION OF PROPOSED USE: �WG1�� �� (��S ► 0 wt',J• nL--
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
SQ. FT OF CONSTRUCTION: I Lito 15. SF. FT 1st FLOOR
VALUE OF CONSTRUCTION: $
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
m
UPDATED 6/25/09
a
4
OWNER INFORMATION
NAME:
a8710 .Ao�koc-O; C
&Qr x . f �afi dS K1 L(CI S 23--
ADDRESS:
CITY:e. STATE: L ZIP:
PHONE (DAYTIME): ��� �_^ bS c`��- 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: STATE:
PHONE (DAYTIlVIE):
CONTRACTOR INFORMATION
ZIP:
ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS
ADDRESS:
CITY: Me---- STATE: \ L ZIP:
PHONE (DAYTIME): n(_-jq Q \ �, SOr� FAX NO. Email:
ARCHIT/ENGINEER�C
ADDRESS: \%D
CITY: dN-e-c-- STATE: ZIP:
PHONE (DAYTIIVIE): &5 `i�l. -c, \655,�>
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE:
STATE:
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.
OFFICE USE -ONLY BP #: p o y car / l
SECTION
0 2
TOWNSHIP
3
RANGE
Ll1
MAP NO.
ZONING
LAND USE rRkA
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
`
1�r FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 1/1990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
1�
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIRE/EMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING: /
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
1 ( N
DATE
COMPLETED
`
INITIALS
fig
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 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.
OWNER UR CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this �n day of 20 \ \ ,
by C—)N-
who is personally knownhas produced
as identification.
_��
Signature of Notary
Commission .otiPnr o�d(• UI fyNeal).`„...
Puhhc - ,Idle of Florida
.•
MY Comm Expires Jan 23, 2015
'=��� •°:' Commission # El 31278
II1,01P,
Bonded Through Nahonat Notar se
v
C NTRACTOR SIGN TURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this ko day of — 20__\�,
by
who is personally know or has produced
as identification.
—` \` \
Signature of Notary
Co 1sNton11`.;lo (Seal)
,�, b•: S1E.(IAMHUNiER
Notary Public .Slate
�. „•
MY Comm. Ex of Florida
NOTE: T EACH SIGNA o. �P\T ,iBri+3�ai LYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE O &NAJ*yy P AR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLI A
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
Qo N(Yiis
TERMITE SERVICE SLIP/INVOICE
° �
PEST CONTROL Time In Time Out
P.O. Box 681
P)m City, FL 34991
J772-223-9891
/ Date ..................... ............................
Name ........0.�..... :�d ?..........G`r ./�......-.......r.-'1���'��.....
Address.......�.............�.......... ,....l .
City/State/Zip-•
............:....-...r..............................................................................:...:........................... Phone.....................................................................................
TYPE OF SERVICE Regular One Time Other
Special Instructions / Remarks f- ^/ nN f I Amount
............................ :........
.....................................................
TOTAL
Account #. ❑ Cash ❑ Check No. v®
TARGET PEST MATERIALS. USED EPA No. % UNITS .
❑ Cockroaches ❑ Millipedes D .....a...n...d........................................................................................ ..-. .................a ....
❑ Ants ❑ Silverfish ❑a...................................................................................
- .....
-
❑ Centipede ❑Mice ❑Merit
..............................................................:..................:;......
❑ Tick ❑ Fleas ❑ Triad
......................................................... ............................................ ........................... :...................................................
ubterranean ❑ Rats ❑ Terro
..........................................................................................................................................................................................
Termites...0. Maxforce......................................................................... ...............................................................................
❑ Other _
AREA OF TREATMENT
❑ Basement
❑ Crawl
❑ Attached Garage/Porch
❑ Bedroom
❑ Bathroom
❑ Plumbing
❑ Kitchen
❑ Cabinets
❑ Cracks & Crevices
❑ Other .....................................
COMMENTS - OBSERVATIONS - RECOMMENDA
❑ BAIT ❑ TRAPS
1 ❑ CHEMICALS ❑ I
❑ Main Level(s) ❑ Att'ic
❑ Living -room xterior,
❑ Void ❑ Dinning -room
❑ Base Boards----------O-Cbset,
.......................................................................................
ONS /
........................................................................................................
Applica9 s No.
/A/CEMEX
�II) �s
Plant:
Begin Loading:
+` To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
090/1.09 i
r
%'
Customer Code: Customer Name: Customer Job Number: Order Code / Date:
-'099732 FIVE STAR MOBILE 1-1011t a SALES) 254 091191111
Project Code: Project Name: Project P.O. Number: Order P.O. Number:
NO PID
Ticket Date: Delivery Address: Map Page: Map/Row/Column:
Delivery Instructions: Dispatcher.
_ J T —1 O)5 NETTLES .a:( [LAND r,, G 1 .a6n ng
} , Ticket Number:
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
1 r)� z-;5
5.. 0o
11(.-)0231483
109003 03
PERC`r` W 1.LSON I
i3f_) NG, .— SI_�1�
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
. "
1 ,fi=i�t�t=a
1 :[L,ERiytE�at�l 15c
t_P
;,q tit3
12 781.0'
i*?LIF� SURCHARGE
I_ , tji D
s �: ` 2 4S
:;_NV �'i7f��MEI�'Tf�L Ct-ft lf;f�F
Cash Check # / Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge
Comments:
i
WATERADDED:
GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
k1) ❑ 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 sa an-d.hea[P. Please refer to the backside of this ticket for important
control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling informatip and �/aFsafetydata sheets for additional Information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE: "!within one business day after the receipt of materials.
68UNIVERSAL PREY TRK r 1 o(_?&,6x-t,-".f: 1
INVOICE LOAD NUM.- ;.:, /�,
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terns_ mid Conditions, Seller's Quotatir- u�., ; and Seller's Order Confirmation (i - ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agre it"). Seller will provide the Standard Terr id Conditions up02,request. Buyer agrees
that, unless otherwise noted on the front liereof, all quantities and items Were delivered as indicated and further expressly agrees to
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. Tliese 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 recommended 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
920 Memorial City Way, Ste. 100
V5 combined Houston, Texas 77024
06/10 For further information, please visit www.cemexusa.com.
Este ticket de entrega incluye coma referencia a.l comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier
termino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confnmaci6n del vendedor (con limitations y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estfindares 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 el 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, grava 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, grava, y otros materiales si.licios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritation en los ojos, piel y/o en
la zona respirato.ria. Polvo del. manejo en el trituramiento, pulido, torte 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.
Seguridad• La humedad puede causar ]a liberaci.6n del amoniaco. La inhalaci.6n del amoniaco puede causar- toser, irritation o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duration y el nivel de la exposition.
Segw-idad: Evite el contacto con ojos y contacto prolo.ngado con la piel. Use guantes, protecci6n en los ojos y ropa.
Primeros adecuada para protecci6n. Lavese las menos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente tluya aqua en la parte afectada por 1.5 minutos.
Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a Tondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX
920 .Memorial City Way, Ste. 100
V5 combinado Houston. 'Texas 77024
06/10 Para mas informaci6n visita www.cemexusa.com.
,5362416b
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
0 9 0 / 10 1:3 0
Customer Code: Customer Name:
3, 09 (--) 7 3 2 FIVE MOBI'l-E 1-10MES SPL.ES
Project Code: Project Name:
Ticket Date: Delivery Address:
0 T / 119 / I I L-OT-11S)5 NETTLES ISLAND
Delivery Instructions:
Customer Job Number:
Project P.O. Number:
Order Code / Date:
2! 5 1
Order P.O. Number.
N FJ P 0
Map Page: Map/Row/Cclumn:
Dispatcher:
G' , �7anning.
Ticket Number:
31ZI0904
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
9 -. 3 G
5. 00
1 10026433
1 109(
BILI-Y PENFOL-D
-).-�GLAB
LOAD
QUANTITY
Q
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
QUAN
MATERIAL CODE
PRODUCTION DESCRIPTION
i'
UoM :
UNIT PRICE
AMOUNT
0)
11G
5) 2 53
2�(-)0 •RE
'-G
YD3
1382'600
FIBERME911 1 5 0
LB
124 7131.S F t JL- L SUR'CFIARGE
.100 1 2�027 /,,9 ENVIRONMENTAL. CIAARGE
Cash Check Auth Code: Signature of Driver Receiving Cash: Cash Received:
Check
Total COD Order Amount to Collect
Without Standby Charge
Charge 7—
Comments:
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE,
El LOAD WAS TESTED BY:
.Notice: Our drivers will make every effort to place materials where the customer designate's, but the SPECIAL TERMS: A . ny 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-bwhalarzlous-to-yp ' ur safety and health. Please refer to the backside of this ticket for important
control after 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.
returned concrete. Buyers exceptions and claims shall be deemed waived unless mad.e. to us in writingAUTHORIZED SIGNATURE:"\\
within one business day after the receipt of materials. ,
'68UNIVERSAL PREV TRK9 10025361
INVOICE N U i"i
This Delivery Ticket .incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotati( ' any, and Seller's Order Confirmation (i.r ling limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agree it"). Seller will provide the Standard Tern.., -.,d Conditions uponfrequest: 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. "
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 recommended 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
920 Memorial City Way, Ste. 100
V5 combined Houston, Texas 77024
06/10 For further information, please visit www.cemexusa.com.
Este ticket de entrega inc.luye como referencia al. comprador (ya previamente ejecutada en su aplicaci6n de cred.ito); cualquier
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y order de confimaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los tenninos estandares 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 el mismo. Acepta pagar el monto de acuerdo at contrato; at menos que se identi-
fique con una rota at frente de este documento.
AGRE(_3'rADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, grava 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, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicoo cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en la piel. Conereto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, cone y/o perforation puede contener materiales
silicon, 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 aqua. Las cenizas volantes pueden contener amoniaco.
La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
5eguridad: 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 pie]. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese las manor con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutes.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco dene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n contimia.
CEMEX
920.Merno.rial City Way, Ste. 100
V5 combinado Houston, Texas 77024
06/10 Para mas informaei6n visita www.cemexusa.com.
.5362416
--
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
(-19[.I f 1( 'Do
Customer Code:_ Customer Na e: Customer Job Number: Order Code / Date:
ll �`97,= E €= T f'E ��"I, AR MOBILE I L E HOME a' SPILE � 2'51; 019Y 1.9 11
Project Code: Project.Name: Project P.O. Number: Order P.O. Number:
,
N0 Plk
Ticket Date;_ el' a Address: Map Page; Map/Row/Column:
U`�:` eJ --1 1 `�;a t IE"TTLEO I SLAND .
Delivery Instructions: Disppal:7tcber.
.
Ticket Number:
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
G r._�U r�tI :f-)o 0s 115 53,4.500 REGI
13 /2,t-" t'Fj 0�
- -�•
1100 1L' t` t (--UE__ I..l t�Fll1Fi(' !�
1.00 1202749 ENV I ROl�It El ITAL CHARGE
Cash Check #lAuth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
Check
Without Standby Charges:
Charge
Comments:
,�
WATER ADDEa7,�1 GAL , YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
'CURB -LINE CROSSED AT OWNER'S/AGENT'S REQUEST: f
I
•.SIGNATURE-
'
f
f �
I
0 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. Cuaomer 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
control after delivery, this Company will not accept any responsibility for the finished results. No credit for
safely handling information, and to the material safety data sheets for additional information::
returned concrete. Buyers exception and claims shall be deemed-w�d'Unless•made to us in writing
a `�
AUTHORIZED SIGNATURE:
within one business day after there pt o rmaterials
O
Due10nJot� Slump: ��r�ft'j �ruck'NurritSeY'(_'� Dove�NUmtjei': iD�VeY:N�me������la_L End Use:�L�•'�f��t�e, Jl����7,
68UNIVERSAL INVOICE
This Delivery 'Picket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatio any, and Seller's Order Confirmation (in ' 'ing limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agree t"). Seller will provide the Standard Term d Conditions upon,yequest. 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.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products are naturally occurring materials. i.ncl.uding limestone, dolomite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), root 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 recommended limits (see MSDS), wear suitable NIOSI-I-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
920 Memorial City Way, Ste. 100,
V5 combined Houston, Texas 77024
06/10 For further information, please visit www.cemexusa.com.
Este ticket de entrega inc.luye como .referencia al comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier
tcrmino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limi.taciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares 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 el 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, coca volcanica, arena, grava 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,
gran.ito, coca volcanica, arena, Brava, y otros materiales si..licios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mds de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n puede contener materiales
sil.icos, 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.
Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritacion o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el n vel. 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 protecci6n. Ldvese las mans con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limiter recomendados, use protecci6n 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 a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritacion continua.
CEMF.X
920 Memorial City Way, Ste. 100
V5 combinado Houston, Texas 77024
06/10 -Para mas informaci6n visita www.cemexusa.com.
t'
53624168
1 � \,,ter 4 i1 �''0 i��� Sitit - r ,•� k
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job: -
Return Plant:
c�9.()/1010- ,
J
x
Customer Code: Customer Name:
309 9732 FIVE s,rArt MOBILE HOMES SALES`
Project Code: Project Name
Ticket Date: Delivery Address:
o,'911.13A11 NI-VADA AVE
Delivery Instructions:
;-LIT- 1195 NE iTL_E S I S[..AND
Customer Job Number: Order Code / Date:
2+54 09 / '19t / 1. 1
Project P.O. Number: Order P.O. Number:
1,140 PO
Map Page: Map/Row/Column:
Dispatcher:
%F tinning .
Ticket Number:
Due On•Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
1C.38
n i 0
1 t Ji ay�3r' 1
1 f�9t 07 . 4,
GREG l_OL DELL
IJ LDNC u ' SLi1L'
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
7
.
- �a�F1
f'H 1150J
l..l
Jiw
L m
,�i;,t}
.I.., t_f 0
1.00
Cash
] Check
.Charge
Comments:
124 318 FUEL SU- (CHARGE
1202749 ENVIRONMENTAL. CHARGE
Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received:
Total COD Order Amount to Collect
Without Standby Charges:
WATER ADDS[ GAL YARDS IN DRUM:
WHEN ADDED.
• l
CURB LINE CROSSED AT OWNER'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
control 'after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling information,Epd ao the material safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATU .
within one business day after the receipt of materials.
68UNIVERSAL PREY TRK' 10f,123483 INVOICE L_OA6 NUM.- 4
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any., Seller's Standard
Terms and Conditions, Seller's Quotati-*f any, and Seller's Order Confirmation (i ' ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agre it"). Seller will provide the Standard Teri id Conditions upoijrequest. 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.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH i .1
Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and ether
siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type 1P), 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 physi.c.ian. 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 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
920 Memorial City Way, Ste. 1.00
V5 combined Houston, Texas 77024
06/10 For further inforination, please visit www.cemexusa.com.
Este ticket de entrega inc.luye como referencia at comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquier
t6rmino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantias), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los t6rminos 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 el mismo. Acepta pagar el monto de acuerdo al contrato; al inenos 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, coca volcdnica, arena, gravy 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 conereto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, rota volcdnica, 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 los Ojos, quemaduras en piel. y ojos, y
reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o peiforaci6n puede contener materiales
sil.icos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, m.antenerse
en temperatura calida, reposar,y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberation del anoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
quemaduras en la nari.z, garganta y pulmones. Acudir inmediatamente al. medico. El. ri.esgo en la salud depende en
la duraci6n y el n vel 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 protecci6n. Ldvese las manor con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n 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 a wire fresco. Si el cemento fresco tiene contacto con sus ojos, ldvelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX
920 Memorial City Way, Ste. 100
V5 combinado Houston, Texas 77024
06/10 Para mds informac.i6n visita www.cemexusa.com.
.. �, r
COASTAL rESrrNq LABOZArORY, L. L.C.
PO 30x 2023
PALM CITY, FLORIDA 34991-2023
772-220-6688
COMPACT
ION rESr zEPOZr
ASrM D 6938 -.10
DATE
JOB NUMBER
PERMIT NUMBER
CLIENT
CONTRACTOR
JOB LECGAL
September 14, 2011
11-0913
1108-0110 -- Iib6-0110
Fwe-Star M&bile ft"w*
FwelStan Mobrae1Uawe.
NIA
JOB ADDRESS 1195 Nettle.-Islan&Bowlev"d,
Jenne vBead, FL
SOIL CLASSIFICATION Fr REMARKS : -A4 F%n& gray sandy SO& wily a
mode ratPi a*nou# t of rru4hed shei.L
TEST SAMPLE LOCATION : 10' IS LR Corner - Ceviter of Pact - 10' IS RF
Corner
PLACE )Rl' DENSITY MAXIMUM DRY DENSITY Y. COMPACTION
1)
103.2
104.0
99.2
2)
103.8
104.0
99.8
3)
102.6
104.0
98.6
RESRECTIFULLY Va4
SUBMMITT
9-0 it7 Cw7
ERNESTO VELASCO, P.E.
v • � A
J
COASTAL TES-r1W LABORA-rORY, L. L.C.
PO 3OX 2023
-PALM CITY, FLORIDA 34991-2023
772 -220 -6688
MOISTURE DENSITY RELATIONS -HIP
ASTM D 1557-09
DATE SeptMibe4 14, 2011
CON7'RACrO2 FLve Star MOW &Vamew
JOB NUMBER 11-0913
PERMIT NUMBER : 1108 -0110
112
98
8 is 12 id
Moisture — Percent of Dry Weight
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY
FILE # 3627994 OR ' K 3323 PAGE 2925, Recorded 09/13/217"'at 03:36 PM
— � a
NOTICE OF COMMENCEMENT
The 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 end street address) TAX FOLIO NUMBER:( i`1�
SUBDIVISION LOC TRACT LOT\\»SLOG UNIT
�'R�'S •iSL„•T`rC'c� �'c�' �Ce1 �����C:�:O��-cJhP.^tC:u.-.����'\�\)
e
2. GENERAL DESCRIPTION OF IMPROVEMENT: S:L, o\Jac YNO tut_ lJ�� uecz G•. �i F p. 0��� yo F o
3.OWNER INFORMATION: a. Name C o F r �rr �k
b. Address c\ _ NL� l„� etY' ' L 1 c. interest in property
d. Name and address of fee simple titleholder (if other than owner)
4. CONTRACTOR'S NAME, ADDRESS AND PHONE NUMBER:.��c\a�
5. SURETY'S NAME, ADDRESS AND PHONE NUMBER AND BOND AMOUNT:
6. LENDER'S NAME, ADDRESS AND PHONE NUMBER:
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 Lienor'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_.
G<����
Print Name and Provlde Signatory's Tltl&OM.
Owner's Authorized OfBcer/Direetor/Partner/Manager
State of Florida
County of • a��e— _
The foregoing instrument was acknowledged before me this Q_day of \. , \ �\ , 20— A �.
By G•C C«ec ti-SCV"tc' ns-, as
(Name of pe n) I (Type of authority... e.g. Owner, officer, trustee, attorney in fact)
(Name of patty on behalf of whom instrument was executed) Personally Known_ or produced the following type of ID:
wP �\,� •,4_a Notary Puhnr jofFloridaMy Comm Expn(Printed Name of Notary Public) (Signature of Notary Public):= Commis
SinnUnder penalties of perjury, I declare that I have road the foregoing and that the facts in it a
belief (section 92.525, Florida Statutes).
Signatures) of Owner(s) or Owner's)' Authorized Otneer/Director/Partner/Manager who signed above:
By: n&!4LI n'1t�.cxart
R—(195mmr(Recon1m¢) •
fi�t1
1
Nettles Islond Inc., o condominium
9801 South Ocean Drive, Jensen Beach, FL 34057
. (772) 220-2930
FAX (772) 229-9901
September 12, 2011
St. Lucie County Building Department, Nettles Island
Inc., has no objection to the Building Plans submitted
for 1195 Nettles Blvd. Jensen Beach, Florida 34959.
The contractor is reminded that the two (2) parking
spaces must be functional with pavers or concrete at
the time of completion.
Respectfully,
�//NiKe`Macherone
Op ations Manager
04 �J
Mark M
Assistant Ope ions Manager
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,
(Parcel Id#/Legal description/Address)
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.
Date
STATE OF FLORIDA, COUNTY OF '3kQ—
ACKNOWLEDGED BEFORE ME THIS � DAY -OF �20�
BY Sr1 K-e Q OSyc �2\�e`-QP<WHO IS PERSONALLY KNOWN 'O ME '4"OR WHO HAS
PRODUCED
SIGNATURE OF NOTARY PUBLIC
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
AS IDENTIFICATION.
STELLA tv, �iUN-•T �
t�
°tc Srate of Florida
mm• Expires Jan 23, 2015
Bonded Through N,isSion a EE 31278
3honai Notary Assn. j