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HomeMy WebLinkAboutSUBMITTED PAPERSI. p�'FICE USE b � . • - ,._ _,' DATE FILED - '] �G�► j�( f� PLAN REVIEW FEE: RECEIPT NO.: P PERMIT NUMBER 1 V I CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 1. 2. 3. 4. 5. 9. 10. 11. 12. 13. ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue SCANNED. BY FL Pierce, FL 34982-5652 .St• Luc- County 772-462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE 3115 PROJEC�T" IINFORMATION�LOCATION/SITEADDRESS: / G 1 h4pyt4F Gam/ . PROJECT-NAME:�,UkCp Sl I i- SITE PLAN NAME: �PROPEXIY I 3 qa - 70 3 -6,3 3 - as ^ r, / LEGAL DESCRIPTION (attach extra sheets if necessary): PLAT BOOK 6. PAGE NO. 7. BLOCK 4NO. � ARCEL, E (ACRES/SQ FT.): Vr LOTDIlAENSIONS: COMPLEDESCRIPTION OF CONSTRUCTION��ROJECT OR WORKACTMTY: _ ,FT� f f� 91 P: �'�P K ___ , �Gl'' t4,Xr1l fteFlg_ t� �, boo �s��-- SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: TYPE OF CONSTRUCTION (Check all appropriate boxes) [ J NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ J RESIDENTIAL [ ] COMMERCIAL [ ] OTHER (SPECIFY) 8. LOT NO. LEFT SIDE'', [ ] INTERIOR RENOVATION [ ] INDUSTRIAL 14. SQ. FT OF CONSTRUCTION: �Jp� 15. SETT 1st FLOOR 16. VALUE OF CONSTRUCTION: ON $ /00 1 C 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 Pup KA UPDATED 6/25/09 OWNER INFORMATION NAME: ll�l r% (COS ADDRESS: CITY: P �L STATE: l z- ZIP: PHONE (DAYTIME): (%x ��J� _ oEmail: 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: ZIP: PHONE (DAYTIME): ( ) CONTRACTOR INFORMATION/ J 7 ST. of FL REG.CERT BUSINESS NAME: %! �% %/%n L1/-, "I QUALIFIERS NAME:. �r , ��� r �.))-7 4/4 ADDRESS: CITY: Iva STATE: PHONE (DAYTIME): (Lza-DZCS FAX NO: ARCETVENGINEER ADDRESS: CITY: PHONE (DAYTIME): U BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER ADDRESS: CITY: ST. LUCIE COUNTY CERT #: lz&g / / ZIP:'�S Email: STATE: ` °. ZIP: STATE: ZIP: STATE: ZIP: IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it wilt be voided and returned to you by mail. 11 =i' CERTIFICATION: 1• - . I ' q 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 fall 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. OWITER OR CONTRACTOR SIGNATURE STATE OF FLORID COUNTY OF The foregoing instrument was acknowledged before me this. day of 20 `1 by 6r ea q xe%. who is personally known rbb L of Notary or has produced identification. SIGNATURE STATE OF FLORID COUNTY OF _t The foregoing instrument was acknowledged before me this P day of . 20� by =�-reQ !� et who is personally known or has produced — as identification. Signature of Notary Nd Commission No. Commission No. DAWN MILONE � �"�••. ��WN MILONE MY COMh113SION N bb 552567 ?k; ,r_ MY COMMISSION # OD 952687 x, a,€ EXPIRES: March 22, 2015 ','• EXPIRES: March 22, 2013 'T ... Bonded Thru Notgry Public UndenaAlare 'c Bonded 7hru Notary Public Underwrilarrs NOTE: TWO (2) SIGNATURE EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, 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 checklist. OFFICE USE ONLY ''--` `J SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE. HRM MAP # 1ST RR ELV MAX HGT CONST TYPE OCCUP TYPE MA,X OCCUP # OF FIRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 111990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE LIBRARY PUBLIC BLD PUBIC BLD PARKS IMPACT IMPACT FEE MACT IMPACT FEE CORRECTION FEE FEE GENERAL SCHOOL ROAD CREDIT Y N LAW ENF 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". REWIRED 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 . • Florida Power & Light Company, 1050 SE Brandon Cir, Port St Lucie, FL 34952 Phone: 772-337-7025, Fax: 772-337-7099 FPL October 25, 2011 Thomas Percoskie 3415 Feriwinkle Court Port St Lucie , Florida, 34952 Dear Mr Percoskie, This letter is in response to your request for the release of a platted utility easement. In meeting with your request, FPL has no objection to releasing our rights in the platted utility easement known as "Savanna Club" in Plat Book 30, Page 405 of the Public records of St Lucie County County. The release is restricted to the following description: The North 6 feet of the South 10 foot utility easement on Lot 23. This property is known as 3415 Feriwinkle Ct, Port St Lucie, Florida 34952 Should you h any questions or concerns, please do not hesitate to contact Vicky Holly at 772-337-7025. Sincerely Mark Cunningham Superintendent an FPL Group company �f Ccomcast Comcast Cable ® 1495 NW Britt Road Stuart, FL 34994 Phone:772-692-9010 Fax:561-747-2250 October 31, 2011 Tom Percoskie 3415 Feriwinkle Ct Port St Lucie, FL 34952 RE: 3415 Feriwinkle Ct, Port St Lucie, FL 34952 Dear Mr. Percoskie: Comcast has no objection to the encroachment into the easement at the above referenced location. Please call 1-800-432-4770, 811 or www.calisunshine.com before you dig. If you have any further questions, please feel free to contact us during normal business hours at 772.692.9010 x 1569936. Sincerely, a Ant on Springsteel 0 Ivan Arill AT&T -Florida 3300 Okeechobee Road Ft. Pierce Fl, 34947 772 460-4441 To: Mr. Thomas Percoskie 3415 Feriwinkle Ct. Port St. Lucie Fl, 34952 RE: Revocable Encroachment Utility Easement at Lot 23, Section 25, Block 30 whose address is 3415 Feriwinkle Ct, Port St. Lucie Fl, 34952 Dear Mr. Percoskie; This letter responds to your inquiry regarding the revocable encroachment of the utility easement on 3415 ,Feriwinkle Ct . AT&T has no objection to the revocable encroachment of the easement. Please use extreme caution, there is an AT&T 25 pair cable buried in the rear utility easement of your property, which feeds other customers. There are also service drops to the house so please locate as per instructions below. This letter should not be interpreted as non -objection to any future modifications of or additions to any property improvements that may impact the remainder of the utility easement as mentioned above. The property owner or the owner's contractor must call before digging in the area for locates of facilities so as not to damage AT&T's facilities 1-800-432-4770. This is Florida law requirement. See chapter 556, Florida Statues. AT&T will hold the property owner responsible for any damages to its facilities. Please contact Ivan Arill at 772 460-4441 if you require any further information. Yours truly; Charles L. Adams Area Manager Cc: is �QORTS7, � �G ► n V M <OR10' November 9, 2011 CITY OF PORT ST. L UCIE CITY ATTORNEY Re: Utility Easement Encroachment P I D: 3425-703-0338-000-0 Lot 23, Block 30, Savanna Club Plat Three 3415 Feriwinkle Ct., Port St. Lucie, Florida To Whom It May Concern: The City of Port St Lucie's Utility Systems Department grants its approval for Thomas and Barbara Percoskie to construct a concrete patio, approximately 15' x 22' in size, on the back lot of their residence at 3415 Feriwinkle Ct., Port St. Lucie, Florida. This letter neither conveys any right, title or interest in or to any of the legal or equitable easement.rights pf,City, nor,serves.as the City's'abandonment of its rights in and to the easement being encroached upon.' Should you have .questions; issues or concerns, please feel free -to contact Laney Southerly, P.E., Utility Engineering Manager at 772.873.6442. Thank You, Stefanie Beskovoyne Assistant City Attorney i .., c: via email: Jesus A. Merejo, Director, Utility Systems Department Laney Southerly, P.E„ Utility Engineering Manager ,Donna" M. Rhoden, PSL Utility Safety & Public Affairs Mgr. HAStefanielUtilitieslUtility Easement Encroachment Percoskie.final 11.9.1,1 Sb.bb.docx- i 121 S.W. Port St. Lucie Boulevard - Port St. Lucie, Florida 34984-5099.772/871-5294 - Fax: 772/344-4298 - TDD: 772/873-6339 id-0 - Microsoft Internet Explorer provided cid=144798&dhid=0 File Edit Go To Favorites Help } Favorites 'ao • I'� property Appraiser -St.Luc... http:/flsrfchl/Localwe... 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T W T F 5 ' 3J 1 2 3 _4 _5 _6 7 ' 91011 12 1314 115 1617 LS 1923®_ 23 24 25 26 27 23 2J 33 31 , . .1 61 Fort Pilerce `F 1 It ti 1' ' Oct 21, 2011 10:35 AM .. . ... . .... v mrt MATCH LINE PLAT BOOK -Y SAVANNACLUB PLAT N 0. THREE MaA LIl INE GRAPIR C SCALE PAGE A SUBDIVISION IN SECTION 25 9 mar 'v g nre mot TOWNSHIP 36 SOUTH, RANGE 40 EAST mm P ST. LUCIE COUNTY, FLORIDA 4 1 UNPLATTED ACREAGE NOTES: (',"!'Vl �IIWT d- RAO_WJ dt U.L DENOMS A -11Y EASEMENT. -- I -m"TAII SO ORIVNAGE EASEMENT. 2&00' ".w E Ol-- -6 25 DENCIES A ORAINACE AND U-TY EASEMENT. 2-k A 28-02'0 0 'W. 1� 4R' T d UUtT- A E Al RJMIT ANCLO OR RADIAL 70 51. 111. .1 WAY LINES -.sl S00—A O� 7 2 11 Ob. 1'7 11 h - R. 2-1 To 5r clo O.Ow 1. 12.21 - -4 1- 1 , � 10 E AN-ir gti LIMITS OF PLAT iu P'No"" OJAI -4- cl, 5D -Y 0" 10 12 <4 S 2 le Od. V.- ci9 225.0 C c T25. 25 0' R 60 =U M 20- MATCH LINE Cti MATCH LINE IINF. CHART U'4ict ­N17' UNPLATTED ACREAGE UNPLATTED ACREAGE L - Nt d.gnile , --- -N LO N Q LIMITS OF PLAT LIMITS OF PLAT UNPLATTED ACREAGE I 15V0' O' � / 29 R - 3D 0 .A 30 LT V• 1111D V 27 . "-NUO 1 32 31 A 16VW FERIWINKLE 9 ;111 COLTR -c' 8 14VOl' 2k 3 8 4 7a 0 S g t`cx, 10 2M1 22 23 g L 103 s 111111 R N '11 20DI BLOCK 30 � 2 A jE. l- 2 4 0 5 /< BLOC 30 7 X OF 9 TRACT B-8 R g 14 �A IS IS 17 - - - - - - - - - SAVANNA CLUB PLAT NO. TWO PREPARED BY., PLAT BOOK 24, PAGE 5" CULPEPPER & TERPENING. INC. SEE SHEET 2 OF 5 805 VIRGINIA AVENUE, SUITE 15 "?y FT. PIERCE, FLA 34982 SHEET 4 OF 5 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, description/Address) &Y SSA 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. Property Owner Name (Please Print) ®1d �, 7 - !t Property Owner Signature Date STATE OF FLORIDA, COUNTY 09.ef j , ACKNOWLEDGED BEFORE ME THIS 7 DAY OF C�/E� �L 20 % BY Jwj o✓� �-2n lWHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED _(�/Ji��, , ��Q AS IDENTIFICATION. Z. 19qc-e1ezZ7"e SIGNATURE OF NOTARY PUBLIC TYPE OR PRINT NOTARY COMNIISSION NUMBER Fed ELLEN L. BANE tary Public - State of FloridaComm. Expires Sep 25, 2015Commission rir EE 101180 ded Throu h National Nolar Assn.SLCPDSD Revised 08/24/2010 !1 y 0 Planning & Development Services Building & Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Permit 1 Address 3415 FERIWINKLE CT Owner(s) THOMAS PERCOSKIE PORT ST LUCIE 34952 Historic No Jurisdiction St. Lucie County Parcel # 3425-703-0338-000/0 S/D Savanna Club Plat III Block 30 Lot # 23 FLU RU Zoning PUD Flood Mal Flood Elevation Flood Zone Application Type I Building Permit w/o subs Status Void t 1110-0176 Activit T e Other - --- y Yp Expiration F Other -Specify CONCRETE SLAB s Egg Permit Type Building (Miscellaneous) Date Applied 10/18/2011 Taken By Miloned Location Mainland* Date Issued Issued By ]at Fee Valuation Date Finaled Posted By Date Voided Please explain in Additional COmn1e Job Address 3415 FERIWI,NKLEaCT ; z a .__ �CONTACT INFORMATION Add Application Contact Category Type Open Contractor . Contractor Registration Property Owner Name Property Owner Property Owner Business Contractor I Address Email PERCOSKIE 13415 FERIWINKLE CT [PORT ST LUCIE IFL 34952-3393 Phone (908) 803-0212 ext Fax ( ) - Mobile ( ) Pager Sub -Trade Permit Permit Type ub Trade Status Contractor Taken By Company Date Applied Contr. ( ) _ Issued -- -" -- Owner / Buildier Issued By Expiration Finaled Sub -Trade Job Description Finaled By CONSTRUCTION INFORMATION Units 1s;00 Floors Buildings 1 #Bedrooms #Bathrooms Total Sq. Ft. 0.00 Vlin Flood Elevatior Flood Map Flood Zone F Foundation/Slab/Wall NOC Required ❑ VOC Receivec ❑ NOC Expiration FCC F915 Setbacks Front Back 25.00 Left Side 36.00 Right Side 36.00 lY �, ;Job Description Additional Info =ORM AND POUR A CONCRETE PATIO IN REAR OF PROPERTY 20' X 20' X 4" WITH FIBERMESH, 3000 PSI. Please include the date and your name when adding intormation. 'ERMIT VOIDED. LIFT IF COMES IN WITH PAPERWORK. SLAB CAN'T GOANY FURTHER BACK CAN ONLY 3E WIDENED. ON MY DESK. DAWN MILONE -_ r -.__ -_ - -= v_ 4 � i Maschmel - Concrete Company oLFl__. 1142 Watertower Road, Lake Park FL e �72) 219-9994 Palm Beach: (561) 844-9994 Martin/S . u Concrete Tested ❑ Yes 0"No LOT # Water Added at Customer's Cylinders Taken ❑ Yes I] No Request , r gals. to full load Comments gals. to 2/3 load gals. to 1/3 load Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water and get prompt AND DURABILITY. ANY WATER ADDED IS BATCH TIME medical attention. Keep children away from cement powder and all freshly mixed AT CUSTOMER'S OWN RISK. cement products. .. • •• 7TICKE­ At Plant ORDER # TRUCK # LOAD SIZE MIX SLUMP DATE CUSTOMERT# # SOLDTO P.O.# PROJECT# DELIVERY ADDRESS ZONE# USE DRIVER INSTRUCTIONS TIME DUE PRODUCT CODE PRODUCT DESCRIPTIO14 SIGNATURE OR RECEIPT - CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING - asc meyer Concrete Company willnot assumeliability or any property damage or any SUB -TOTAL equipment damage for any deliveries beyond the curb line. TAX AUTHORIZED BY SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE, 1111iTAL .) `< ...,. . r ' VjN a.t-UJp 6 4r#ArDe! E SU.B; .. JECw RdTH�.{»Op Ny _�#4� 4 ►'e..s to powlda a sui aP!e rrrrayrou,- aCut:rCs ,, fare tie stfee, pavement to thepIac.a of ci��ivery of nnsterial tf 4uth .s c dways ar a ii4t p 'Od,� rep-e.ve'che rigE't to sty . deliveries until co nit-ons are rerned;ed and, in such will r i respcats)bla for any IoEL �c:a.txed the.re�' h- n diVive y i4 rnad yr r? 't` ' t . fil I?['u . ° is i?§ r r tt�rrier tar G` t$'t'Cl^?e? `'rE #£'SE'Cit{itEli 'S r ±, any (#?irnapes '3's5",ludi!?g, b It b.<ildings, try. E�s ' dubbery, ser�V tank4,,�rid sep°ic ysterris, including tine drain rein,buisc• said Cornpany for lw of tirne andeq Apmeht byioasai-. of such de!O.ie 11, and also to from any aqwi all claims, der-ia`an(i x and, suVs foi or on account of or in any ^'• as • YF et crack iowledge to a rna F. di rijis:� ri ti ti+''•N f i Vs bee re Al ed, that tra ;�: Win C3vlh afe c%rect, aj id i•, t, amount cf .ter 'v , , , tcam s r ued ,HIV. Wn corrc .tly, CA�i"i 1> r . Tlaa a, diti6n bf water peduces r to strar?cth and d i a. ;il#� " w; r ;t , C� ,p bie r f;nsra ...: r ,tslt ai; r d from this ICt� t c r�crc-toll r i�,, s u ��?i9 t�tc5#tin nit c, rn letw }ob a' r ec : c , slai i? grid control c r.-e r• 51.0 er s,inuft �rfifl . Yq4 4 M�a k t5 • � fiz cn�=rgci� niter r"f1i"?ut�a �' cubic yr. - az�ir{�i tirxiq as ip000dlomd. 7 F. SItRI rep-, to ?_flt«aS1le t!`ish it k,Yri i:: { ; ' far our truq.ks ref f o 'the Place of deliYf�ty ofi#ia�€�rl�l•. -�rfe r' _, y :,a�t�es to ;p 1y ai; sts and expen sus � .:� tncl ng a sariab4c� attcrney's fee, f e steall +,-,;S Ni S''3?i,f� $ ast du a unt4 OreU jctto a I - '` o service e q `i?- ha he w, tcatf & kriowlec#es r ii of thecomplete copy of tlris'oritra' 5 k_ ' 7, i ti riaF _ ti y1 4 rf Fj.�, g<,�` ,� ,.?'.,: � �i�• �.Fo- may.,,_..;.___.---" �j St Lucie County Inspections J 2300 Virginia Avenue Ft Pierce, FL 34982. (772)462-2172 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERNIYT # 1 I1 k Cl 7� JOB ADDRES V_ �—e RUILDEXY 0< Y-3-t> PEST CONTROL CONT ACTOR��'� \ (­�1Z' PEST CONTROL LICENSE # We, the undersigned$ hereby certify that we have pretreated the above -described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet of area treated: 37 q Percentage of solution: �" Date of treatment: Chemicals used.�"�"� Total gallons used: Time of Treatment: � 0 Footing ❑ 1siTreatment FBC104.16 CenlflcateofPioateetive7!rcatmentforpreventionoftermrtes. ❑ Re -treat lab 1 st Treatment ❑ Retreat A weather resistant jobsite posting board shall be provided to receive duplicate Treatment Certaifu'ates as each required prorecrive rreatmrent is completed, providing a copy for rho person rho permit is issued to and another copy for the building permit files. The Treatmenr Cerrotitle shall Provide the product used, identity of the applicator, rime and date of'the treatment, site locatdon, area treated, chemical used, percent cancenrration Q Drivewayand ❑ 18t Treatment number of gallons used, to esrablish a verifuuble record of proreetive treannenr. If the soil chemical barrier merhod for tem dre prevention is. used, final exterior treanwr shall be completed prior ro final building approval ❑ Rw,eat St Lucie County requires for the final Inspection, for CO, s Permanent ❑ Pools Sticker to be placed on the electrical panel box cover, tfstine all the ❑ ist Treatment treatments and dates ofspplirations. :3 Re -treat Q Other n _ ❑ 1st Treatment Q Re -treat 0 Perimeter for Final Inspection NOTE: SIPature of exterminator There must be a completed form for each reqZedreatment or retreattnent and this form must be oft the job site to be picked up by the inspector at time of each fnspection or the scheduled inspection will fast and a re -inspection fee charged: 1l�nsed 6/l9/oJ dmp . a , Saps J 1vi Sig s. - �..'— ..:... . Sgrimkler L. err �f L ` �v✓ "J - 1 - _ i FD LR. - -- - - Fff&C' _._ BLO P_QSEQ: CSTOR r —`mow`= — �__. �- a -:. _ �,.-,..�..d•-,�+.o-..:b•^��� _ _ __ _ PR OPQSEO . F F. .._..O +o . _ �. .. Y occrtPIf`a N ~ O m. I PROPo o...- - CONCRE9 5 O V - OR1VE '31 - .---- r_ i -- '�.U.E. FD..DRILL. H ,C ,22.3.poQ .. c.a. FD. R&C #4 4 Ft��2 O N 197 77'( ..b. _.. _ _ U'c.';'. ANNA CLUB ACC PROJECT FORM H(,.. '-wNERTAISSN IN(;' DATE: 449APPLE& NAME: ADDRESS: 34 PROJECT:4 LCI�4 POST IN WAD6W')j(kj 0 SCHOA OFFICECOMPLETION OFT HIKMiCr.- TURN T RE, PR T-M-UST. B.E. COMPLETED WITHIN SIX MONTHS, OR RESUBMITTED FOR APPROVAL. FINAL APPROVAL WILLAE: GR7TED! AFTER THIS FORM IS RETURNED TO THE SCHOA OFFICE. rm SCHOA MANAGER: I DATE: ACC CHAIRPERSON: DATE:' it�l L4d 9.14 Ff.� - K, .)vvNF-R3l A35N. INC. DATE OF INSPECTION SIGNATURE: "RABAPPLE D e