HomeMy WebLinkAbout15-16178 �, CITY OF ZEPHYRHILLS
, , 5335-8TH STREET
` (si3)�so-oozo 1617
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit IVumber: 16178 Address: 38817 10TH AVE
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s)�: Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-07500-0120
Improv. Cost: 9,000.00 OWNER INFORMATION
Date Issued: 4/15/2015 Name: JOHNSON FAMILY LIV TRUST
Total Fees: 120.00 Address: 13505 WOERNER RD
Amount Paid: 120.00 MANITOU BEACH MI 49253
Date Paid: 4/15/2015 Phone:
Work Desc: REROOF METAL
CONTRACTOR S APPLICATION FEES
TRIPLE ROWN R OFING I REROOF RE IDENT AL 120.00
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Ins ections Re uired
DRY IN ROOF INSP �
TAPE JOINTS R F 4i�IS,�
FINAL ��
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your 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."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRA O SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION �
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: _ ���2 Cf'`l�L�►'1
Date Received: ��f�s
Site: J���/ 7 �v 7�►�
Perrnit Type: ��---�C /�r��
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
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Kalvin Switze �= s Examiner Date Contractor and/or Homeowner
(Required when comments are present)
o��-.o�,�v Gity of Zephyrhilis Permit Appiication Fax-843-780-0021
Suilding Depar#ment
date Recetved '�.��r-�� Phone Gontaat for Permittin O�3 �3� - s�'�'d
Owner's Name ��W�+� ����N Owner Phane Number ��� �?����02Y�
Owner's Address •���� D ��4 ��`�° Owner Phone Number
Fee Simpte Tftioholder Name � � Owner Phone Number �—
Fee Simpte TitFefiaider Address
JOB AQpRESS ��� ��� d`9��� �OT# �a �. �3
SUBDIVISION �— � PARCEL ID# ��""�V"a7 t� '"���� °'� ��������
{OBTAINED FROM PROpERIY TAX NQTlCE�
WORK PROFt?SED e NEW CONSTR 8 ADDiA1.T [� S1G�1 Q [� DEMOLISH
INSTALL REPAtR
PROPOSED USE Q SFR Q COMM �] OTHER
TYPE OF CONSTRUCTiON Q BLQCK [� FRAME 0 STEEL [�
DE8CRIPTION OF WORK /1�0� �30P�'2 'S�rn ,�S �i1i�� �ut-�"--�r/f+ ��7°}�L./�'"�j�'ril+Lt-S ��d,� a�
BUILDING S12f � � SQ FOOTAGE ��� HEIGHT {��
QBUIIDlNG �+ � Q��� VALUATION OF TOTAL CONSTRUCTION
[�ELECTRICAL (9i � AMP SERVECE Q PROGRESS ENERGY [� W.R.E.C.
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[�PLUMBING �—� �, f� � � .2,/�
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OMECHANICAL $ VAl.UA7lON OF MECHANICAL INSTAl.LRTIQN 2'��r'�� �
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QGAS ,� ROOFING Q SPECIALTY � OTHER 4J��
FINtSHED F�QCtR ELEVATtONS FLOOD ZONE AREA QYES NO � �`�"
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BUI�DER COMPANY
SIGNATURE REGISTERED Y 1 N FEE CURRE� Y/N
Address License# � ���
ELECTRICIAN � COMPANY
SIGNATURE , ,, REGiSr�RED Y/ N FEE CURRE� Y/N
Address �icense# �` �
PLUMBER � ` � Ct}MPANY
SIGIVATURE REGISTERED Y J N FEE CURRE� Y/N
Addrass License# �— --�
MECHANICAL L� CbMPANY {
SIGNATURE _ a�G�sT�R�D Y! N FEE CURRE� Y/td
Address � License# �� —�
OTHER '�� �COMPANY Y�""t�P�+L �OQWd'l c �w/ L
SIGNATURE REGfSTERED Y/ N FEE CURRE� Y/Id.
Address ! � ,�� .� �L 33,� License# �GG G�q 3�(� �
RESIDENTIAL Attach(2)Plot P�ans;(2)sets of Building Plans,(1)set of Energy Fattns;R-Q-W Permft for new canstruc8an,
MiNmum ten(10)working days after submittal date. Requi�ed ons(te,Construction Ptans,Stormwater Pians wJ Sitt Fence instaited,
Sanitary Faclllties&1 dumpster;Site Work Permit for subdivisions/large proJects
COMMERCIAL Attach(3)complete sets of Buiiding Plans plus a life Safety Page;(1)set ot'Energy Forms.R-O-W Permit for new construction. ��
MiNmum ten(10�working days'after subm(ttal date. :Required onsite,Constrtfction Pians,Starmwater Fians w/Siit Fence installed, `
5anitary Facilities&�1 dumpster.Site Work Permit for all new proJects.Ail commerciai requitements must meat compliance
SIGN PERMIT Attach{2}sets of Engineered Plans.
""PROPERTY SURVEY requUed for a!!NEW conshuction.
Directions:
Fill out applicallon campletely.
Owner&Conhactor sign back af applicatfon,notarized
If over S254Q,a Notice af CommencerrseM!s reqaired. (A/C upgradss over ST5d0}
" Agent(far the contractor}or Power af Attomey(for the owner}would be someone with notarized letter fmm owner authorizing same
DVER THE CdUNTER PERMITTING (Front of Application Onty)
Reroofs(f shingles Sewers Servlce Upgrades A/C Fences(PtoUSurvey/Footage)
Drlveways-Not over Counter if an pubitc roadways..needs ROW
�OTICE OF DEED RESTRIC'PIONS: The undersigned understands°that ihis.permit,may be subJect to"deed" restrictions"
vhich may be:moce restricttve than County regulatfons. "The undersigned assumes responsibility for compliance with any
ippNcable deed restrictions. ' �
1NLICENSED CONTRACTORS AND CONTRACTOR RESPONSI8ILITIES: If the owner has hired a contractor or
:ontractors to undertake work, they may be required_to be:licensed in accordance.with state.and•local regulations. If the
;ontractor is not Ilcensed as required-by law, both the owner and contractor may be cited for a misdemeanor violation
inder state law. If the owner or intended°contractor are uncertaln as to what Ilcensing.requirements may apply•for the
ntended work, they are advised to contact the.Pasco County Bullding Inspectlon Divlsion—Licensing Sectton at 727-847-
1009. Furthe�more, If the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
�ortions of the "contractor Block° of thls appllcation for which they wlll be responsible. If you, as.the owner sign as the
;ont�actor, that may be an indication that he is not.properly licensed and is not entitled to permitting privileges in Pasco
�ounty.
�RANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
hat Transportation Impact Fees and Recourse Recove.ry..Fees may apply to.the construction of new buildings, change of
�se in existing buiidings, or:expansio� of existin�g:buildings, as specifled in Pasco County Ordinance number 89-07 and
a0-07, as amended. The undersigned also understands, that such fees, as<may°be due, wlll be identified at the time of
�ermitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be pafd prior to
•eceiving a "certificate of occupancy" or flna{ power release. :If the project.does not invoive a certificate of occupancy or
•inal power release, the fees must be paid prior to permft Issuance. Furthermore;if:Pasco County Water/Sewer Impact
`ees are due, they must be�paid prior to permit Issuance-In accordance with applicable Pasco County ordinances. �
CONSTRUCTION LIEN LAW(Chapter 713� Flor�da Statutes�as amended): If valuation of vvork is$2,500.00 or more, I
�ertify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowne�'s
Protection Guide" prepared by the Florida Department of Agric.ulture and Consumet Affairs. If the appl(cant Is someone
other than the"owner", I certify that I have obtained a copy;of the above descrtbed document°and promise in,good faith to
delive�it to the"owner"prior to�commencement.
CONTRACTOR'S/OWNER'3 AFFIDAVIT: I ce�tify-that all the Information in this applicatlon is accurate and that�all work
will�be done in campliance with all appl(cable laws regulating construction, zoning and.land development. Application is
hereby made to obtain .a permit to do work.and installatlon as indicated. ;I certify that no work or installation has
oommenced prior to issuance of a permit and that.all work will be performed to meet standards of all laws regulaking�
construction, County and City codes, zoning regulations, and land development regulations�in the jurisdfctfon. I al'so-�
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify�what,actions I must take to be�in:.compliance. Such agencles-include_but are not limited to:
- Department of Environmentai Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management- District-Wells, Cypress. Bayheads, Wetland- Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalis, Docks, Navigable Waterways.
- Department of Health & Rehabilitative ServiceslEnvironmental Health Unit Welis. Wastewater Treatment,
Septtc Tanks. -
- US Environmental Protectlon Agency-Asbestos abatement.
- Fede�al Aviatlon Authority-Runways.
I understand that the following,rest�ictions apply to the use of flll:�
- Use of fill Is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material-is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florlda.
- If the fill material is to be used in Flood Zone °A" in�connection with.a permitted building using stem wall
� construction, I ce�tify that fill�will�b.e used only.to.fill the area within the stem wali.
- If fill material is to be used in any area, I certify that use. of such fiil wiil not adversely affect adjacent
properties. If use of fill is found to adversely:affect ad)acent properties, the owner may be cited for viofating _
the conditions of the buildfng:permit issued under the attached permit application, for Iots less than one (1)
acre which are elevated by flll, an engineered drainage plan is required. •
If I am the AGENT FOR THE OWNER, I;�promise in good faith to Inform the owner of the permitting conditions set forth in
this affidavit�prior to commencing construction. I understand that a-separate permit may be required for electrical work,
plumbing, signs, welis, pools, afr condttioning, .gas, or other installations not speciflcaliy included-in the application. A
permit lssued shail be construed to be�a`Iicense to proceed with the work and not as authority to,violate, cancel, alter, or
set aside any provisions of the techn(cal codes; nor shall issuaace of.a.permit-prevent-the Buildirig Officia!from thereafter
requiring�correction nf errors in.plans,-construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit.�ls-commenced within siX months of permlt issu�nce, or if work authorized by
the pe�mit is suspended or.abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing, ftom the Building,Officfal for a periodrnot to exceed ninety(90) days and will-demonstrate
justifiable cause for.the extension. If work ceases.for ninety(90)consecutive days,..th�job�is considered aba�doned.
WARNING TO OWNER: YOUR.FAILURE•TO,REC.ORQ A NOTIGE OF�COMMENCEMENT MAY RESULT iPl YOUR
PAYING TWICE.FOR IMPROVEMENTS-TO YOUR:PROPER-TY. IF YOU�INTEND`TO OBTAIN�FIPFANCIfdG; CONSULT
WITH Y UR LENDE O AN A'�TORNEY FO E�RECO DI G� OU D � C '.O C �'M E ME T�
FLORIDA JURAT(F.S.117.03 � _ __ _ __ _ _
OWNER OR AGENT e`� CONTRACTO �
Subscribed and swam o(or a(flrmed)beto me this Subscribed and b om (or afRrmed)�befo 'me this
by � Y
Who Islare personally knovm to.me or has/have produced Who Islare personally knovm to me or has/have produced �
as Identlftcatlon. as Idendflcatlon.
Notary Public NoGary Public
Commisslon No. Commission No.
Name of Notary lyped,printed or stamped Name of Nolary typed,printed or stamped �I
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Force End neering&Testing Inc.
19530 Ramblewood Drive
Humble,T'X 77338
Product Evaluation Report
GULF COAST SUPPLY& MANUFACTURING, LLC. ,
29 Ga. Ti� Rib Roo Pane!over 1x4 I�Jood Purlins I'
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Florida Product Approval # 11651.27 R1 ,
Florida Building Code 2010 `
Per Rule 9N-3 I
Method:l—D I
Category:Roofing '
Subcategory:Metal Roofing �IJ�L���T� `,
Compliance Method:9N-3.005(1)(d) � �T��`?_ �'�1,���,�� �,�rt� '
`i�,�""��'�?L.�i;/��I,c�3UILDiNG,
NON HVHZ ET�.(;'���zJ q� ni.LTiV��I1�TG�11tTL'
Product Manufacturer: �y��`�?���� -�"'�°-��°���
GULF COAST SUPPLY&IVIANUFACTURING,LLC.
4020 S.W.449`�Street
Horseshoe Beach,Florida 32648
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En�ineer Evaluator: �/��" /
Teerence E.Wolfe,P.E.#44923 �sTY�.�f=;`��;. `�
Florida E�aluation ANE ID:s92o �L,����fi �����ER�1LL� -
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Validator• ��
� Locke Bowden,P.E.,FL#49704
9450 Alysbury Place
Montgomery,AL 36117
Contents•
Evaluation Report Pages 1—4
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FL#11651.2�xi February 22, 2012
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Force Engineering&Testing Inc.
195301tamblewood Drive
Humble,TX 77338
Compliance Statement: The product as described in this report has demonstrated compliance with the
Florida Building Code 2010,Sections 1504.3.2,1504.7.
Produtt Destription: TufF Rib, %" Rib Roof Panel, Min. 29 Ga. Steei,36" Wide,through fastened roof
panel over 1x4 wood purlins over one layer of asphalt shingles (optional) over
min.7/16"OSB or 15/32"Ptywood decking.Non-Structural Application.
Panel Material/Standards: Material: Minimum 29 Ga.Steel,ASTM A792 or ASTM A653 G90 conforming to
Florida Building Code 2010 Section 1507.4.3. Paint finish optional.
Yield Strength: Min.80.0 ksi
Corrosion Resistance:Panel Material shall comply with Florida Building Code
2010,Section 1507.4.3.
Panel Dimension(s): Thickness: 0.014"min.
Width: 36"
Rib Height: %"major rib at 9"O.C.
Panel Rollformer: MRS Metal Rollforming Systems
Panel Fastener: #9-15 x 1-1/2"HWH Woodgrip with sealing washing or approved equal
%"minimum penetration through plywood
Corrosion Resistance:Per Florida Building Code 2010,Section 1506.6,1507.4.4
Substrate Description: Min.lx4 No.2 SYP wood purlins over maximum one layer of asphalt shingles
(optional)over min.7/16"OSB or min.15/32"thick over supports at maximum
24"O.C. The 1x4 wood purlins shall be fastened to the wood rafters(24"O.C.
Max)with(2)9 x 2%_'Deck Screws per rafter(Minimum 17/8"embedment into
wood rafter). Design of 1x4 wood purlins,OSB,plywood and OSB/plywood
supports are outside the scope of this evaluation. Must be designed in
accordance w/Florida Building Code 2010.
Design Uplift Pressures:
Table"A"
Maxfmum Total Uplift Design Pressure: 101.0 psf
Fastener Pattern: 9"-9"-9"-9"
Fastener Spacing: 24"O.C.
*Design Pressure includes a Safety Factor=2.0.
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FL#11651.27 Rl February 22, 2012
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Force Engineering&Testing Inc.
1953012amblewood Drive
Humble,TX 77338
Code Compliance: The product described herein has demonstrated compliance with
The Florida Building Code 2010,Section 1504.3.2,1504.7.
Evaluation Report Scope: The product evaluation is limited to compliance with the structurai wind load
requirements of the Florida Building Code 2010,as relates to Rule 9N-3.
Performance Standards: The product described herein has demonstrated compliance with:
■ UL 580-06-Test for Uplift Resistance of Roof Assemblies
■ UL 1897-04-Uplift Test for Roof Covering Systems
■ FM 4471,Section 5.4-Foot Traffic Resistance Test
Reference Data: 1. U L 580-94/1897-98 Uplift Test
Force Engineering&Testing,Inc.(FBC Organization#TST-5328)
Report No.117-00407T-09,Dated 11/16/09
2. FM 4471-95,Section 5.4 Foot Traffic Resistance Test
Force Engineering&Testing,Inc.(FBC Organization#TST-5328)
Report No.117-0238T-09E,Dated 07/21/2009
3. Certificate of Independence
By Terrence E.Wolfe,P.E.(No.44923)@ Force Engineering&Testing,Inc.
(FBC Organization#ANE ID:1920)
Test Standard Equivalency: 1. The UL 580-94 test standard is equivalent to the UL 580-06 test standard.
2. The UL 1897-98 test standard is equivalent to the UL 1897-04 test standard.
Quallty Assurante Entity: The manufacturer has established compliance of roof panel products in
accordance with the Florida Building Code and Rule 9N-3.005(3)for
manufacturing under a quality assurance program audited by an approved
quality assurance entity.
Minimum Slope Range: Minimum Slope shall comply with Florida Building Code 2010,including Section
1507.4.2 and in accordance with Manufacturers recommendations. For slopes
less than 3:12,lap sealant must be used in the panel side laps.
Installation: Install per manufacturer's recommended details.
Underlayment: Per Manufacturer's installation guidelines per Flo�ida Building Code 2010 Section
1507.4.5.
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FL#11651.27 Rl February 22, 2012
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Force End neering&Testing Inc.
19530 Ramblewood Drive
Humble,TX 77338
Roof Panel Fire Classification: Fire classification is not part of this acceptance.
Shear Diaphragm: Shear diaphragm values are outside the scope of this report.
Design Procedure: Based on the dimensions of the structure,appropriate wind loads are
determined using Chapter 16 of the Florida Building Code 2010 for roof cladding
wind loads.These component wind loads for roof cladding are compared to the
allowable pressure listed above.The design professional shall select the
appropriate erection details to reference in his drawings for proper fastener
attachment to his structure and analyze the panel fasteners for pullout and
pullover.Support framing must be in compliance with Florida Building Code 2010
Chapter 22 for steel,Chapter 23 for wood and Chapter 16 for structural loading.
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TRIPLE CROwN ROOFING, INC.
, . 7140 ANDRE DR. � ZEPHYRHILLS, FL 33541
' 813-833-7720
STATE LICENSE CCC049370
WWW.TRIPLE-CROWN-ROOFING.COM � LNAULT1963@AOL.COM
SPECIALIZING IN ALL T YPES OF METAL ROOF SYSTEMS
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i NAME PHONE DATE
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STREET CITY STATE ZIP
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, We hereby submit specification and work description: r � � � ,,,, ( �i �;��` c.
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� TF��E��BO��VE DE�SCRIBED ORK WILL BE COMP ETED ACCORDING TO SPEC�FICATIONS, FOR THE SUM OF �
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($ �': �'� �''' � �). PAYMENT TO BE MADE AS FOLLOWS: $ .�fa /'�O AS DOWN PAYMENT
�a� ���Q� `�BALANCE OF$ . �?�`��� DUE UPON COMPLETION.
***ANY ROTTED WOOD DISCOVERED WILL BE AN EXTRA CHARGE AT A COST OF$�"`°�`�P�ER 1/2"SHEET OF
PLYWOOD$ --�'°'°°`�° Lin. Ft. Lumber.
NO ORAL AGREEMENTS HAVE BEEN GIVEN OR ACCEPTED. THIS WRITTEN CONTRACT IS THE
ENTIRE AGREEMENT COVERING ALL THE WORK TO BE PERFORMED AND/OR MATERIALS TO BE
FURNISHED. THE WRITTEN PORTION ABOVE IS THE ENTIRE CONSIDERATION FOR THE AMOUNT
;� OF THE CONTRACT. PURCHASER MAY CANCEL THIS CONTRACT ANY TIME PRIOR TO MIDNIGHT
OF THE THIRD BUSINESS DAY AFTER THE DATE PURCHASER SIGNED THIS CONTRACT.
IT IS AGREED: �"�f� l��c�.�✓/�r�'�i��.� �,f�0� y�'�7���',S" �`��'���
Contractor will do all saitl work in a good and workmanlike manner and in strict accordance with the ordinances, rules and requirements ,
of the city, Town or Village, wherein the above mentioned property is locatetl. If purchaser shoultl cancel this contact after time stated
above, the Purchaser agrees to forfeit down payment paid. In the event it becomes necessary for Contractor to employ an attorney to
, collect any sums due the Contractor pursuant to this contract, then the Purchaser shall pay all reasonable attorney's fees incurred by
�� _ the contractor.This contract shall not be binding upon Contractor until accepted by them. Upon such acceptance by said company, this
_ contract shall be binding on me/us without any further notification to me/us. The undersigned property owner agrees that this contract
-may be assigned for the performance of the work and labor required by the description of the work to be performed. Upon assigned the
parties hereto consent to the performance of the.work by antl payment to such assignee of the amount of this contract.Any Alteration or
deviaiion from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over
and above the stated contract amount.
NOTICE TO THE BUYER : (1) Do not sign this contract before you read it or if it contains any blank spaces. (2)You
are entitled to an exact copy of the contract you sign. (3) Under the law you have the right to pay off in advance
the full amount due and under certain circumstances to obtain a partial refund of/�th�e time charge. Owner acknowl-
edges receipt of a true copy of this CONTRACT. `�'' ,� �,,f�f ,�
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� �� PURCHASER DATE
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�'BY: Tr ple Crown Roofing; Inc. DATE PURCHASER DATE
This contract is enforceable only when accepted by management of Triple Crown.
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PermRNo. PeroeilDNo I�'���0'����Od1D "�D7SOD�DJZD
NOTICE OF COMMENCEMENT
Stete ot �L��1 O4 Caunry af P/'�SGO
THE UNDERSIGNED haraby givas notice that imp�avemant will be made to c�rtain real property,and in accardance with Chaptar 713,Flodda Statutes,
the fo�ouAng IMartnation Is providad In this Notlee of Commencement: /�
1. Descriptlon ot Propeity: Parcel IdeMifiwtlon No, i� �..�L BY �� C.3 �0(J�7,s 0 � ft,4�y3
StreetAddress: � � G ��. 3���
2. Genaral DescripUon of Impmvement f�e.— LDOL'
3. Onner Infortna8on or Lecsee infomwtion Htha Lessee contraded Tortha unprovemanh
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Address ' �.1.,^/J Ciry state o
Interest in Property: n�L 1L �
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Name a(Fee Simpla Titleholder. � A � o�y
(if dif(erent trwn O�ner listed abave) _ m .-. �
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Address ..��P�� ���,� ���,�y „�� Ciry State x �
4. Cantrodor. �� � �
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Contrectors Talephona Na.: ��3 O 33��7OZ� �F- • ¢ �
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� OZ � T-6°C Lender. '� '� °N Y
D -n m v� � Name .,i�� u'�m
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� p '�Q n n7?7 Persons withln the Stete of Fbrida desfgnated by the wanar upon whom notices or other docvments may be served as provided by
rn � _ � � � � Sedion 713.13(1)(a)(�.Florida Statutes:
D -� :u -i
r O z C fTl T � Name �
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Ill C� C� 2° Address City State
T� � m .� .� o Telephone Number of 6e6ignatad Persan:
� n � _� In adddlon to hlmself,the ouner deslgnatas � of
O � � � � � to recefve a copy of lhe Lienor's Notice ac provlded in Sadion 713,13(1)(b),Florida Statutes.
� r = � Telaphona Numbar of Pereon or Entity Desfgnated by Ovmor.
� � m � m m� Expiratlon date of Notice of CommencemeM pha explretlon date may not be before the completion of construdion and final paymant to tha
� O N � � � O D contractar,but will be one year from tho date oi rocording unlass a dHfarertt date is specKe�:
� r O= Q C Z � �C�ON IOER DE MPROP RA PAYMENTS NDER H HAPTEER 713 PART 1 E ECTION 713.13,HFLORID'A S�TATUTES,EAND CAN
r m — Ti � 'n Q RESULT IN YOUR PAYING T1MCE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
m � -il m � RECORDED AND P0.STED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF Y � 1 END TO OBTAIN FINANGNG,CONSULT
� � z NATH YQUR LENDER OR AN ATTORNEY BEFORE COMMENCINO RK OR RECO I OUR NO E OF COMMENCEMEN7.
� m � D Undar penalty of per�ury,I dedare thet I have read the fo�egoln otice wmmence e that th a sWted therein are We to the hest
af my knoYtledge and beliet.
STATE OF FLORIDA �
COUNTY OF PASCO
gnatu�e of Orme ae,or Owners or Lessea s quthorized
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,� °-y '� as e � thority,e.g„oN r, te,attom in fa )for
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o � �. � T Id��caHon Produced Name(Print) �
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'� o �°� =.�:;����, MARY M.HIED
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