HomeMy WebLinkAbout15-16614 CITY OF ZEPHYRHILLS
5335-8TH STREET `
- (si3p8o-oo20 1661
BUILDING PERMIT
I
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16614 Address: 38819 SOUTH 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: 11-26-21-0010-21400-0171
Improv. Cost: 6,475.00 OWNER INFORMATION
Date Issued: 9/22/2015 Name: BRADLEY KEVIN WAYNE
Total Fees: 70.00 Address: 3253 CALUMET DR APT G
Amount Paid: 70.00 RALEIGH NC 27610-1917
Date Paid: 9/22/2015 Phone: 813-525-0290
Work Desc: REROOF SHINGLE �
CONTRACTOR S APPLICATION FEES
AFFORDABLE ROOFING S S EM INC REROOF RESIDENTIA 70.00
� � � � � � `Jr
►��,
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Ins ections Re uired
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP .-
FINAL�f9 .- �,�'C S
REINSPECTION FEES: (c)With respect to Reinspection Ifees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,�for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe 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 oif 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 pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
`��� �'
�
CONTRACT'OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
e�saeo-oozo City of Zephyrhills Permit Application FaX-s�saeo•ooz�
Bullding Depertment
• • Date Recelved phone Contact for Permlttin
Owner's Name Owner Phane Number �5" .Z. �
�nar's Addresa �2�3 ��(�,jn Q'�'� � Owner Phone Numbar
1 �, /�
Fee Simp Itleholder N�e� Owner Phone Number
Fee Slmple Tltleholder Addresa I
JOB ADDRESS (L � I �pT� '��
SUBDIVISION -L y'ML�S PqRCEL ID# I '���� —c.V d
(OBTAINEOFROMPROPERTYTAXN CE)
WORK PROPOSED NEW CONSTR ADD/ALT Q SIGN Q DEMOLISH
INSTALL e REPAIR I R�fZ('jQ�
PROPOSED USE � SFR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME �I� STEEL Q
` 1f1�+ 1
DESCRIPTION OF WORK �� �L � � vy�
�,�(�J_ �� �RJ
BUILDING SIZE � �"�"�ILL� q FOOTAGE� ` HEIGHT � � • '���-���'�
QBUILDING $ �7C d� VALUATION OF TOTAL CONSTRUCTION
�r)
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W,R.E.C.
QPLUMBINO $
QMECHANICAL $ VALUATION OF MEICHANICAL INSTALLATION
QGAS �OOFING Q SPECIALTY IQ OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE I REA QYES NO
BUILDER COMPAN�
SIGNATURE REOISTERED Y/ N FEE CURRE� Y/N
Addreae License i!
ELECTRICIAN � COMPAN�' —�
SIGNATURE REOISTERED Y/ N FEECURRE� Y/N '
Addreas License#
PLUMBER COMPANY
SIONATURE RE019TERE Y/ N FEE CURREA Y/N
Address Llcenae#
MECHANICAL COMPAN
SIGNATURE REGISTERE Y/ N FEE CURRE� Y/N
Address llcense#
OTHER COMPANY rf O�Lt���/�L.Ur�
SIGNATURE REOISTERE Y/ N FEE CURRE� Y/
Addresa 1 �� J�� Llcense# ��2 �/,Z
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RESIDENTIAL Attach(2)Plot Plana;(2)sets of Building Plans;(1)set of Ene�gy Forms;R-0•W Permlt for new constructlon,
Minlmum ten(10)worlcing deys after submittel date. Requlred onsite,Constructlon Plans,Slormwater Plans w/Sllt Fence Installed,
Sanitary Fecllltlas&1 dumpster;Slte Work Pertnit(or subdivis ane/large proJacts
COMMERCIAL Attech(3J complete sets of Bullding Plans plus a Llfe Safety Page;(1)set of Energy Forms.R•0-W Permit for new constructlon.
Mlnlmum ten(10)working days after submittel dete. Requlredlonsite,Constructlon Plana,Stormwater Plena w/Sllt Fence instelled,
Sanitary Facllltles&1 dumpster.Slte Work Pertnit for ell new proJects.All commercial requlrements must meet compilance
SIGN PERMIT Attech(2)sets of Englneered Pians.
""PROPERTY SURVEY requlred for all NEW constructlon.
Dlreetlons:
FIII out applicatlon completely.
Ovmar&Contractor sign back of appllcatlon,notarized
If over 5�600,a Notice of Commencement Is requlred. (q!C upgrades ol ar 57500)
'• Agent(for 1ha contrector)or Power of Attomey(for the owner)would be aomQone wlth notarized letter from awner euthorizing same
OVER THE COUNTER PERMITTING (Front of Appllcatlon Only) I
Reroofs If shingles Sewers Servlce Upgrades AIC Fances(PIoV urveylFaotage)
Drlveways•Not over Counter If on publlc roadways..needs ROW
NOTICE OF DEED RESTRICTIONS; The underslgned understalnds that this perm(t may be subJect to"deed"restrictlons"
, • which may be more restrictive than County regulatlons, The undersigned assumes responsibllity for compliance with any
appllcable deed restrictlons,
UNLICENSED CONTRACTORS AND CONTRACTOR RE8PONSIBILITIES; If the owner has hlred e contractor or
contractors to undertake work, they may be requlred to be Ilcensed In accordance wllh state and local regulatlons, If the
contrector Is not Ilcensed as requlred by law, both the owner 'nd contractor mey be cited for a misdemeanor vlolatlon
under state law, If the owner or intended contractor are unce�ain as to what Ilcensing requirements may apply for the
intended work,they ere advised to contact the Pasco County B Ilding Inspection Divislon—Licensing Section at 727•847-
8009, Furthermore, If the owner has hired a contractor or c•ntractors, he Is advlsed to heve the contractor(s) sign
portlons of the "contractor Block"of this application for which tt�ey will be responsible, If you, as the owner slgn as the
contractor, that may be an indlcation that he is not properly Ilcensed and Is not entitled to permltting prlvlleges In Pasco
County, -
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURC�RECOVERY FEES; The undarslgned understands
that Transportatlon Impact Fees and Recourse Recovery Fees may apply to the constructlon of new buildings,change of
use In existing bulldings, or expanslon of exlsting bulldings, as ispecifled In Pasco County Ordlnance number 89-07 and
90•07, as amended, The undersigned also understands, that s,uch fees, as may be due, wlll be Identifled at the time of
permitting, It Is further understood thet Transportatlon Impact Fees and Resource Recovery Fees must be paid prlor to
recelving a"certiflcate of occupancy"or flnal power release, If�he proJect does not Involve a certfficaie of occupancy or
flnal power release, fhe fees must be pald prlor to permlt Issu�nce, Furthermore, If Pasco County Water(Sewer Impact
fees are due,they must be pald prior to permit Issuence In accordence wlth appllcabie Pasco County ordlnances,
CONSTRUCTION LIEN LAW(Chapter 713,Florlda 5tatutes,as amended): If valuatlon of work is$2,500.00 or more, I
cerfify that I, the epplicant, have been provided with a copy of the "Florida Constructlon Llen Law—Homeowner's
Protection Gulde" prepared by the Florida Department of Agrfculture and Consumer Affalrs, If the epplicant Is someone
other than the"owner', I certify that I have obtafnad a copy of the above described document and promise in good faith to
dellver It to the"owner'prlor to commencement,
CONTRACTOR'S/OWNER'S AFFIDAVIT; I certify thet all the I formation In this applicatlon is accurate and that all work
will be done in compllance with all appilceble laws regulating c nstructlon, zoning and land development. Application is
hereby made to obtaln a permft to do work and Instellatlon as Indlcated, I certlfy ihet no work or Instelletlon has
commenced prlor to Issuance of a permlt and that all work w II be pertormed to meet standards of all laws regulating
construcilon, County and Clty codes, zoning regulatlons, and Iland development regulatlons In the Jurlsdictlon, I also
certify that I understand that the regulatlons of other governmei5t agencles 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 Iimited to:
• Department of Environmental Protection-Cypress 6ayheads, Wetland Areas end Environmentaily Sensitive
Lands,Water/Wastewater Treatment.
• SouthwesC Florida Water Management District Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses,
• Army Corps of Englneers-Seawalls,Docks,Naviga le Waterways,
• Department of Health & Rehabilitaiive Servlces/ nvfronmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks,
• US Environmental Protectlon Agency-Asbestos eba ement,
Federal Avlatlon Authorfty-Runways.
I understand that the following restrlctlons epply to the use of fill
- Use of flll is not allowed fn Flood Zone"V"unless e pressly permitted,
• If the flll meterial Is to be used In Flood Zone A", It Is understood lhat e dralnage plan addressing e
"compensating volume"wlll ba submltted at timo o permitting which Is prepared by a professlonal englneer
licensed by the State of Florida,
- If the flll meterlal Is to be used In Flood Zone "A In connectlon wlth a permltted bullding using stem wall
construction,I certlfy that flll will be used only to flll�he area wlthln the stem wall.
- if flll meterlal is to be used in any area, I certi� that use of such fill wiil not adversely affect adJacent
propertles, If use of fill Is found to adversely affec adJacent propertles, the owner may be clted for vlolating
the conditions of the bulldfng permit Issued under the attached permit appllcatlon, for Iots less than one (1)
acre whlch are elevated by flll,an engineered draln�ge plan Is requlred,
If I am the AGENT FOR THE OWNER, I promise In good falth�o inform the owner of the permittfng conditions set forfh In
this affidevlt prlor to commencing construction, I understand t at a seperate permit may be required for electrical work,
plumbing, signs, wells, pools, alr condltioning, gas, or other Installatlons not speclfically Included in the appllcation, A
permlt issued shall be construed to be a Ilcense to proceed wit�the work and not as authorlty to vlolate, cancel, alter,or
set aslde eny provislons of the technlcal codes, nor shali Issuance of a permit prevent the 8uilding Offlclal from thereafter
requlring a correctlon of errors In plans,constructlon or vlolatio�s of any codes, Every permlt issued shall become Invaifd
unless the work authorized by such permit Is commencod wlthln six months of permit issuance, or If work authorized by
the permlt Is suspended or abandoned for a period of slx(6)months after the tlme the work Is commenced, An extension
may be requested, In wrlting, from the Bullding Offlclal for a perlod not to exceed ninety (90) days and wlll demonstrate
Justifiable cause for the extenslon, If work ceases for ninety(90�)consecutive days,the Job Is consldered ebandoned.
WARNING TO OWNER; YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPRO MENTS TO YOUR PROPERTIY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR A ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S,117, I
OWNER OR AGENT �� CONTF�ACTOR
Subecribed an b�wo o r b fo me thls Subscrlbed and bworn t�gr eHirm�)be,fgr�mq t s �J
!Vt ll
Who Islere person�known to_m r haslheve produced Who Is/�repersonelly�QO�5±a1n o�e or Fieslheva produced
-`�e Idenllflcallon, --T- as Identlficetlon,
Nolary Public Notery Publlc
Commi sion o. `� C� c
� 4 Comml9slon o. ����J
> I
Neme of Nolery typ d,printe ar ste Neme df Nolary typed,printed or sl mped '
ta�;P�e� JOY A.� 1PRY PbB� JOY A.VITO
��'� ��'�c* MY COMMISSION�FF 039560
'� EXPIRES;August 3,2017
�o'•••,�c* MY COMMISSION#FF 039560
��'•,�,.;,�Q4 * EXPIRES:August 3,2017
•�,,u��y�r� pa-�deC Thru Budget Notary Services s,, .o`' Bended Thru Budget Notary Servi�es
ATFOF F�ON
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, �������� ��� � �������
RooFiNS srs�MS �
i4ffo�dable Roofing �����c��9 9��o CORITRACTAMOUfdT' �G��s,°° i wE��s F,�Q6o
12573 N. U.S. 301 Toll Free (888) 397-ROO�' DEPOSIT AMOURIT °'�
Thonotosassa, FL 33592 Phone (813) 986-6683
License No CCC1326722 Fax (813) 986-6779 ��LANCE AflflOUN7 Cq�l�-S.00 DATE S��
No. CGC1517188 �AL,APdCE DUE If� FULL UPOP� COfUIPLE IOP�
I/We the Owner(s)of the premises mentioned below, hereby engage and ire you as Contractor,to furnish and install all necessary materials and
labor, to install, construct and place the improvements according to the�ollowing specifications,terms and conditions, on and in the premises
below described which we warrant and represent that we have good record title as to Owners in our own name.
8r3-�s�S- 0�40
OWNER'S NAME(S) K�VI�V [3/2/�D�L�`/ PHONE 813' 3.5.1'S�`�8
ADDRESS 3 8 819 SOZJTFF ANLcNUE CITY �FP�YRI�r�G S STATE FL ZIP �3s��
Contractor agrees to furnish ali labor and materials according to the following specifications.
1 Furnish County or CitY permits required for reroofing. � f}�( �41.$ �
2. Tear off existing StFln16[.� roof to a usable surface and haul �way debris. �g.. «�iERS�
3. Inspect decking, renail to code, and make necessary repairs at an xtra charge as outlined in wood work sheet enciosed
4 Install �PEE[-+ 1Tt CK underiayment. �
5. Install new eave drip,valiey reinforcement, lead pipe flashing, goose neck exhaust vents, and a�trm'rwm� ridge vent system.
6. Install fungus resistant shingle roof with six nails per shingle.
7 Affordable Roofing Systems, Inc. will warranty workmanship for ;� years.
� A.) 25 Year Three Tab shingle_ $
B.) Dimensional shingle $
C.) Lifetime shingle Gf�t= " T1Yh(3�,12.LIIU� Fl-,�� ` $ �9 �'� �-.5��b
�� � ��
D ) Enhanced Coverage Warranties C�lq-F �'.,gl...�EN PL�OGE � ��e�u�pEp
.� ��
E. Shingle over ridge vent_ G�F C�(S2A V E(3 $_ �lv Ct u��D
I
F) Leak Barrier-Self Adhered Modified Area E NTl ROO l� $ •�N C 4 U�Q�l�
G.) TPO single ply roof system Gl4F " �JERc►c1ARJ, A�'r `dLt/-S��� ,Q.�QEf� �/V E $ � N C 1-U,���
H ) Roof Color Drip Color Ridge Color
Ca1JTleRcT tNc�upES tnS57i4LL�4-T(dn� o� GooS�NECk R�F V�r�fTS Fo2 �8�4't'rF FAn(
,a nr i� Fu T�2E.. K�Tc�EN rEaaD � �n�c N��c A�L cb r�N�c'r?o N S � a�C�a N E. 3Y 0 T�-£QS
The undersigned Contractor agrees to sell and the undersigned Buyer(s)Qointly and severally,if more than one)agrees to purchase the above described goods
and services which are to be furnished or used in the modernization,rehabilitatior�, repair,alteration or improvement of real property located at Buyer's address
given above Final payment shail not be withheld due to punchout or inspections.l
APPROXIMATE START DATE �(—(e (,t1EEKS APPROXIMATE COMPLETE DATE C�—�'I � `�
(Material supplies and weather permitting)
� S
NOTICE OF RIGHT TO RESCIND CONTRACT
Either party of this Contract may cancel the Contract by giving written notice to the other party by certified mail or registered mail on or before midnight of the
third business day following the execution of the Contract. Buyer's notice to Seller must be mailed to AFFORDABLE ROOFING SYSTEMS, INC. 12573 N.
U.S.301,Thonotosassa,FL 33592 and state the Buyer does not want the goo i s or services.
NOTICE TO THE OWNER
Do not sign this home improvement contract in blank.You are entitled to a copy qf the contract at the time you sign. Keep it to protect your legal rights.
This home improvement contract may contain a mortgage or othervvise create a lien on your property that could be foreclosed on if you do not pay Be sure you
understand all provisions of the contract before you sign.Any monies not paid a�completion wiil incur a 1'/z% per month interest rate.Any costs incurred by
Affordable Roofing Systems,Inc,for litigation will be paid by non-prevailing pa� y
�
ACCEPTANCE
The prices,specifications and conditions are satisfactory and are hereby accepted.AFFORDABLE ROOFIfVG SYSTEMS,INC.is authorized to do the work as
specified. Payment will be made as specified above
Bu er � ,�)
Y �"'" �' Date�J S�I�Jv��I
Agent Date _Q'�-(n,�[� i o-Buyer Date
��-----`--
BUYER ACKNOWLEDGES RECEIPT OF THIS CONTRACT 111�f1flEDIATELY UPOtd EXECUTIOPI THEREOF,
NO VERBAL AGREEMENTS WILL BE HOfVORED�ITEMS ORDERED MUST BE ON CONTRACT.
This is a legally binding contract. If not full4 understood,seek comoetent advice. aac�is
i
11-26-21-0010-21400-0171 � Pasco County Property Appraiser Page 1 of 1
. Mike Wells Pasco Coun ly Property Appraiser
Data Current as Of: Weeklyl Archive - Saturday, September 5, 2015
Parcel ID 1i-26-21-0010-21400-011l (Card: 001 of 001)
Classification I 01 - Single Family
Mailing Address Property Value
BRADLEY KEVIN WAYNE Ag Land $0
3253 CALUMET DR APT G Land $14,400
RALEIGH NC 27610-1917
Physical Address Building $33,818
38819 SOUTH AVE Extra Features $483
ZEPHYRHILLS FL 33542-6009
Leqal Descriotion (First 4 Lines) 7ust Value $48,701
See Plat for this Subdivision AsSeSSed (Non-School Amendment 1) $48 701
CITY OF ZEPHYRHILLS �
PB 1 PG 54 LOTS 17-19 INCL
BLOCK 214 EXC EAST 60 Ff Taxable Value $48,701
OR 9198 PG 890
]urisdiction
City of Zephvrhills
__ Land Detail (Cal-d:_001 of 001)___ __ _
-----�---------------;---,— ----r-- �, —-- -- --- ------ -
__Line �; Use �Descriptioni Zoning _;_ Unrts � Type__;__Price �Condition� Value
-i-� 0100 SFR � --- � 200.00-�----SF --------- ------------
I I OOR2 i 7, � ; $2.00 1.00 ; $14,400
Additional Land Information
_._-' -__.__ __.______-y_ T___'I____-''_-- _._- _______-_ _.- _______.
Acres � 0.17 I Tax Area � 30ZH � C de j -- '�esidential Codel ZHLHLP2
Buildina Information - Use 01 - Sing e Family Residential (Card: 001 of 001)
Year Built 1948 Stories , 1.0
Exterior Wall 1 Asbestos Shingle Exter�or�Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interio Wall 2 None
Flooring 1 Pine or Soft Wood Floorin� 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
_ Line __ i _ Description � Sq. Feet Repl. Cost New
__- ----'--- ------- -
1 � BAS ----�----- - 886
----- ----------- --;-- — ' _ ! $43,538_
------------------ ------------- -- .-- --- - --
2 � FEP � 176 ; $6,044
- - -- ----- --- --------�---------------- ---- � -- ------ - ---- ---� -- - --- -- - - ----
3 I UDG j 336 ! $4,963
_ ___ Extra Features (Card: 001 of 001)
-- -�--— --- -------
- ----------------------------_ _--- -
Line_____j Description _�____ _ Year j____ _Units � Value
----- - i------� ------ --- --- ------ -
_.,_
2 � CLFENCE $� � 244 $351
- - . i---- 1991-----I-------320 ------ - ------ ------
--------- �------ DWC ----
$132
Sales Histor -ISee All 8 sales .
Previous Owner: REYES JOSE
05/2015 ---- --J -----
�Y - ----------- -------
------------��---
Month/Year 9198 k0890 e , Warran Deed ! DO�R Code � Condition Amount
--- ------
'-----�--9 - ---'---- -- e �
_ ,YP-- -- ----- - - - -----� -------- -
; � Improved ' $43,900
- -------- _---------------�--------------
11/2014 � 9114 / 1252 � ---- ----�---------- --
Quit Claim Deed I 11 _ ', Improved � $40,000
- ---- --�----- ----_ ___------ - ----------- --
08/2012 � 8739 / 1853 � Quit Clairr Deed ; 11 � Improved ; $40,000
http://appraiser.pascogov.com/search/parcel.aspx?p I ce1=2126110010214000171 9/8/2015
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This Instrument Prepared By: i{Cp}�,�.173,4$6? Rec: 10.00
Affordable Roofing 3ystems, Inc. DS: 0.00 IT: 0.00
12573 US Highway 301 QJg{2212@15 K. M. , Dpty Glerk
Thonotosassa,F�i,33592
NOTICE OF COMMENCE ENT
Permit Numbei• Tax Folio Number_,����"�����"" ���._�j�j
ParcellDNumber ��,-rp LA S 0'NEIL,Ph R PRSCO CLERK & GOhIPTRO�LER
State ofF�orida �/�„�� 09/22/2015 r0�1:45 m 1 +o�f 1
County of_____ a.'G(� OR BK �6��� pG 'iq,�7 '
THE UNDERSIGNED hareby gives notice that improvements will be made to certain real property,and in accordance with Chapter 713,
� Florida Statutes,the following information is provided in this Notice of Commencement;
1, Desoription of property(legal description); �� � I ���'� �T5 �7�
a}Street{job}Address: Sov ts� ,' �S � �` 2.,
2.General desr,riptlan af Impravement; Reroof I
3.Owner informatioq or Lesse,e,�nfo ation If the Lessee contraf�te for the I pr veme t;
(a}Name and address:�i �/t �____�__���-�'' �;��%, t�t�,�1`�� �i'"_�����'�� ,��... ���o�(�'
(b}Interest in property; $t,t.Ty(�,�.,J `� �
(c)Name and address of fee simple titleholder(if other thazi owner): I � ��
Q Coniractor lnfarmatfon: �
(a)Name and Address;Affordable RoofinQ Svstems,Inc 12573 N Hrvv 301 Ti honotosass� rL 33592
(b)Phone numbar_(813)986-6G$3 I
5.Surety
(a}Name and address:
(b)Amount of bond I
(c}Phane number: 1
6.Lender
(a)Name and address;
(b)Phona number� I
7.Persons withln the State af F(orida desfgnated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7„Florida Statutes:
{a}Name and address:
(b}phone number: � �
8 In addltlon to hlmself, Owner deslgnates the following person(s)to receive a copy of the Lienor's Notice as provided in Section
?13.13(1)(b},Florida Statutes:
(a)Name and address:
(b)Phone number; I
9.Explratlan dafe of notice af commencemenf(fhe expiration date is 1 year from the date af recording unless a different date is '
specified): I ,
WARNING TO OWNER:ANY PAYNIENIS MADE BY THE OWNER AFTER TNE�XP1FtAT14N OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UND,ER CHAPTER 713, PAR7 I, SECTION 713,13,
FLORIQA STATUTES,AND CAN RESULT IN YOUR PAYING TWIGE FOR IMPROVEMENTS TO YQUR PROpERTY.A
N4TICE OF CQMMENCENiHNT(NUST BE RECORDED AND POSTED 4N THE JQB S(TE BEFORE THE FlRS7
INSPECTION, IF YOU INTEND TO QBTAIN FINANCING, GONSUI.T WITH YOUR LENDER OR AN AT70RNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTlCE OF COMMENCEMENT.
Under penal#y a erjury, I declare fha# I have read the faregping nofice af commencemenf and fhat fhe facfs sfated
�, fherein are;fr �o e b f owledge a elief
� . -t Jt� �,1 �j�iJL4..
(Signature a€Owner o sses, r Owner's o " ssee's{Authorized O�icedDirecto'lPartner/Manager} (Pdni Neme and Provlde Slgnalory's Tflie/otti �
The foregoing instrumant was acknow(edged before me khfs oZ d�ay of_ �� ,Zp��
By�.�,/ ,j Y� 1n,�;�121a C�L e..�_as �✓W�Q-� (lype ol eulhorlly,a.g,omcer,Irustee,allomey In fed)
For 1".stV��il t�t?• �J�2,..,(���v...y.�� as_ C�1J.1Vl,f��
•.(Name oiP8t500) J (lype of eulharily,..e.g.aKicer,Iruslee,eNOmey in IaU)
For �kU 1�'"� w • ���-�;1 l�� � (name ot party on beha!(o!whom instrument was executed}. �
' Personally Known_ Produced ID�� �
, TYpe ot ID�,�(�3�
Notary Slgnat re ��1/t�
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,�,��R�, Ptint name i�
ASHLEY AYSCUE
, ' NOTAAY PUBL�C
JOi�lNS7QN COUNTY
z ; NORTl�l�'CAROLINA