HomeMy WebLinkAbout16-17383 CITY OF ZEPHYRHILLS
5335-8TH STREET
, � (si3)�so-oozo 17383
PLUMBING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit#:17383 Issued: 5/26/2016 Address: 6650 NORTH LAKE DR
Permit Type: PLUMBING � ZEPHYRHILLS, FL. �
Class of Work: PLUMBING RENOVATIONS Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 5,500.00 Total Fees: 97.50 Subdivision: SILVER OAKS
Amount Paid: 97.50 Date Paid: 5/26/2016 Parcel Number: 03-26-21-0150-00000-0190
CONTRACTOR INFORMATION OWNER INFORMATION
Name: AMERICAN SOLAR ENERGY LLC Name: BRAVINDER JON R & NANCY L
Addr: 5109 MEADOWS END Address: 3831 TEXAS AVE S
LAKELAND FL 33810 ST LOUIS PARK MN 55426-4352
Phone: (863)859-7800 Lic: Phone: 612-720-7044
Work Desc: INSTALLATION SOLAR HEATER FOR POOL
APPLICATION FEES
PLUMBING FEE 97.50
INSPEC ONS QUIRED
1ST ROUGH PLUMB
2ND ROUGH PLUMB ��
SEWER
WATER
FINAL �
REINSPECTION FEES:(c)With respect to Reinspection fees 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 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.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"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 and Fee Must Accompany Application. All work shall be performed in accordance with City
Codes and Ordinances. .
Complete Plans, Specifications and Fee Must Accompany Application. All work shall be pertormed in accordance with City
Codes and Ordinances.
CTOR PER OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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City of Zephyrhills
, BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: Y���`GI�V( � �Cei�v 1 L
Date Received: �J'Z 1 l�
Site: , l� �o c�0 /��TY��-GCGC�JJ2
Pemut Type: ���-�' ��� �CP'6�r" .
Approved w/no comments: Approved w/the below comments: ❑ I�enied w/the below comments: ❑
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This cornment sheet shall be kept with the pernut and/or plans.
:Zf'
Kal 'n itz lans Examiner I3ate Contractor and/or I�omeowner
(Required when comments are present)
a��aaaoo2o Ci#y of Zephyrhills Permit Applicatian Fax 813-7$0-0021
• Bullding Depactment
� • .
E1ate Rsc�iv�d .. ��,,. : . . �qhonaCoritac#�for`�Permittin°��} �� " �
Owner's Ham� �:. � _ . � . .. . , . . .. . W. � l�� — --� f` -
�?�"'� Ownet f►bone Number
Owner's Address �d: a,�.f� � �QwinerPhone-Number � � � �e
Fee 8lmple TltleholderlNam� �� � ` . � ' � • Owner Phone Number � ,. �
Fee Simple 7ltlehaliler Addre�s •, �� '�=- ' " � •
JOB ADDRESS �`o�C� . D/Z""�lf �' . L07# �,�,�.
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SUBDIVI3IQN � ,� �`` � 'PARCEL ID# ' d 5�-' �4a "�I^ L�'/�C'� —C���� "'�lq�
:: �(08YAlNED FRQlN PROPERTY TAX-NCTiC@j. �
WORK PROPOSEO � NEw CONSTrt ' �� ADD/10.1,`f Q� SIGN [� - [�"� DEMOUSH
e INSTALL 8� . :RERAIR� .' ` '
PROPOSER ttSE - •, Q' ' SFR � � COiUI{Ut� °� ' OTtiEFt #� .. .
TYPE OF CON3TRUCTION;� '.Q� BCOCK�'' ;Q..''�, FRAf�IE � ST�EC. ,Q, ' � - �
, _� _
DESGRIPTION OF WORK eV'SJ�� ' ` � ,�,'..l�Z 011.G rZ — ��'�—
BUIL�ING�IZE�,�^ �T SQ,FOOTAGE,� ...��. . . .. HEICiHT`C: �� , �
,�x.
. �BUIIDiNG , $ -'�s�:r..;„�v.., .: . ��:_,�,;, . . ..
, , � VALUATIdN`�OF'TOTAL'CONSTRUCTION .
�,I
�]ELECTR1CAt. $ . �,' AMP SERt/ICE Q' PROGRESS ENERGY . [� W.R.E.C.
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�t�i1MBiNG $ �` .
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QMECHANIGA� � $ �VAGUPiTtOPI OF MEC1iAP11CAl tNSTALLATIOt�! • ��
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Q�+� . . C�. - �oa����..,C] s�Ec�,a��r �, = a�K�R : . .
FINISHED FLOOR ELEVATIONS � � FLOOD ZONE AREA �YES. NO �. .
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BUiLDER Ct'iMPANY� ` "
SIGNATUP2E REGISTERED Y/ N- ' '�ECU�n" , YLN.,_.- :
Address �� � � �°' � `Llcense#�� ` �
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EtEC'fRtClAN.��._ . *y '.CCIMPANY � -� " . ' . ._ , - ' .
SIGNATURE '' ��is�REo Y/ N �cii�n '�.Y/N `
..r Y'�. _ - '_
Addres�s � . . ' a - _.:L-Icense=#«�'`. ,� -, � �
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PlUMBER ' . . COtNP<ANY° ., . . � . , �
SIGNATURE " .,,� . - , •�c#�s7Ert�p - -... �:Y%��N : -F.EE;,CURREA� .. .=Y/"N:' -
Addre�s .,. - � ._ ._ , `- Ucsnse#,� _ • ��� -• =1
allECHANIGAI:� . _�' . � ` � ' � .CCiMP14Pilf _ � - ._ , , .
SIGIVATURE ~ . '.' , . � , . , � , �R�G�srert,�o.� , . .Y;/�N�- ,,;��CURtten - Y/-N. �'
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Address.;t , ..., r . ..... _ ::, .. ,. _ . :L•icense# � - ��'
OTHEit �.�., ��~- ��r'��`_ ,-G01�liPANY� t-� ;.;v;GY� - .
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SI(3NAYURE. .-,-•' °: .,,��'' • .-- �.��.. �istEii�o. .'Y/.:N..: . .;���CUR�n� - ,..Y:/:N-.,., -
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Addre�s •�l�L��.�..:�";' !�� '�J `�'?I,� ,r � .. ..._ � ��ei��se.�:° :_�'��o�,:�.
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REStpENll'tAAL,:: �Attach(2):P1ot;P.lan§5;;(2):sets=of�8t�ili3�ng�Alans;'(Sj'sef,of.°Energy°Forrris;R-0�1lV�Perrrilt:fornewconsbuc�on;; �
tw.. •�:, •_ , . � _ ,.... .�. _. . .. :-
.-.;Mlrilmum=ten:(10.))worlting;days;afte��sutimlttaCiiate:�Requlred ons(te;�Consfr�cBori�Plans;�Storinwater Plans w%Sllt Fencednstalled,
... >SanlfaryrEaci�4H�ss�8�:,1,,�$u�!�ster:Slte;Woric=Per.rr►it_.fc�:sutidlvl�lo�istlatge:pro}ect`s_.�i>:':,_;�'._" .� _ _ _. ._ _ _ . _ � _
C01WtNERC1�L Attach(3j'eoinptete=sets of'8u11diiig Pians'plus a L`ife 8afety Pege;(1)set o�Energyi Fqrtns.R-O W Permit far new conatnictlon.
M1Nmum ten(10)working days'after suhmlttal date. Requlred onsite,,Gonstrucdon Plans,Stonnwater Plans w!Sllt Fence Installed, , � ,
SanitaryFadlitles�'l;dumps:ar.>�Ite,Work.Petmlt.faPafl,s�einr`prcijeots.`;All,commerclai:requlrements�must=meetcompltance . „ ,
SIGN PERMIT Attadi"(2}set"s afEng1neer.eil;.Pians:��;:��rr��., , -- � . " -= "' -° � , . ... . � _
- """•PRQP_E_RTY SURVEYrggulred;for�all:NEVI/constructlon.... _ -_. ' - - ',.. � -
,:
Directlons: _<;�;•,.�. , . . ..__..�-- - .___ ..� __ �. , ..
� FIII out appNcaNan completely.
Owner&Contractor'stgn.bacic•of appllcatton,natarized
If over SZ500,a Notic,e,of Connmencement.ls requytra�i. (AIC upgra:de�over S75pQ),_._, • . • ...
..,.�,•.: .. .,,:.H._..._..._.,u__.,_ .� .
'• Agent(for�ie'contiactox)'o�=Power`of attom's"y(t'6r the'ownec)wauld be semeone wlth nohadzed letter from awner authadzlrsg same
- .
,,�;... .. _ _ _
'OVER'THE=COUNTER,.PERMITTING�=�=�;""{Fr�ont:bfAppllcatlpn•Only)=,,�`• �
Reraofs If shingtes Sewers Servlcs Upgrades A/C� Fences{Plot/Survey/Foatage) -�� , - -
. . _.�_.r_--_ ....-:.- ..., ._:,_.. �;, ,,. . �:;: "`;..._�,., . . , . .
.._4...�:i'a�l..`.::. - . ,
Drlvaw��rs-Not over Counter IE on publlc roadweys::needs ROW;�,,�"
10710E OF DEED,RES�RICTIONS: The-.undersigned.,unde►gt�nds,�:th�t:ihls::.p�t�nit�,,may;.Nbe;.sub)ect�to;°deed",rest�Cctlons"v�'- '
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rhichmay:tie�more�sresttictfve•�fh��tCounty!reg�lafforis:�`-The�ilnders1gned��as�umesrespo�i�lbilitji°:fo"r;ct�mpltance�with'any � �
�ppUcatile:.deed�resMctlons: - - _ �-4���.}-�>:r<'_, ; � - -• _ _ _ - _ - __- -�-''"��:- � - .
�=='��.... .
- .. : ::-�:.,::... .� , . ,.._..� ...._r ,-:� .�._�._ .:.. _:..:..x.,.._,__:�..:..........._, •
INUCENSED=��`G:ONTRi4C�:ORS .At�D�:CONTR�IGTOR RESPOhISIdlLITI�S:;���if=the'owne� has°fileed��a'�coritractor or
�onuactois to undertake�wo�k;they may.�be::c�qu'ire�d:�to.<�e�IlEensed�:in�acco�dance:with�,sta#eY:and;loc�l tregu.l,ations:���iff:th�a�=�•��- �
,.4. •• : .f8d --w-eFe[r:'_
�ntracto��;is�,not•:licensed;es`r.equlred:`tiy law; both�the ovmer•and=contrector-may be��cit�d for°�� mis�etneanor violatlon
�nder state law. lf tFie�owner or intended>.cont's�torri;ere;<uncertain aa.to-wNat�licensin8:.re.quirements:;ma.y,i;apply�:�r;_'ther�-��-�~°°=° �
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�tended�work;�tMey�re>adviseil'to:c�ntacC�the_Pasco;�.�outtty,Bullding'Inspection,;Dlvlslon�-;Licensing`$ecNon�at�727=847- ,
_. p_�- '-
009. Furtherrtiore,�if tFie=oviine�'�hais''Nlred`°a�conhaotoP o� contractors; he is adviaed�to�fiave;_the conUactor(s)rsign,.,, ,, _,_,.
_..1.a:�.t�� �,. ..,..,
ortlons of`the"contractor Block"_.,,of.`this;appl�atton,to„r...which<they..,will__be�%e.sp.onslt�le..Plf:you;��as`:fhe�oviinerr.stgri as�the � �
ontractor;thaftnay be�an-lndtcation-fhat he=ts�-not"•prope�ly=licensed`and�'ist°'not°entiNed'to�perinittfng prtvlleges•in Pasco: ,
:ounty. � � - ' ._ � _ � : � ,...;.:,._.r��:_._.� �.: .�� ��� . :� ` �,,
, , ., . .. , .._ . _. .. .__: _..._ . ..�. ..__...
.
'RAfdSPORTATION.<.IMPACTlUTILItIES'�INIPAC�'�AN6=�ItE30�J�tCE R�COVE[tY�FEE3:��Th�°und'ersigned�understands ;•
�at Transpo�tatfon Impact Feas:and.Reco.ut�se Recove.ry:F�es,.may�;epply�#ortf�e_constructto.n,.o#new:bulldings;,:changerof��'��F`�"�` �"�'
se in exisNng�buildings;=���texpansibrt:of.:�ez[s�i�ip}�buil�irigs; a§�specified.in Pasco�County-0rdinance number 89-07 and `
0-07, as amende.d.,.�Th�.undetsigned alsa:�urtderstands, thait'such fees;=;as:�may'be�r,due;,�wiIl:-De identffted at the�time°of �����"�� ' � �
ermitting. It is fiirtfier unders'tood that Tra�portatlon.Impact�Fees and��Resoucce Recoveryt}Fees mu�t be pald prlor to '
.
�ceEv(ng a�"certificate:�of��occupancy"-�or flna��.power;,celease:�:if�the.proJ�ct;does,not involue.a�=.certtflcate of occupancy o��-=-='���'�'�'
nal power�,release,;�:the�,fees::mu�it�•tie~pald::prio.r."to;;permft tssuance. -F��thermore;,�ff:Pascm;,County;VVater/Sewer•�Impack':: :� �;�� � - ,
�es are due,they musi be.pald.p�lor to;permit`:Iss4ance:ln.accordance:`wlth:appllcabfe.Pascc`:County�'ordinances.
:ONS'fRUCTiON'CIEN�LAW(Chapter 713� Flor�da"Statutes�as amerrded� If valuaHon of work ls$2�500:00?or��more;I�- :- �.
erlify that_.I, the_applicant,__have.been�prrovidetl-�vvith-.a-copy of:�the__"Florida~�Constivction�:Lten��=Lau�--Homeowner's
�rotection Guide" prepared by tF�e Florida DeP�rtment�of Agric.ult�re and Consum�r:Affa(rs: If the appllcant Is sohieone-. ,, �-.•�.
ther than the"owner", I certify,..th�t I hav.e obtained'a�copy.of the'�above.:ries,cribe�tl'�dbc`ument;and,°promise�;tn;good•:faith;to ,
eliver It to tMe�'owne�';prior>>to�comrnencemerit:``°: F, '" .. '.; . � -� . �'`, .� `."' "' .. . '" '•-. ..." � - .
�ONTRACTOR'�/OWNER'8 A�FIDAVIT: I:cert(fjr•;}tki�t�:alt:-the;,inf.ormationx.inFthis,appllc�tion ts accurat�:and that all work
rili'be done in compliance wlth all.applicable laws regulating construction� zoning and�l_and:development. Appllcation is
ereby made to obtatn=.a.perm(t;,to;,;do;,wotl��and:'liistallafion as indtcafed:�� -1�:certify"tfiat no-work=-or Installatton`fias
ommenced'p�lor to'Issuance of'a pemnif"and"thaf.alf�rork will be perFormed�to meet-_standgrds_�of..all laws regulaking-
onstruction, County and City codes, zoning,regul�tlans� and land development,regulattons�In�'ttie-:Ju�isdtction.��: .I=al'so�
ertify that I understand that the regulations..of other�government agenctes may�apply�.to,the.:;lntended:work, and that it is ,
iy responsibility to Identlty�what.actfans I must•take:to be.,In:.corr�pllance:,.Such�:agencles�include-but-are:not Iimited.to: ; -- ,
- Depa�trtient of Er�vironmental�'Prote`cti�n=Cypress`�'BayFiead�;�Wetland rA�eas and Environmentally Sensitive .
Lands,WateNWastewater Treatment. .- " �� � �
- Southwest Florida Water Management�;.�I�istNct Wells, �Cypress.��.Bayji�ads�� =Wetland � Areas, Altering `
Watercourses. -- , = • �
- Army Corps of Englneers-Seawalls,Docks, Navlgatile VVaterways.
- Department,,.of.Health: 8;Rehabilftafive..ServlceslEnytronmental�Nealth:Unit=Well.s;.:Waste.water�Treatment;
Septla Tanks: __� . . •• , . .
- US Environmental Protection Agency-Asbestos abatement. -
- Federal Avlatlon_AWMo�ity,=fiuraways: -, ; � � , _ �
understand that,the.following:resd�ictions"�apply fo the-t�se�offlll:•
- Use of flli is not allowed in Flood;Zone"V"unless exp[essly pem�itted.
- If-.the flll��materlai:;;("s:-to.:.:6e�.used;µln.�Flood-Zone. "A", 'It�is� understood�that a drainage�plan addres"stng a
"compensattng volume"will_be submitted at#ime of permitting vir6lch Is prepared by a professtonal engineer
Ilcensed by-.#he��tate�of�Flotida: - -, . � ,
- If ih�:.flll materlal�=_is.,to:be,�used in �lood �one °A° in�connectton�with:a�'•permitted building using stem wall
� construction, l certify,th�t flll�:vi►111=ti�e:used only.to.illl the..are.a.within�the:stem�wall. �. -
- 1f'flll�riiaterlal•�Is-to��tie��used°in��any area;`I'�certify that .use. of such�"flll wlll:not adversely affect�ad)acent
properties. If use�of flll.is found�to adversely_�,�ffecfY'adJaEent�=properties,.the owner may be'cited for violating• ,
the condi#lons�:�of`the�ti"�iiiding;;permtt�issued:u�der ths=atfacfied_.�ermit_:�ppllcatlon,�foe�lots less�than.�one (1)
acre wh(ch are-elevateii�6y;fl11;a�t engtneered dralnage plan ls requlred: • . ..
I am the A6ENT:FOR�THE�O.IMNER;�1>�proml'se in good falth to�inforna=the owner..of;the.pecmitting condftlons_set fo�th in �
�is affidav(t prior fo-coinr'rie�acing'construcfion:"'1'understand-that enseparate permft may be requlred for electrical work,;
lumbing� signs, wells,::po,ols.;<<alr_condttloning,..gas...or;.othec_�instai��itions nok spec�flcally included-in.the application. .A .. �
ermit issued shall tie construed io be a'license>:.to��p'raceed wlth the�work�and nokas;authoNiy�.to violate�.°cancel; alte�, or � '
9t aslde any provisions-of�th'e=tecfinical:codes;�nor shall Issuance�of'a.permtf.prevent the�Bulidtrig OHicial from thereafter ?�
:qulring a conectton af errors:in plans;Kcons;`t�iaclion,or vlolatlons�of=any�codes..,;Every_p'ermit.lssued:shall�bec�me�invalid .
nless the�ivork autfiorized:by sucii�pertnit���is-commenced•within ,shc smonths�of permit Issuance� or (f work authorized by
ie permit is suspended,,or..aba�doned;�for;:a�::#�,etiod,qf,sbr,EB)_mo�.tFis;�.aRe�fhe tirt�e the�work��s commenced. An extenslon -
iay be requested, tn inrriting;;-from''t1ie::Building;.Official.foc=a perlod;.no#�'to..exceed'ninetj+�{90,)"days-a�d wilf'demonstrate `a,;
stifiable cause�for:�the exte�ision: If�work,ceas.es,for ninety(90)cons.ecutive:d�y.s...the Job�is�constdered abaadon�d.�
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IAItNING TO OWNER:`��"YOUR._FAl1:.IJRE�'C1:;;R�E.COR�;;A>N.071GE:OF:COMMEMCEMEMT�NtAY:RE$ULT IN�YOUR. •--
AYIMG TWICE;FOR,�IMPRO�/EMEN�3:Tfl:.YOUE�::PROPERTY�:.:IF°.:YO.U�It��EKID��TO"�BT'AIN�FIN�ANE1NCs;�ONSULT �'
-�f�'�Q-L Y�2!!R'LElFtDE13�01��►IN-�,� O''�T�R�EY`�B�FdR�}R-EC�R�INC��1(OUR''NOT�F'ti.��COriA�1111ENC�E�Ii�IENT� " � • � `
.ORIDAJURA�•(F.&1:1,7.03} - - .. , . , � . - --- _ ._. _ :-_- _-- -. ,
NNER OR AOEN7 " � � • CONTitACTO • '
ibscrlbed and swom to(or afflrmed)before me thla - ' Sutisalbed'and' t ai d fore:r ie�fhl� -,
by f �/:r�S.
ho Is/are personally known to.me oahaa/heve produced Who erep@rso ry�p to me�.or.has/have;produced. • .
ea:identlflc`aMon. - , " � IJ (� . . as'IdenBflcatlon.
Notary Publlc . � _ � Notary Publlc
�mmisslon No: ComrAlsal o. �
,.�•��?�:�?s1e`4.;,,,JACQUEL-INEBOGES... ,
ime oI Notery typed,printed or stamped Name of Notary typ ��3d ;.�E"v' � ` -' � "� `j ., ,
, :�,�.: Xpi, s:•.ecembey;�2,,2Q18';��.: - , .
�'�OF.F��a`` Bondad.Th.ru T Fauiln�.�r�ce,B00385.�70fY� `,,"' '4
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$ALES AGREEMENT
Buyer _�0 J� ��t�1 N�� Home Phone#:
Address. Q 6S"n N��"Ni�a k4. ,[�r i U�¢.' Cell Phone#: �f a."7� (�a.11"'�
Ciiy �e r��«s State �l. �p 335�f�2- Email. �o s��o,n5��,,,_@�.�uL�c�n� i
SECIER AGREES TO FURNISH THE FOLCOWING:
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The above prices,specifi tions an 'ons are here y awepted. Payment will be made es ouUined above.
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ASE Rep s�entative � Installa�on Date
8234 U5 NWY 98 N � laketand,F�orida 33810 • Phane(863)859-7800
SOLAR POOL SYSTEM WORK ORDER
Customer Name: ��� 'Jr�''�+�`�'���
Customer Address: ���v �o�-ti^��v1�.G /✓✓.
City: 7e G�cr ,�'�-' Zip: � �Z
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Special Instructions:
Roof Tvpe: Roof Con ition: Number of Stories:
� Shingle� Good 1
Flat Tar/Gravel Fair 2
Concrete/Tile Poor Other
Barrel Tile Need Waiver Bring Big Ladder
M eta I
Roll Out
Pool Surface Area (sq.ft.) �
Pool Panel Brand SwimMaster. NUVIS unStar circle one Other
Pool Panel Size 4x8 4x1 4x12 ircle one
Number of Panels �
Auto Controller YES
VSPP (YES / NO 1 Su erflo I teleflo circle one
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� 2016061270 08%24%2016 K. D ,
Permit No. Parcel ID No (/�'�f����-alSa-r��aa `(J170
S/H �/ NOTICE OF COMMENCEMENT
/� r `,1�
Stateof__ /'!�� Q.� Countyof�9�E^�
THE UNDERSIGNED hereby gives nolice lhat improvemenl will be made to ceRain real praperty,and in accordance with Chapter 713,Florida Sta[utes,
the fallowing intortnation is provided in this Notice of CommencemenL• I
1. Description of Property: Parcel Idenlification No. ��/����Q - 0����`0�9U
StreetAddress:JQlO1,U /VO'�`IV� ' d�w+�G��yf-�;�IS� L d3j7 Z��[o�y
2. General Descri�tion of Im'rovement•�S/L�� 5���✓ ,�QQ� Ci� �j+JrJ�ju-
3. Owner Infortnation or Lessee infortnation if the Lessee contracted for the impravement:
�on� R 13rav � �d�✓'
N Nama 2`�E ZC7J/�vl�l-F�u.s �c- 3�1y�
Address City � State
Inlerestin Property: �Q� �d
Name of Fee Simple Titleholder:
(If differenl from Owner lisled above)
Address ��r�� �1 City� State
4. CoMrector: d
� N m !� �� o�-� �33�03
Address p��A ^r ��O� �ity State
Contractor's Telephone No. � 7
5. Surety:
Name
Address Cily State
Amount of Bond: $ Telephone No.
6, Lender:
Name
Address City State
Lendefs Telephone No.:
7. Persons with(n the Stale of Florida designated by the ovmer upon whom notices or olher documents may be served as provided by
Section 713.13(1)(a)(7),Flbrida SWtutes:
Name
Address City State
Telephone Number of Designated Person;
8. in addition to himself,the ovmer designales of
lo receive a copy of the Lienors Notice as provided in Section 713.73(1)(b),Florida Statules.
Telephone Number of Person or Entlty Desfgnatetl by Owner:
I 9. Expiration date of Nolice of Commencement(the expiration date may not be before the completion of consWction and final payment lo lhe
contractar,bul will be one year from the dale af recording unless a different dale is speclfied):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTfON. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
� Under penalry of perjury,I declare that I have read the foregoing notice mmence nt an at the fads stat herein are true to the best
, of my knowledge and bel�ef.
STATE OF FLORIDA �
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COUNTY OF PASCO
ignature of er or essee,or Owners or Lessee's Authorized
OfficedDi rectodPaRnedManager
�Signalorys TillelOffice �7�^
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The foregoing insWment was acknowiedged before me this_day of�,20�by.V� �• �/�i2 y//L���
es b�.� (type of authority,e.g.,officer,lrustee,attomey in fact)!or
.���� �/' (na of party on hall of w insW Atwas executed).
Personally Known�,O�Produced Identificatlon I�- Ncta.y Sigr.atura�
Type of Identificalion Produced S61�����Z��� Name(Print) Ll..� � ��',S •
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PRULq S 0'NEIL,Ph.D.PRSCO CLERK Q COMPTROLLEA NOTARv' . C0f1AMI5510Ni��fF58370
rueuc ' �p�RES November 16,2017
' 05/24/201 2: 5 m 1 of 1 sraeoF
� OR BK ���� PG �40 �ORIDA' 80NDED•THRUUGH
Rtl INSURANCE COMPANY
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; , �. k.` - � 9��1t���3R Q�P�Jk3i.iC RECaRD IN TH15 QFFICE
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�``"a'�� � �l�ULf��'u.O'NEIL,CLERK OMPTROLLER
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