HomeMy WebLinkAbout17-18244 , , CITY OF ZEPHYRHILLS '
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DRIVEWAY PERMIT �
PERMIT INFORMATION - LOCATION INFORMATION
Permit Number: 18244 Address: 4829 18TH ST
Permit Type: DRIVEWAY ZEPHYRHILLS, FL. .
Class of Work: DRIVEWAYlNEW Township: Range: Book:
Proposed Use: NOT APPLICABL.E Lot(s}: Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 14-26-21-0014-02200-0060
Improv. Cost: 5,000.00 OWNER INFORMATION
Date Issued: 3149/2017 Name: V111NDSOR IVIQRT�AGE HULDINGS GIIVIIT
Total Fees: 40.00 Address: 11920 VALERIO ST
Amount Paid: 4Q.00 N HQLLYWQOD CA 91605-3734
Date Paid: 3/09I2017 Phane: 818-809-9571
Work Desc: DRlVEWAY 30 X3Q
CONTRACTOR S APPLtCATItJN FEES
AROUND THE CLOCK EMERGENCY S (352)206-1 C DRIVEWAY 40.00
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D E W „- ^""
Ins ections Re uired
FINAL �
REINSPECTION FEES: (c)With respect ta Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
loca!governmenfi shatl impase a fee of four times the amount of the fee impased for the initiai inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permitJ there may be additional restrictions applicable to this praperty that
may be faund in the pub(ic recards of this caunty, and there may be additiana( permits reqvired 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
"1Narning to owner: Your faiture to record a notice of commencement may result in your paying twice for
impravements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Comp(ete Plans, Specifications and Fee Must Accompany Application.
A work shall be perfarmed in accordance with Ci Codes and Ordinances
CON C PERMIT OFFI
PERMIT EXPIRES IN 6 MCINTHS 1NITHOUT APPR4VED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED �
PROTECT CARD FROM WEATHER
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PERMIT�APPI:ICATION " `��:.-� •
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DRNEW/4Y:P.ERivM�IT.A�P.PLICAT:IQN
aCO�lSTRU.CT:I�N 1NITM�N>PUBLIC�RI�H�'--O.F=WAY
A� Infiormatlon�be-fllled-In completely
:Ci�y.of:Zephyrhills
'S335 8�'Stree�Zephyrhlll�,'F.L 33542
Z'elephone.813.780.000Q . Fax 813.780.�Q05
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__ =�RO�ECT.70B{ ITE: �PR�PERTY'OWNER
Address: - Name: / v • SOd• • Y. ��,c � fy tS L •�i�c�'s'""
�Unit#: - � Addressc - - ! ; r" _ Uni .
, . Parcel Identffiratiori Number: --: - - Ci State �"i �, :Z�a:,; „- 1�Ll t `
- - - - _ - ; �Phonec � -- > • Fax: �
•�ONTRAGTOR:� - _- - - - _
ComRanY� fn�.z.� +.t bG-� �✓�llf L-���
=Name: .2.�` �
ContractaCs lloense#: - � I !y�' - ,-,.. E-Mall: ra .t� Le� 1."� - ��� C".a��
' .Phone:- .�"�I�-- Cell: 2�- IGl f� Fax:
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ARCHITECT/6NGINEER:
'Name: '{� ��' Rrm Name• 1�� {�. � - -- - -
Addrn.ss• Gtv' - Sta�� - - _Z'ip•
State Uoense#• Phone: _ Celh Fax: � �
Deserintion of proiect - -
K �l.EN6fH OF DRIVEWAY CULVERT'5�NEEDED
RESIDENT7AL bRNEWAY „j�_WIDTH OF DRNEWAY � )RQNFpRC�CapICRETE
CbMM�3tQA1.DftIVEWAY R.d.W. �7CGAVATIdN ( )�p{�J�,p'�p'�47�q�
PUBLIC ACCE'S DRIVEWAY DEPTH LINEAR FEEf ( )BmC dJLVERT
� )O7HER(ACPi11IN)�`
CONSTRUCTxON MAT�RIA4 CURB CUTRE UIREb
ASPNALT YES Np --
�_CONCRETE
JIEADW�.�REOUIRED2 YES �` NO
NOTICE Tg,gPP�NT: If actual woric exceeds scope af this slescription,additional permits or drawings �
will be required.
UTILiN LOCATIONS REOUIRED: CAIeL BEFORE YOU DIG: 1.800.432.477D �,
Page 1 of 3
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1 PERMTi APPLICATXON
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UnLtRES LOCATE CONFIR�lA'RON NUMBER: � �,y� �
I�R171/IDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQtJI�RED,ATTACH TO THIS � � � �
APPLxCATIQN. '= � �
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AFFIDAVIT: App(#caficsn is hereby made to obtain a permit to do work and instailations as Indicated. I oe�tify that ali fonegoing
lnformatlon Is accusate and t�tat ap uuadc wil!a�mply wittt aq apptEcabte cades. i understand these cndes sha11 take preredence ov�r aii
approved o�structfon dacuments,,and issuance a�f th(s permlt ts veriticadcan that I w!!I notify tt►e pmperty owner of Fbrida Uen Law
req,,F.S.713.
The lssuance of this permit does not ensure cnmpliance with deed re.strfckions and I understa�d that additiona!deed
restrictions rr�ay appty ta this properly.
Ail wrork sfiail compty with the cument Fiorida Buttdln�C�de,PublTc Works Design Nlanual and FDOT Des➢gn
StandaMs ttP appliCable). (Pablic Works C7esign Ntanuat anline fink;www,ci.xephyrhNts.fl.us/pubtk_works.asp)
APPLiCATION iS VOID UNLESS SIGNED 1NITH PitUPER IDENTIFICATION AND WiT1VESSED 8Y A PERMIT
7EC�iNIt�4N�R NOTARY PUBLIC,
NOTE: 'i'he City o}2epfiyrhills ts not rcspansfWe!arc mainten8noe or repairs of driveways. Driveways shall nat alter/
interfene with exiating atormwaber#re�bnent and J or aanv+�ayance.
PROPERTY C3W ER�: 8y SlgNng thts applic�tlon: I .r�rtify that I have rea��and underskand the owner/builder disclasure
sbt_ment �•d�'' (ptease in1t1a1) /
� r�L�•� G�p_ vl�d � { d`
Appllcant Print�latne Ap�lica t St ture ti Date
Fet'tNtNt Techntdan Slgnat�re (flr)Nabry S(gnature Dat+e
ApppcaM is( )persoaaliy Imown to me ar produced as identiflcatlon.
�tYPe of trlentiFicatiart)
Page 2 of 3
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H.PEDPSI'RIt#N ROUTES If en existing dcsigoated pedcshian route(sidewalk)iWersects
with a proposed or revised driveway,the driveway portian thet aligps wIth the pedesttian route/
sidmvelk stiall ba constiucted to ADA stendecds end shall include sn expansion joint on both '
sides of the sidewalk.'Itese expaasion joints seperace the sidewalk fram the d[iveway in the everrt
oFtcpairs or xeplacement of the sidewalk.
I.DRIVEWAY MA'I'ERIALS lt�e portion of 16e driveway]ocatod within the public right-of-
way shsll be con,truchd of conerete ot asphalt Any other type af mate[iel shall be approved by
the Diieator of Public works.Coczcicte drivcways shall bc e minimum of six(�iaches in depth.
Asphatt driveways sfiall mcfude a lime roek hase no less t6�six(6)laches in dtpth and the
asphalt shatl be a minimum thiclmess of one-and-one-half(1-12'�ittehes in depth.
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� pEf�MIT AppLICAi"xON
OF�ICE US€Ofii[.Y
!'�l�BLI�If�dRKS i3SE t3NRY � .
cottcr�t� (mtr�.6"a � Y;- , N
As halt Base(mfn. 6 Y iV - �
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AsphaR{min. Y�la'� Y N ` � '
lengtFr min. 19 � N
Width(�.U'min—20'max) � 'Y N
Existln •sidew�lk. Y '
New sidewal�. Y
ADA c4m lant. Y N +��
nsion mat�erla! ufred. Y . N
ContJguous arking pad. Y . , N
Triangufar Flare(3'W x 7'L) ` N
Visib111ty trlangle o.k.a N
Side set badc 3`min.1L0.W,) N
, Plan Revlew Fee -
�Addllionaf d���aiaa°a#wack�€;e�ie�+�d� Pijbfk 1Narlcs DTr+ector�nd-or`deaivia ; •
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Pecmit ai7piitatior�appraved by: ` Dafie: �Aa�4 2 11
Pege 3 ofi 3
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
� , • Building Department
Date Received •phone Contact for Permittin —
9 - .
Owner's Name / S�` �Y�� � � Owner Phone Nytmber O U ^ ' �� /
7 � 9 �pl Wo��
Owner's Address �1 g�a D (.-�t�(� � /l/�Y er Phone Number
Fee SimpleTitleholder Name �/`���� S?'� ��v�,C ,� "�'�Owner Phone Number
Fee Simple Titleholder Address / � < `� v .W ev'� S T �Or�� (� F�� CQ `^
JOB ADDRESS �?5 0� / I i5 � `-' � � LOT# �
SUBDIVISION ��dO rt'`S � �d v' PARCEL ID# �1��-a � ~�v/O ��°���� �O�v
(OBTAINED FROWI PROPERTY TAX NOTICE)
WORK PROPOSED e ,. NEW CONSTR B ADD%ALT 0 SIGN Q � Q DEMOLISH
INSTALL -REPi41R
PROP.OSED USE Q SFR Q COMM 0 OTHER : / G—
TYPE:OF CON$TRUCTION Q BLOCK • Q FRAME 0 STEEL Q
DESCRIPTION OF WORK � ��U� � �� ! /�/U��-UG+` .
BUILDING SIZE � SQ FOOTAGE� HEIGHT •
QBUILDING $ VALUATION'OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � / /�Z- �y�
� v /
QGAS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER �� COMPANY ✓0� � � G G���p��'P�c
SIGNATURE REGISTERED Y' N FEE CURRE� Y/N J
Address Y� d�t� I�J �{�-vGc>u�s �icense# �� � I�d���
; "'ELECTRI,CIAN : COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N.
Address` - License# �
PLUMBER.;_ COMPANY
'SIGNATURE REGISTERED Y,�/ N, = FEE CURRE� Y/N
Address. � License#" .
�- .MECHANICAL � COMP.ANY
SIGNATURE'' ' REGISTERED ; Y/ N Fee cuw�en Y/N
Ad`die"ss��` � ' � License.#
�,;�_: . ... . .
'�:.OTHER:�,;',". .. COMPAfVY
, .:'SIGNATURE.� c= ' � REGISTERED Y/ N . FEE CURREK Y/N
�:._ , _ ,, ,
Address�:.. _ � � - ' � ' License#
���RESIDENTIAL:^�;. .Attacli::(2j;:PIot�P.lans;'((2):sefs�of�Building�Plans;(1�)`set of Energy,F�or"ms;R=O-W Peimit.for new,construction,
•� '••-� •--�,�Minimum:ten,(10)�working;days afte��subinittal:daCe::Required�onsite;GonstiiicUon Plans;Stormwater Plans w/Silt Fence.installed,
..q�N.,�.;°-,t...:... . ........ . _ , .
_- ' Sanita.ry.Facilities;8�;1,dumpste_r:,'Sife;Wo[k Permitfor.,subdivisionsAarge�projects� ' _ _
-�Y;COMMERCIAL Attach-(2)�complete sefs`ofBuilding Plans�plus a`Life Safery 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,
I' ,::` Sanftary FaciliUes&1 dumpster.Site Work Permit fo��all•new projects.All commercial requirements must meet compliance
S.:SIGN��PERNIIT 'Attach'(2)sets,of,Engineered,Flansi�� �
•s' � •"'•PROPERTY SURVEY required for_aII.NEW construction. -
`�j:i,`a .
�::-Directions:. -.. .,. ,
, - - � �Fill-.out application completely. ,
� o.wner:&Con c r ( n back I tion notarized
tra to s of a ica
9 PP
� If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
."' Agent�(for'�th'e�cont�actor)�or Power of'Attomey(for tFie owne�)would tie someone with notarized letter ftom owner authorizing same
„... , _
,',OVER:;THE�COUNTER�PERMITTING. ,.(copy..ofcontract•required)� '�' '`�
;"=Reroofs if'shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
�. Driveways-Not over Counter if on public'�roadways..neeiis ROW �� �
...
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NOTICE OF DEED RESTRICTIONS: The undersigned�undecstands.that,.this�peemit may be.subject:to"deed",restrictiori`s">��''S
�; ��,::=:''; - - ;. ..,: � ..r::,:.,.m�.:=,:.=,: _- ,�:., r-:;t-.�f.�.:;�,-..�;:•7-�- _-$���z`�..,:f�
wliich�,may�be�more�;cestrictive�than;_Counfy_cegulations. Thezundensigned�assumes°responsibilityfo��eompfiianceanntli``ariy; r:
applicable deed`restrictians. . � ' ;,��,�::;�_��•-��::, .�;�,i;r:�
UN�:IGENS.ED ;CONTRACTORS AND CONTRACTQR RESP:ONS18![:ITlES:'��1€•fhe�-owrier;has•�-lircec!'�a���eonfraetor or
contractors to undertake work, they,may.�be;;cequired to be�licensed in acaordance with state and;local regulatioms:.:='Ift'�ttie~�'�::�,:��
contractor �s not:licensed..as�cequired`'tiy�'law, both.=the owner and:canttacfor-=r»ay�be�c�#ed�fory;a`-m�sdemeanor uiolation• ,. �".�
under state-iaw. If the owner or intended�._cont�actor are'uncertain as to what licensing requirem.ents.�rnay�.apply��far;�tkie;���s'�;'-'s
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intended wark, they-are advised to contact the"Pasco County Building Inspection`D�'ivision�:.icensing_Section at 727=847= 1.
8009. -Furthermore, `if the owner Fias£�Fiired a contractar ar contractors, he is advised to��jhave tiie:contractor(s)nsign�;.,�„y`
porkions of the contractor Block of this application.far which they will.be responsible.- If:yau, as'hfFie�awner`sign�:asrtlae ''"'��,;
contractor., that may be an indication�ihat he-is not praperly licensed anti�is not"erititled�to�perm�tting��privtleges�in_,.Pasca,,;.;,:,;�
County. � �-�•. '
TRANSPORTATION-IMPACT/.UTILlTIES�IMPAGT AND RESCIURGE RECOVERY'FEES:-AThe undersigned understands ..,�sii
- o-_- -.�. . :
that Transportation Impact Fees and Recourse Recovery Fees.mayaapply to the const[uctian of new:buildings,.ciiange.�of'�.�':;�,
use in existing buildings,;or•expansian.of''exi"sting buildings, as specified in Pasco County Qr.dinance number 89=0,7�=.and ''°
90-07, as amended. The�unders�gned also,understands, that such-fees, as-.may�b,e,due, wili:�e�identified�at�tfi�e�:tirtie�af��;,;}-`:'.•
permitting. �If is further understood that Transpartation Impact�Fees�and Resource��Recovery Fees must be paid pcior,to ,.
receiving a°certificate of occupancy.° ar�final.power release. !f the �roject does not inuolve,a�certifrcate cif accupancy:ot.�:��:a�:;
finalupawer re(ease,.fhe;fees-must be.paid Prior to per•mit issuance.,.Furtfiermare,..if}pasco County W:ate�/Sewer,-lmpact�.;rµ� �
fe.es are due, tfiey.must:be�paid priar.to permit'issuance in accordance with applieable Pasco.Goun#y ordinances. �
GONSTRUCTION�CIEN�i�A�t1t-{Chapter 713, Florida Statutes,as�amended): If vaiva#ian af work is$2,500.00,.or mar:e;Mt.;;:;�ry �
certify that I, the applicant, have been. provided with �a capy;:,of the "Florida Construetian.�Lien-.Law:Homeownec's y ,
Protection Guide° pcepared�bjr ttie Florida.�Department of Agriculture and Consumec.Affairs. If the applican#�is;s.omeane;,.,.
other than the"owne�',;I,certify that.l�have obtained a copy of the:above described`document-and promiserin,good�;faith;to,�„ .
deliver,it.tb the;."owner"r°priorato;:coirimencement.� " ' - =
CONTRACTOR'S/OWNER'S AFFIDAVIT;.M�;I:certify,fhat ail the.inforrnation in this application is accurate and'that all'work
will be done in compliance wlth all applicable�law's regulating construction, zoning�and land;develapment. Applicatian,is ,
hereby made ta-obtain•,;a,.:permit:to�.;:do;�wor,k�=arid installatiort,�as.:indicated. E certifjr thaf na=wark or.installat9an�has
commenced prior to issuance of�a p.ermit,and-•that all work will be perfarmed to..meet standards of all laws regulating
canstruction, County and City codes, zoning regutatians, and land developmen# regulations��in the jur�sdic#ion. =t also s-
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 campliance. Such agencies include;but are not limited.,to: `;�
- ;Department of Envlranri�tental?'Protection-Cypress 'BayFiead`s; Wetland Areas and Environmentaily Sensitive
Lands,Water/Wastewater Treatment. -�
- Southwest Flarida Vllater Mar�agemerit District Wells, Cypress Bayheads, Wetland Areas, Altering <
Watercourses. .
- Army Corps of Engirieers-Seawa(Is, Docks; Navigable Waterways. �
- Department of Health & .Rehabiiifative Services/Environmental.Health Unit Wells,..Wastewater Treatment, ;
Septic'Tanks.
- US Environmenfal Protectian Agency-Asbestos abatement. _
- Federal Aviation•Authoriky-Runways. ' � .
1 understand that�.the fo!lowing restricflons apply to fhe use af�Ik -
- Use of fit(is not allawed in Flopd Zone"V"unless expressly permitted.
- If the fi!! material� �is to be used in Flood Zone "A", it is understood that a drainage plan addr�ssing a
"compensating volumen will be submitted at#ime of permitting which is prepared by a professional engineer '
licensed by the State of Florida.
- If the fill material is to be used in Flaod Zone "A" in connection v�rith a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- !f fill materia! is to be used in,any area, ! certify #hat use of suah'�fi11 wilt �ot adversely affect adjacent
proper#ies. (f use af fill is found to adverse(y affec# adjacent properties, the owner may be cited for viola#ing
the conditions of the building;permit issued und"er the attached-permit.application, for lots less�than one {1}
acre which are eleva#ed by fill,an engineered drainage plan is requi�ed.
If I am the AGENT FOR THE OWNER;-1�promise in goad faith to inform the�owner of-the permitting:conditions set forth in �
this affidauit prior.to commencing consfri.ic#ion.'� I understand tha#a separate perniit may be required for electricat work,. i
plumbing, signs, wetls, pools, air conditioning,,gas,. oc�otfie� installations not specifically included in the application. A
permit issued shall`.be construed�to�'be a license-#o.proceed with the work and not as authority to violate, cancel, atter, ar
se#aside any pravisions af the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter `
requiring a correctian of errors�in plans, construction.or violations of any cades. Every permit issued shall become invalid
untess the wark author�zed by such perm�# is commenced.within six months of permit issuance, or if wark authorized by
the permit is suspended.or abandoned for a p.eriod�,of six(6)�`montlis after the time the work i�commenced. An extension
may be requested, in`writing, f�om the.Buifding C?fficia! for a period noi to exceed ninety{90) iiays and wiil demonstrate
justifiabte cause for the extensian. .if work ceases for ninety(9Q)consecutive days, the job is cansidered abandoned. �
WARNING�TQ OWNER: Y UR �AI�.U.RE TO R�C.O,RD,.A N�TICE OF COMMENGEMENT MAY RESULT IN'YOUR__ _. . .
PAYING TWICE'FOR IMP .,1/EMENTS_TO,YOUR.;PROPERTY..,IF YOU.,INTEND~TO�OBTAIN,FINANCING, CONSULT
_ -_�!!T'H XQUJ�'I:E#�d?El�.- -Ad�- ��- �- �!�`F �'4R��:E��E�Di��'Yt��R`°N- - E=�F°�Oiittii�`vSE�f " E�'�:—__— _ _
�'LORiDA JURAT .5.1 7 -
QWNER OR AGE CONTRAC R
Subscflbed and swo to( a rrned}before me tfiis Subscribed a to(or affirrned)before me this -
by �y
Who islare personally knawn ta me or haslt�ave produced ~ Who�stare petsonaliy.known to me ar haslhave praduced
as idenUficatlan. z�� as identificaUon.
Notary' Public Notary Publlc
Commission Na. Commission No.
Name af Notary#yped,printed or stamped Name af Notary typed,printed or stamped
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2017033317
• . . Rcpt:1844242 Rec: 10.00
DS: 0.00 IT: 0.@0
03l09J2017 E. t1. , Dpty Clerk
PqUl,R S 0'NEI�,Ph D.Pp5C6 CLERK & GOSM1PTR�LLER
�TOTICE OFCOMMENCEMENT 030R9BK0195@7 m PG �4Z
Pccmit No. �"'i� /1/F - •- -.. _ . .- -- -
Fzoperty Ide�ific�tion Ha. •
'I7�:TJND�RSICaNED hexeby give InSormv you thet the iruprovoment wIll be mede m cecmin rcel property,end im eceordsace with
Sectian 723.13 of tha Fiorfda Smmus,she foltowiag infarmasiott#s praviacd ia tlsis 2Vi}TICE QF C4MMENG'8M[ENT.
' l.Desaiption ofProP�Y��'8'al dcs tp8oe) 01. 7 � cJ / /- �- �-�����~G7d�e�
a)S�eet Addiess: rS
2,C3eneta2 desciipiidn of impravemenb• C r
3.Owner Info�meHtm f, , � '/
a}Namo and addxess� f�-�'I h�(�,'��y+ /�D���e,.p f7� t�Zu.,1' j .
b)Name ahd address of fee simple titlaholda("af othei than ow ,,,�f __... ,� l!�r r1 I G1„
c)Inte�st im�PraP�"h' �(„���"s'-�
� 4.Goatr�cibrInfezmatina . J / �, ` d
a}Namaeadaddress. �+C- GJC� /U�+�r :3�'�"f y /YCL ���/y� ��7"y.�.-
b)Telep&one No.:,,,������„�,/pj_� . Fmc No.(OPW._.._ „,� /`�u-
S.StiaetyInformetioa ��1�7i�
e}Name sad'sddress: �! �-
b)Amoupt ofBond:
e)Tclephone No.: • ' Pex No.(Upt)
6.Lender'Neme and eddra9: �!�
Phoae No.
T.ideatisy of geisan witLin the S �te�f�Plmida�2 d y awaez stgon wham 'ces oF dncs�eutsm�y be servg d' ��...� .�/
a)xame end aadRas:_17Lt = •'i E�t� :�`y�r�"' �+"iS�.vtott:u t/!�^W �R�
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b)Telephpne�o.• "� ��!}iafollo ': /�� FexNo. . , ..
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81n edditton to himsal owner desi wzng pecson to xecoiyq a copy ofthe Liennr"a Notice as'proridsd'm Seetion �
' 723.23{I}(b}Ftonda Smiuua: � /J _'� y� L.�'Q-H D ��� ��
a)Name ead address: ✓�G-rY I1� NR�' ���� ���w�'�
bj Telephone No.:!�'�,�''"`�L� f M _Fax No.(Qpt)�' � �r
9.F.x pua Hon d a c e o f Na tice o f Commtncem e a t �b.sex�h fl f ion d a t e 3 s one year fr'otq t h e t i a�a f r e c a x�d�g u n Trss a d i R'e teat d a f a is
specl6ed): � h/L/)n`-�'�+�.-f-t
WA�R�11+IG'CO Ot?VNEiL Al�tY FA'PlV�NTS MADS ITY�dWNiS12 AFTER T�EXPIRATION OF T�[E FFOTICE OF
�OMML�IYCEM�+.NT ARE CONSID$RED�OPER PAYMElV1'S UN�ER CSAPTER 713,PART T,3SC1101V 713.13,
FI;ORIDA STATf1'1'ES;AND CA2V TtBSUl.T IN YOUR PAYII�TG TWICE PbR IMPRO'V�&MEN15 TO YOX1R�ROPERTY.
A NOTiCE QF C0143MEN�EMEPI'T l►3ITSZ'BE R.ECURD�D AND POSFEb ON THE JOB S1TE BEF4R&Tf�E FLftST
1NSPECa'XpN. IF YO[T IN1'END TO OBTAII`�FiNANCIlYG,�ON T YOU�L E[t OR AN A. RNEY BEFORE
CS�MMENCING WORIC OI#RECORAIPiCr XOUR PT� pF �N1:' .
SFAtEOFFLORIDA ` ��e',,.�`T'
COUNIY QI�PASCO
� L�a'r �nam/Patna/M�r ,, r �
LYr'�_.
P' ome
The focegotng{ostrument was aclmowlaiged befoxo me this 4! day of MA�3.CM . 2U�7,by Hl'3RoLD
W H b'Ktts.. aa �t3'Pe of suthority,e.g.officar.trvsteq attamay �
ia fact)fnr (neme ofpaxty on babatf of wham insttumeat was emceouted). i
PersonaEty Known "�R�'rodeued Idtntificetion,� Idatary Signafure�o�+G ��t� .
Typo of Fdeatificatian Produeed Name{pcmt) i�A'r"R�e tR L• �"('ar�n�f"au1 "
Vrsificalloa pursuant to Section 92525�Flarida Statutes.Undec pmshtes of perjury,I declexe that I have raad rhe fotep,oing and that
ftte facts stated'm it azs ttue W dit best of my kaoivledge sod beHeL
. r s;g�iswre attaenuet r+uaoa si�ilne Anove,:
FCW�bR�JHOC1'OG3WT
'.�"�"`� PA'FRICIA L JbHNSON �
MY C4MMISSION#FF18S$47
�o,ti�EXP[RES.December28,201$ � �
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�� � . : � G� �������'���C�IDA,�OU�lTY OF PASCO
� • � TMIS 15 7Q CERTIFY THAT THE FORcG01NG IS A
� ' � TRUE AND COftREC7 COPY OF THE DOCUMENT
� � �' ' .' ' ' ON FILE OR OF PUBLIC RECORD IN l'HIS OFFICE
x� �.a^�+���t � dx W� E MYHANDAN FFICIA�SEA2 T���
7!� 0 i�y.�c c�,_.,, C
'�-�! �� � DAY OF
'y� OMPTROLL R
�� "' � pA A S. O'NEIL,CLE
1�87 EPUTY CLERK
" ����� BY ��'
� °�T�Ti�6�r F4o