HomeMy WebLinkAbout16-17590 i
� CITY OF ZEPHYRHILLS
; 5335-8TH STREET ,�
I (813)780-0020 1 '590
'I � BUILDING PERMIT
. ,
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17590 Address: 5817 8TH ST
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Squa;re Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-02600-0010
Impro�. Cost: 6,000.00 OWNER INFORMATION
Date,lssued: 7/22/2016 Name: PATRICK S J & KATHLEEN
Total Fees: 97.50 Address: 5817 8TH ST
Amount Paid: 97.50 ZEPHYRHILLS FL 33542-3607
Da;te Paid: 7/22/2016 Phone: (813)480-5546
Work Desc: ALUMINUM ROOF OVER ,
I CONTRACTOR S APPLICATION FEES
HOMEOWNER REROOF RESIDENTIAL 97.50
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I Ins ections Re uired
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
FINAL I
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
I 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 properly 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.
"Wa�ning 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."
Compl'ete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
� City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
I NO OCCUPANCY BEFORE C.O.
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,CONTRAC OR 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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� a�3-7ao-oozo ' l � City of Zephyrhills Permit Application , Fax-s�3-7so-oo2�
� � � ' • � � � � � Buildfng Department , , ,
Date Received � � ' � phone Contact for Permittin v i3 - �o �- _ �3/� r�G
_._ . _
Tl-ITrITr
Owner's N Ime H"r V 1�el.°I'1 I''Q.� �C k Owner Phone Number ��3���'S54�P
Owner's Address J � +h STr��-r Owner Phone Number
Fee Simple Titleholder Name h ��<<-°en ����C� Owner Phone Number
Fee Simple TitleholderAddress �o � O�•` cJ�• Ge �' �( �-• 33J � �. �,
JOB ADDR�SS 5 0 �� O '�'h 5�, � �'1 1��1��5 (.._ 33SU �. ��or# � I
SUBDIVISION PARCEL ID# I I '�lp�� -� �O '�D �Dd- O8 f D
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e , NEW CONSTR e ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER e- o0
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK A I U VY1 1 1'�V Vt� �Op�'O U G�
BUILDING SIZE SQ FOOTAGE ��0� HEIGHT
�ITI"ffi ITITrTT�1�TTTI�ITI�TP7TrITITTI'�T�r1�T1�T1'9Ti�T1�1TTI�TT�1"
QBUILDING ��DDD. �6 VALUATION OF TOTAL CONSTRUCTION
'�ELECTRICAL $ � AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
,'� 7 S��
QPLUMDING $ ,�' l /
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QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � ���� �'"'
QIGAS Q ROOFING � SPECIALTY 0 OTHER �
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO � �� �
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'I BUILDER � � � ,J COMPANY D t�un e r^ �Q,`t'y1 �e.L°.1'� �f�-T�1 L,�
SIGNATURE � REGISTERED Y/ N FEE CURREN Y/N
Address 1 �st, ZC h � , � FL.33 Z License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License# �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN .Y/N
Addl ess License#
OTHER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Addlress Llcense#
IIIIIIt11t11It11t1It11111 'IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIItllllllltll
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction, �
� Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/large projects
� COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
� Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
� "**"PROPERTY SURVEY required for all NEW construction.
-1--1-1--k�-�-�--4-1--4-1-1..t-t..1-{-I..I-1-I-1-1-1-1-L..1-[-l..l..l-i-i-l-i-i-f.�f-f.a-1-1..1..1-1-1-{..1-I-{-I..f-4.E.1-f--f-4-4-1-f�-f-f-i.i-l�.l..f-1-
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
, If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
'" Agint(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITI'ING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Dri�eways-Not over Counter if on public roadways..needs ROW
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NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more resfricfive than County regulations. The undersigned assumes responsibiiity for compliance with any
appiicabie deed restrictions.
UNLtCENSED CONTRACTORS AND CONTRACTOFt RESPONSIBIL.ITIES: !f the owner has hired.a contractor or
cantractars ta undertake work, they may be required to be licensed in accordance with state and lacal regulations. If the
contractar is not licensed as required by Iaw, bath the owner and con#ractor may be cited for a misdemeanor violation
under sfate (aw. If the owner or infiended contractor are uneertain as to what iicensing requirements may appiy for the
intended work, they are advised to contact�the Pasco County Suilding Inspection Division—Licensing�ection at 727-847-
8p49. Furthermore, if the awner has hired a contractor or contractors, he is advised to have the contractar(s) sign
portians of the "co�tractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contracfar, that may 6e an indicatian thaf he is not proper(y licer�sed and is not entitled to permitting privileges in Pasco
County.
TRANSPOftTATiON fMPACT/UT1LlT1ES IMF'ACT AND RESt�URGE RECOVERY FEES: The undersigned understands
� that Transportation lrrrnpact Fees and Recnurse Recovery-Fees-may apply to the construction-of new buildings, change of
use in existing buifdings, or expansion of existing buiidings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned aisa understands, that s�ach fees, as may be due, wi11 be identified at the time of
permitting. It is further understoad tiiat Transpartation lmpacfi Fees and Resource Recovery �ess must be paid prior to
receiving a '"certificate of occupancy" or final power release. !f the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasca Caunty WateNSewer Impact
fees are due,fhey must be paid priar ta permit issuance in accordance with applicabie Pasco County ordinances.
GCiNSTfZEJCTION �IE1V I.,AW{Chap�er 713, Fiorida Statutes,as amended}: If vafuatian of work is$2,5Q4.00 or more, !
certify that l, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other fhan the°owner", I cer�ify fihafi i have obtained a copy of#he above described document and promise in good faith to
deliver it to the`bwner"prior ta commencement.
CCINTRAGTOR'SIQWNER'S AFFIDAVtT: [ certify that a!!the infarmation in this application is accurate and that a!!work
wili be dane in compliance with a!! applicable laws regulating constructinn, zoning and land development. Application is
• hereby made to obtain a permit to do work and instailation as indicated. I certify fhat no work or installafion has
commenced prior to issuance of a permit and thafi all wark wiii be pertormed to meet standards of a11 iaws regulating
construct'ron, County and City codes, zoning regulations, .and land development regulations in the jurisdiction. l also
certify that l understand that#he regulatians.of other government agencies may apgly to the intended work, and that it is
, my responsi�ility to identify what actions 1 must take to be in compliance. Such agencies include but are not fimited fo:
- Department af Environmental Protection-Cypress Bayheads, Wetiand Areas and Environmentaiiy Sensitive
Lands,Water/V1/astewaferTreatment.
- Southwest F(arida VUafer Managemerrt District-Wel(s, Cypress Bayheads, Wetland Areas, ACtering
Wateccourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- .Deparkment of Health & Rehabilitafiive ServiceslEnvironmentai Heaith Unit-We11s, Wastewater "i reatment,
Septic Tanks.
- US Environmental Protectian Agency-Asbestas abatement.
- Federa!Aviation Authority-Runways. � � . -
I understand that the following restrictions apply fio the use of fill: i
- Use offii(is not al(owed in Flaod'Zone"V"unless expressiy permitted.
- If the fi1l material is fio be used in Flaad Zone "A", it is understaod that a drainage plan addressing a
"compensating volume" wi!! be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.�
- If the fill material is to b� used in Fload Zone "A" in connection with a permifted buiiding using stem wa11
construction, 1 certify that fi11 wi1l be used only to fill the area within the stem wa(l.
- If fill material 9s ta be used in any area, 1 certify that use af such �!I wi!! not adversely aifect adjacent
praperties. !f use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permif applicafiion, for lo#s less than one (�i)
acre which are elevated by fi11, an engineered drainage plan is required.
1f i am the AGENT FOR THE OWNER, ! promise in gaod faith to inform the owner of the permitting conditions set farth in
this affidavit prior ta cammencing corsstruction. ! unders#and that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other insfiallations not specifically included in the application. A
permit issued shal( be construed ta be a license to proceed with the work and not as authority to vioiate, cancei, aiter, or
set aside any provisions of fhe technical codes, nor sha11 issuance of a permit prevent the Suilding O�ciaE from thereafter
requiring a carrectian of errors in plans, construction or violations of any codes. �very permit issued sha!!become invalid
un{ess the work authorized by such permit is cammenced within six monfihs of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time fhe work is commenced. An extension
may be requesfed, in writing, from the Buiiding Offtcial for a period not to exceed ninety (90} days and wili demonstrate
justi�able cause#or the extension. If work ceases for ninety{90}consecutive days,the jab is considered abandoned.
WARNlNG 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 . i
WtTN Yt3UR�ENDER OR AN Al'TORNEY BEFORE RECORDING YOUR iUt3TtCE OF COMMENCEMENT.
F�OF2lDA JURAT{F.S.9't7.43} I
OWNER dR AGENT��__�����_� _ CONTRACTQR__�G�l��� YL y`L'�'w"`
s ribsd and sworn or ffirmed befgs� e this �Sa c ibed and swom to'ar #Fir ed beforg�ne this
1 � by R.`� 1 ts er� Y�Y"i c.jL ! 1 / by �h�e� !�✓•1-�-i'"r G�G.
islare persona3{y knawn to me or haslhave produced V�o�sl e persanally known to me or haslhave produced
L, fl��ver� L�cenS�asidentiflcation. _/'U• �flVe�Ps LICG.�&� asidentifiGation.
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Commission No. �� � � �J tp% % Gommission No. � p �cv� /
N me of Nofary typed,printed or stamped Name of Notary typed,printed or sfamped
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I City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: ��l��f'��s'� /'�L����!C_-
Date Received: �"� �"�!D
Site: ��� 7 D — " I
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Permit Type: y� �LZyVti6 r°if.t. t�yf �"G°`�' �
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Approved w/no comments:� Approved w/the below comments: ❑ Denied w/the below comments: ❑
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This coi ent sheet shall be kept with the permit and/or plans. ,
7`�� ���
B'- – cial Date Contractor and/or Homeowner
�; ��� (Required when comments are present)
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� `� Mike Fasano 2015 Real Estate Tax Notice �
�
�; Pasco County Tax Collector
. : „�.�������d��„ NOTICE OF AD VALOREM TAXES AND NON-AD VALOREM ASSESSMENTS
� . - • . .- . . �
� �11-26-21-0010-02600-0010 30ZH Pay your taxes online at www.pascotaxes.com �
, �
��� PATRICK STEVEN J & KATHLEEN & PATRI 5817 8TH ST �,
'� 5817 8TH ST
CITY OF ZEPHYRHILLS
ZEPHYRHILLS FL 33542-3607 �
, PB 1 PG 54 LOTS 1-3 INCL
BLOCK 26&Si/2 OF VACATED
� See Additional Legal on Tax Roll
Ad Valorem Taxes '
� . • . -. . - ..- � -. - - . . . - - - - -.
- � COUNTY COMMISSION-OPERATING 727-847-8980 7.6076 63,535 0 �`� �u'' 63;535 483.35
SCHOOL OPERATING STATE LAW 727-774-2268 5.6090 63,535 0� � � 63,535 356.37
SCHOOL-CAPITAL O�TLAY 727-774-2268 1.5000 63,�35 0 63,535 95.30
' CITY OF ZEPHYRHILL� 813-780-0000 6.3500 '63,535 0 63,535 403.45
SW FLA WATER MANAGEMENT DISTRI 352-796-7211 � 0.3488 63,535 0 `63,535 22.16
PASGO COUNTY MOSQUITO CONTROL 727-376-4568 0.2336 63,535 0 63,535 14.84
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Total Millage 21.6490 .� Total Ad Valocem Taues. $ 1,375.47 '
' Non-Ad Vatorem Taxes '
� , . � . - -. . � .
� COUNTY SOLID WASTE ,o� 727-847-8123 �,�,�`��b ����o ; � 62.00 '
,/�0 0 � �a° i ���,
�1���J����� � � 4�0� �^�;,�
5 � � •
Total Non-Ad Valorem Taxes $� 62.00 �
� Total Combined Taxes 8�Assessments , $ 1,437.47
� If Paid By No 30, 20 Dec 31, 2015 Jan 31, 2016 Feb 29, 2016 Mar 31, 2016
Please Pay $ 1,37g,g7 $ 1,394.35 $ 1,408.72 $ 1,423.10 $ 1,437.47
Cali Center M-F 8:30a- . 21-4338•(727)847-8032�,(81�)235-6076�Or visit us online at www.Pasco�axes.com
. Pasco County Tax Collector Office Locations�
� DADE CITY - GULF HARBORS - LAND O' LAKES - NEW PORT RICHEY - WESLEY CHAPEL
Your r.heck is vour receiof, or vou mav visit our website. www.pascotaxes.com, fo print a receipt.
���-� �e�n P�}�r��k
Name
�3'8i� S+�' Sf..
Address
2e�h��rl�� lls _ �'L, 33S�-I��
To Whom It May Concern,
Please be advised that:
Spenser Bahr, Suzanne Bahr and Kathy Mims of FBC Plans &Engineering
have my permission until further written notice to act as my agent to sign and pick .,
up permits.
Sincerely,
s�o��.� ���
Signature
� - �- � �
Date ' -
NOTARY
STATE OF FLORIDA, COUNTY OF PASCO
The foregoing instrument was sworn to and subscribed before me this � day
of ��, 1.1 , Zo I L .
Personally known or Produced identification � ✓ rL• (��'��e1s �c e�rs �
�
e=��'RYPue4pi_ �ANCY J BROOKS
" •' MY COMMISSION#FF093699
:N�`: 'OQe /' �
-•',��oF�o?;.� EXPIRES February 18.2018 1 /1/] � "" `l��r��- ",!/
(ao�)sse-0153 FloridallotaryService.com `� � LUvr✓G�'� �
Commissioned Stamp Notary Signa
and Expiration Date
Frorri: 05l18J20�� �0:49 #d-�4 P.00�
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� DxSCLOSiTRB STATSi+1�NT FOR O�PNER
�
GITX OH Z8P13YRHTLLS BIIILDIIdC3 bSPAR'iRdBNT
�, x. I�l�'7��'Pl� ��'�Y'7C. !L ��.�re rea� a�ad L�1].g us�uerai�snd �ad
' agree to the pravieions af �his 3astzumeat.
The�undersigned s�atas aad a£fisme that h� or ahe ie desiroua af coastructing,
reaovating, x�dctiag to or reroofing hia �r her own dom3ci3.e, that h� or ehe
ac�tiially occupies, or wiil occupy by said domiG3le, aad eame is not for
rea�, lease or saZe. T'hat he or she shall compl.y with the £ollawiag coaditioae:
1. 'Pha� the owae� aad he or ehe aloae shall act ae the builder for all phaee� o�
canstructiaa.
2. That the owaex� will comg2y w3Ch a].Z provis�ons of the City of �ephyxhills
ordi�naaces aad codes pertineut to Che build3ag.
3. That 3n tha eveat variaue phases af aoastruct3art are subcoutracterl. he �t.11
engage oalg pxo»esl�r liaenaQd su3�aonbraators and will peresoaal�.y supezvise
such �vo�lc.
4. That ia �he eveat tbe Bu9.ldimg =aepea�ar shali xeguire aazractioas �.o be made,
ithe o�vaer wiil assvme full respoaeibility ta iaaure �hey are made, and upon
con�pletian will ca11 �or a refaepect3an beEore groceadiag with the building.
S. That the owaer shal.l aaeume �'ull reapaaaibility �or the cascetrnctioa aad wili
aat e�sect snpesviei.on of h3s work from the City o� Zegl�yrhi.11s Suilding
i D�����za�.
6. Tha� psiox to final fnapectiaa any addi�ioaa2 �e�s, i�ncluding reinspectioa
� fees, mus� be paid 3.a �ull. 1�1 wr3ttea r�queet �'za� t3zis o£fice slza3l
icoas�itu�e an affiaiai notice ko �►ay ad8itional fees.
' 7. That the awaer eha11 camply �arith �Z1 Ci�y, atate aad P'ederal la�ta ia regard to
Sac3.a2 ser.ur2tyJ woa'kma�'$ t�iQmgan$at�.oa, l.s.ea I.aws, et+r.., SQh�re t�y3g]."a..r.abl.e.
8. That the owaer shal]. comply with all the ea�ety codes isaued by the Florida
� �1���BLL�6� LWiYYLOO�CtE�s
9. 3ta�e law requires coastruoticn to be dane by iicensed con�raators. You I1ave
j appl3�ed Ecir a permi� uader an exetttptior► to that �,aw. The exempt3oa a�llows
� you, as t.,2�te owasr cf yaur groper�y, to act as ya�cir otra contraetot watth cextaia
reetr3ctians e�vea though you do aot have a liceuee. You musb provide direct
oasi�e supervieicu at the con��suction yourself. You may build or improve a
� oae-�amily ar �wo-family resideace ar a €arm autbuild3ag. You may alaa build
oz im�rovr� a commnrcial buildiag. Prov3�i�a �^v�r� ����s �a �r�� �cea3 �'35.00Q.
The }suiidiag or residea�e must be for gour owa use or accupancy. It may not
be built or aubebaatisi3.y improved �or aaie or leaee. I� you se�I dr �ease s
buildiag you h�ve built or subetaabial�,y improv�d yourael� withia 1 year aftar '
the canstruct3an is c�lete. the la4r will presume that you built or {
substcasstir�lly imprcve� i� €os aa�e m� 3.e��ge, w}a�.�h is a vialatioa o� thip
exemption. Yau may aot h3re an unlicea�ed persaa ta act as yaur coatraatox ox i
to eupervise ��op1.e wo�ckimg aa your bui.lding. =b is �rou�r respoasibi�ity �o ;
�nake sure that peopZe em,�►loyed by you have liceae�ea required by state law and ,
by cauaty or muuicipa2 13.cen�3.ag ardinance�. Yau may aot de3egate the
reaponsibility for sugesvisiag work to a lic�used coa�ractor who ie a�ot
liceased �o pexform the work beiz►g doae. Any persan worki.ag oa your buildzng
- r+�1so ie aot liaenasd must work uader your direct eupervisiaa aad mus� be
emplc��►ed b� you, which �eaas th�t you aeust deduct F.I.C.li. and withhaZding taaocc
I and grovide workers' campeasafiian fcr that emglcyeer ax3 aa pse�exibad by iaw.
Your cans�ruc�ioa must compiy ovi.th all applicable lawe, ordinancee, bui2d3ag
i eodea, and zaniztg regul,atione.
QWNER�3 SIGNATURE � Gx;<x� DAT"E � �fa
�nnn��s � Z ! 3 2
o�o!?a, p- .
WIT��B ������%Yt� � P�RIdIT #
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� F8C Plans � 2016115584
Fio�� �, ' &Englneeting '� _._- .::. _ �--- � _
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P� � �����2' 07I25l2016 K. R. M., Dpty Cierk
Ad. Parce!ID No '. .-. _ _ . ..._ . ._
i / NqTICE OF C4MMENCEMENT
stace ar I (—�O�(i N Counly of �S��
THE UNDERSIGNED hereby gives notice thal Improvement wiil be made io certain reai property,and in accordance with Chapter 713,Fiorida Statutes,
the Co1loWing in(orrnatfon is provided in this Notice of Commencement:
t � Qescription of Property� Parce!ttlenti6cation No. ���02 G.•.2 I�" QC�f�-� d�(o O(} ^- � � ).,�
StreetAddress: �Q l7 �� S�• �/,.,r�i�jt� I"( �.'1"'S�/�-
2, + General Description at Improvemenl �f'd t.E�✓
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3. Owner information or 4essee tniormation i(the�essee cantracted tor ihe improvernenL•
fl��t��.. �r�/,�.�,�.
J t3��d�Y�S 7`me �, �2{)�,p 1r i��S �C. ���'
Address �— City State
Inierest in Property: ��jil.�..�--
Name of Fee Simpie Titiehoider
(it dif(erent from Owner listed above)
Address - // / Ciry State
4. COntractor !Yt P v1.U,(�K''/"� -��?�'/J/�Ph 2�//4�'�C
s'�'l��m�"r�+ S t �'.aok..� L:lr.� 1��-
Acidress ,�}j3Y/' City ���' State.���,�,
Contractor'sTetephoneNo, �S � 7�d^- S 5����.o
5, Surery;
Name
Address Cily Siate
Amount of Bond: $ Tetephone No.
6. Lender ��e��D� �,' �
Name
Address City State y�� `� `
W � A�
Lender"s Telephone No.. `� � • d�
� �r+ �
7 Persons vnlhin the Stale of Florida designaied by the ovmer upon whom notices or other dacuments may be served as prouided by � .��.",,£�'` a�+j�~`,} , �
SecUon 713,13(1)(a){7),Florida Stalukes: � �• ,�v' `' `��. ��
� ,�,..'sy `���`�.a„#� �.X� E19,.
� � r'"tF�"Ld`t,� ... �.�� "Pd1.,
Name T� a�=. rw .;'�oF"y,."a a
s�'p °' ����;��'�'„r'�;;<','� t �
Address City State Y�� }'��a u��� �"P��°z "�y;��
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Teiephone fJumbat of Designated Person: ���r �,� y T �`%�""e��,r
-- �V `�'.i.i.".��G.� �;;
8. in additiQn to himself,the owner dasignates o� �
to receive a copy of the Lteno�s Notice as provided in Sectian?13.13{ij(b),Florida Slatutes. �' '��
Teiephone Number of Person or Entily Designated by pvmer
9. Expiratioo date ot Notice of Commencement{the expiration dale may nol 6e be(ore lhe completion o(construction and finai payment to the
conirector,but wiii be one year frorn the data of rewrding unfess a diNerent daie is specited): Q �, I,LJ �
WARNING TO OWNBR: ANY PAYMEN7S MADE BY 7HE OWNER APTER THE EXPIRATiON OF THE NOTSCE pF COMMENCEMENT C!) �� [� �
ARE CONSIDERED IMPROPHR PAYMENTS UNDER CHAPTER 713, PART t, SECTtON 713.i3, FLORlDA STATUTES. ANQ CAN Q -' w V- (/) W
RECOROED AND PO TEtO ON TH�d08 Si E 8Ep0 EE HE FI ST MSPECTtON R!�YOU lNT�END�TQ OBT�ArIN F NA CI�NG,CONSUI.T �z � d x J �
WtTH YpUR�ENOEft OR AN ATiORNEY BEFORE COMMENCING WORK OR REGQRqWGYOUR NOTICE OF COMMENCEMENt. Q a C'3 (A J �O F�-
I Under penalty o!pet}ury,1 deCla�e that I hav0 read the foregoing notice of commencemeni and ihat�the facis stated therein are true to the best �"' ,,U�, w�� �� �
ot my knowledge and helieL �„ ��i
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S�TATE f7F FLORIDA �,�f--,� �O �a � C'c Q
COUNTY OF PASCO �C�L2� ��rx„u,� � Q
Signature of Owner or lessee,ot Ovmet's or lessee's AutAarized Z =�a�
OKoeNOirector�PaAnertManager � r � � � �
�q� �O Y
Signatary's TiOetOKce �j � � �
The toregoing instrument was acknow{edged h2fore me this ��day ot CJI ,_,20�G by />��l �.•��/(�°/� �� ��a � U
jas (rype af authority,e.g„officer,trustee,atiomey�n tact}tor � �'�' � � � ��
{ {name ot party on behalf ol w,n�om1 in',s,t,r,um!ent was executed). o a ��� Q
personaity Known Q O�Produced identification�j Not2ry Signature ���i �7�}'Lv� �U� �} �
h� � �l� G
Type ofldentification Produced�� (tU��2.D/}✓P�L✓ut,7s+G Name(Print) lILQ.,Y1 L:4f-��El/�O d f'L'S � � � Q Q
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� i:f�'.``s*3 NANCY J SRQOKS (3 F-�- �O� � ?-
� y, %! MY COMMtSSiON#FF093899 �
�''.�`orn�%' EXPIRES February 7g,n,�py8
. (4��)�se�ots9 Flor(tlallotaryService.cflm
wpdatatbcslnoticecammencement pc053Q48
'PRULR S 0'NEIL,Ph p PASCO CLERK& COMP7ROLL.ER
j °7��5BK019401 m PG 3505
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