HomeMy WebLinkAbout18-19693 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 19 3
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 19693 Address: 37443 SERENITY AVE
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: VALLEYDALE RO ASSOCIATION
Est. Value: Parcel Number: 03-26-21-0170-00000-0150
Improv. Cost: 8,900.00 OWNER INFORMATION
Date Issued: 5/16/2018 Name: VANDERVEST GARY& PATTY
Total Fees: 85.00 Address: 37443 SERENITY AVE
Amount Paid: 85.00 ZEPHYRHILLS FL 33542-1847
Date Paid: 5/16/2018 Phone: 813-782-7050
Work Desc: A/C CHANGE OUT 3 TON HP
CONTRACTORS APPLICATION FEES
SUPER ENERGY MANAGEMENT LLC A/C CHANGEOUT 85.00
DUCTS INSTALLED Ins ections Required
DUCTSINSULATED
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 rinspection,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 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 BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
& &"40
CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 'City of Zephyrhilis Permit Application Fax-813-780-0021
Building Department
Date Received S P 4q j phone Contact'for Permitting° Z l l J V��
Owner's Name {' o L!S� Owner Phone Number
Owner's Address . �`Z S °�G 4�U�� ✓jT V Owner Phone Number
_e
Fee Simple;Titieholder Name- Owner Phone Number
Fee Simpleilitleholder Address G
JOB ADDRESS -7G►�� LOT#
SUBDIVISION PARCEL-ID#. 03 Er-_Z/--017 C) C.)I�Z1
(OBTAINED FROM PROPERTY.TAX NOTICEI
WORK PROPOSED NEW CONSTR ADD/ALT = SIGN 0 = DEMOLISH
8 INSTALL a REPAIR
PROPOSED USE _ SFR -COMM 0 OTHER
TYPE':OF CONSTRICTION Q 'BLOCK = FRAME 0. STEEL 0
DESCRIPTION'OF WORK
4
BUILDIWG'SIZE SQ FOOTAGE HEIGHT
=BUILDING. $ VALUATION'OF TOTAL CONSTRUCTION
i
ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY 0 W.R.E.C.
=PLUMBING: $
MECHANICAL $ q VALUATION OF MECHANICAL INSTALLATION
=GAS Qv ROOFING Q SPECIALTY. 0 OTHER
-
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
i
:.BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License#
.'`:'ELECTRIC..IAN. COMPANY_
SIGNATURE REGISTERED Y/ N • FEE CURREN
Address License#,
PLUMBER.. 'COMPANY:• .
SIGNATURE ' REGISTERED Y/ N: FEE CURREI. •
Address ` Llcerise#;
MECHANICAE — OMPANY. e('rc1�.�vte-9 •e�
`:`'- SIGNATURE"'' � "'`� REGISTERED Y/ N FEE C E� Y/
AddPess.r..., t ... V ti Licensee.#
OTHER:: ::.,:,;..: .. COMPANY
SIGNATURE;S;t;; : ,*. .:;. . _ REGISTERED Y/.N FEE CURREK
Address.; License#
aItESIDENTIAI:z., Attacli.`'4 1?Iot P.,lans 2=sets ofi;Bulldin .Plans'1 sef`of Ener Forms R=O Permit 'r new,constiuction
4Miriimum<ten 10.' Orkin"`da s'aftersubrtiittaldate::.'F2e u"ired':onsite'Constrlction'Plans StocmwaterPla 'sw)SiltFenceinsfalled
:..
Sanitary;Facllities:8�.l.dumpster;,Sife;:Work Permit forsubdivlsionslla;rge=:projects":... '
r COWIMERCIAL Attach(2)'complete°sets of`Biiilding`Plans'pliis a Life'Safety'Page;(1)set of Energy Fonns.R-O-W Permit for'new constructlon.
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 fog all new,profe6ts.All commercial requirements must meet compliance
'',=$IGN PERIWIT -Attach(2)'FiiR,,of,EngineerediPlans:.11- ,
h: ****PROPERTY SURVEY.required,for,alL NEW construction._.
rr,
Directions:`
Fill out�8pplioation completely.
'Qwnerj8 Contractor sign�back.of application,notarized
If over:$2500;.a Not ice.of:Commencement is required. (A/C upgrades over$7500)
Agent'(fo�lftie'.contMdtor)*or�Power•of•Aftomey(for�the owner)would tie someone with notarized letter from owner authorizing same
OVER;THE COUNTER:PERi tTI T.IRQ., _(copy of-contract,required)
N:yRorpofs if hIngles Sewers Service Upgrades'-A/C` Fences(Plot/Survey/Footage)
.Driveways-Not over Counter if on public%aluvays:needs ROW 4 Y
a t '
NOTICE.OF,DEED:RESTRiCTiONS: The undersi ned_understands:that:this;pet.mit,ma`.,:be sub'ectto";,de.od".restnct'66's ,J%
which;mayfe'mote.resti icfive=than#Courtly:regulations ?he�undersigi led assumes tesponsihitrty£for compliance inn#h oily
applicaible.deed restrictions.
UNLICENSED:,CONTRACTORS AND" 66N04*4CTOR REBP;ONSIBiLITIES - If°:the=ouvrier has_ ti `4contractor or
r
contractors to undertake work; they.,maybe r_equiredto bey licensed in accordance:with.stateanditoeal:regulations;
contractor.is not"licensed•as.required by`Iaw,=botl:=the owner and.'eontracttir maybe clfedafor a mild"emeanor.vioiation
under state:law.' if the owner or:;intended.cantractor, are:uncertain as-to what:licensing,.requirements irnaysfapply foil µthe-
intended works:#he�r:are advised'to`coritact'the Pasco County'Buildng;'.inspection`piv'isran Licensing Sec#ion at 727-847=
8009. •Furthermore, 'if the owner has'°hired`-a'aor tractor or contractors, he is advised to.;have"the;-contracto..r„(s.}.;sign;
portions of the "contractor Block":of.this-,application.far which-they.will.be responsible: if you,,as ffp�avner
contractor, that.may 6e an indication that he is not properly licensed'and"is not entifl"ed"'to`permitting privilegesyin`Pasco
7.3
County.
TRANSPORTATION-iMPACTLUTiLrriES-IMPACT AND RESOURCE RECOVERY'FEES:`The undersigned understands.. Y ,;
that Transportation Impact Fees and Recourse Recovery Fees may:apply to;the.construction"of new,buildings,.change oft`= ;`
use in existingbuildings,-or,0xpansion of'ekIsting`buildings, as specified in Pasco County Ordinance number 89.07'and,
90-07, as amended. The undersigned'.also.understands, that-such.:fees,-as``,.mayrl%e.due, wili"�be.identified°at�the=it 4r),ofy'I
permitting. -it is further understood thatl'ransportation Impact Fee's:and ResourcerRbcovery.Fees must be paid prior-to
receiving.a-°certificate.of,occupancy" or final power release. if the:project.does not involve a certificate of.occupon`cy,, F y'_'i'
final power release,,the 40es.must be.-,pald prior to permit issuance.:_„Furthermore,.if;Pasco County WaterlSgwer,impapf
fees are due;.,they,must-,be:,paid,prior to.permit�lssuance.in:accordarice with'applica, a Pasco County ordinances.
CONSTRUCTION LIEN1' (Chapter 713,Florida Statutes,as amended): If valuation of work is,$2,540 OO..or>more;,lx,-,,
certify that 1, the:applicant, have .been provided with-a .copy,.of::the °Florida.Construction Lien :Law-hlonieowner's
Protection Guide" prepared'by the Florida Department of Agriculture and Consumer-Affairs. If the applicant is:someone:. . .
other than the"owner",Certify that i.have obtained,'a copy of the.above'descritied:`docurrient a_nd,promise in;gaod';faith>:to
deliver it:td'tlrte"owner",,0nor�to.coinmence,ment. '
CONTRACTOR'S/OWNER'S AFFIDAVIT::=—,bbttify�that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws,reguiating construction, zoning and land development. Application is
hereby made to obtain.,a .permit to::do jvirork"-and. installation as":Indicated. 1 certify that no work or-Instaliatiori has i
commenced prior to issuance of'a permit and that all work will be performed to.meet standards-of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in she jurisdiction. y,;'Palsd
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 agencies include but are not iimited to:: y '
Department of Environn ental``Protectiaii=Cypress Bayheads Wetland Areas and Environmentally Sensitive
Lands,WaterMastewater Treatment. t
Southwest Florida Water Management District-Wells, Cypress .Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of E fig ineers=Seawalls, Docks', Navigable Waterways.
Department;-of,Health:;.& Rehabilitative. Services/Environmental:;Health:_Unit=Wells,:Wastewater.Treatment,`
Sept* Tanks:
US Environmental Protection Agency-Asbestos.abatement. ' !
Federal.Aviation Authofity-Runways.
I understand that:the:following~restrictions apply to the use of fill:
Use of fill is.notaliowed in Flood Zone"V" unless expressly permitted.
If the fill-:matenalm 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 engineers-
licensed by*th ,State of Florida.
If the fill`material is to be used in Flood Zone "A" in connection with a permitted building using stem wall!
construction, I.certify;that fill will be used only to fill the area within the stem wall.
If fill-material-it to be used in any area, I certify that use of such,fill will not adversely affect adjacent;
properties. if use of fill is found-.to adversely-affect;adjacent properties, the owner maybe cited for'viola#ing
the conditions.of-the'buiiding_permit issued under the attached:permit.application, for lots-less'#han one (1)
acre which are elevated by fill,an engineered-drainage plan is required.
If I am.the AGENT FOR:THE OWNER 1,prdmise in..good faith to inform the owner ofAhe permitting.conditions set forth ini
this affidavit prior to commencing consfuction. 1 understand that aseparate permit may be required for electrical work,; {E
plumbing,,signs, wells,,pools,:air,conditioning,gas,.or otherin5tallations not specifically included in the application. A,...
permit issued shaii'be•constrt edJd-"6 a`iiceise=to-proceed wit! the,work"and not-as.authorityto'violate,.cancel, alter, or
set aside any provi6ions'of"'this"techrticai codes, nor shall issuance of a permit prevent the Building Official from thereafter'
requiring a correctionof=errors>in.plans>constructlon,or violations'of any�codes. -Every`permit issued shail-beconie invalid;
unless the work authorized`by such permit is commenced within.six months of permit issuance,~or if work authorized by �.
the permit is suspended.,or abandoned for a-p_eriod=�of six(6) months after the time the work is commenced.. An extension ;
may be requested, In-writing,,from the Buiidiiig-•Officiai for a period.not to-exceed ninety (g0)�days and will demonstrate
justifiable cause for.the extension. if work,ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO�OWMR--.YOUR.FAILURE:,,T,4 RECORD_A, NOTICE,OF C QMMENCEMENT,MAY,RESULT IN YOUR;
PAYING.TWIC,,E,FORIMi?i30YEMENTSTO YOUR PROPERTY:, IF YOU:INTEND T.O OBTAIN FINANCING;:CONSULT ` f
WITH YOUR`LENDER Oa AN ATTORNEY BEFORE:RECORDING'YOUR'-NOTICE'OF'COMMENCEMENT:
FLORIDA JURAT.(F.S:117.03)..
OWNER OR AGENT CONTRACTdR� M
Subscribed and'swom to(or affirmed)before me this subscri e d swo r affirmedAefore m. is j
Who is/are personally known to me or has/hbve produced Who i$$/a__re,�p�r^s�on known to me or hasthave produced.
as identification. �tkJn "^� L as identification. -
Notary Public Iw Notary Public
Commission No. Comm
,k ,'i;yp., JAC COMMISsion#FF 150422
Name of Notary typed,printed or stamped Name ' pfaip W. pots
.,ra ��o. Banded ThN Tray Fain insurance
Craw qI;W0 moo e..Vaa®o
❑ COMPRE5SOR Per Customer Request X G�_ _ 7135 US Hwy 19 N. • New Port Richey, FL34652
PSI —+r 727-312-5550
Q HEAD PSI. ���JO(??U'f� . • Q.. " 1t�
. ;Q VOLTS, .: - WS,AMPS, .."•.� S'.TZ:..(1!i .
`Q'EIECTRICALCONNEC11ON5 sUperlorSerVlCeQaIIs7135@gmall.Com
•: CONTACTS O CLEAN', ' - . ,• ,
Ej OILLEVL,&'CONDI710N State Certification#CAC 1817514 DATE ORDERED I
0 C{)NCSENSER'COii
QCLEAN COIL&CHECKTINCOND.' NAME ,�..1 �y DATE SCHEDULED
❑ENT - ' ,2F 'I-VG.;F f 1 , t J Ti,. Ile- ,-1 f
❑ REPRIGEFiAIUT •I M' j'1 4 e'n STREET . �_ L
Q LEAK CHARGE /f c '� J '. W'^'_{� P�10 r;ry ?Q,'-
❑:FA�!•A.ItSO'MOTOR' G'`fr`r� !"� �.,.,. 7 (� CITY '""7 STAI- ,... ZIP WK.PI�IONF-
[]VOLTS AMPS'
FI ELECTIItCAL CONNECTIONS �. / 4e I Mi KE AODF:L SERIAL.iv'UtiARFR
Q CONTACTS TIGHT&CLEAN - i.�WARRANTY
❑FAN PULLEYS(ADJUST BELT) �' � J � � El t:nN1 RAC 1
❑CHECK,LUBE'BEARING&&100TOR _ �, /1 ,,... ❑ SEORMA:COIJ"I RAC I
❑-EVAPORATOWCOIL {J�F f tt 0 NORMAL
Q CLEAN COIL&CHECK.FIIJ J r.-t,`✓" �" ems! "� 106 /J, ,-�- „� ,!? RES. [� comm,
Q.ENT DB_ _2F''LVG C1B i ! ' +y \ LOCATION �t .
QENTWFi,— r'F•L-,GWB_,_,—_t'1.' ttt j''
❑ coNDENSATE AREAS , 1 r
❑INSPECI&CLEAN DRAIN PAN ' +, L) .7 [ 4
❑INSPECT&CLEAN DRAIN '- f
❑. AIR FILTERS'.,
Q CLEANED. �. ❑REPLACED
FtiFERSIZE__:_ _ RE RQFI7 APPLIED
�V%. cI C Cam, � � r - '/ �, 1� �-(•
❑ _HEATING ASSY. t f�
Q BURNER&HEAT'EXCHANGER'
Q FUEL SUPPLY&PRESSURE _ '"` —--•- -- : _ _ `�-! t
Q PiLoTASSEMBLY, REF IGERANT ADDED
Q PLAME ADJUSTMENT SL � - ✓ I-r n7�'" l.�)e, ._L.... !—..
Q PRIMARY RELAY&FLUE,
Q PAN&LIMIT SWITCH OP,ER:
❑•BEOWER ASSEMBLY
.,
Q HyvALve TOTAL PARTS
Q.STRIP HEAT t WRITE OR CODE AMOUNT[]DEFROST CYCLE ;: PARTS WARRANTY n $ 60 36J i U
❑ ELECTRICAL COMP TS. All parts as recorded are warrante'd'as per,
manufacturers edflcations. G t
�' p El bax to authorize Superior Energy Management to
❑f vikt: CONTACTORS E continue to call me form to ular air condiIionm needs. a,��//tt
Q OVERt.gAO' ❑RRE55.541+ITCH LABOR GUARANTY � � :' �- � 5. Y ' 9 9 �!�
The labor charge as recorded,here relative to the R TECH aF.GU11tR v 'HRS. OVERTIMP. t
I� THERMOS equipment servicesas noted,Is guaranteed fora R 9 HRS-ra FtR.: E HR.= t
Q O.K. i ❑REPLACE period of 30 days. O — R
M race NIACH USAGE RFi;ULA, T OVERTIME, t
Q RELOCATE a., We do not,of course,guaranty other parts than TECH{ I I-IRS.
those we supply:If repairs become necessary B #2 +�Hr,S. /HR.= E I1It.= I
due to other defective parts,tbey#'III be �; _ CER i.I+'
chargedseparately:J", p TOTAL TECHNICIAN `, •-- OTHER I
TIA4F _ IN OTHE,RCHARGES- S SIGNATURE �.-L,j (, CHARGES
ARRIVED - ,
------ — � D D o e • ;5U6 TOTAL �"��� :d 6
TIME 'er TYPE SYSTEM E' OUT ORCHANGD I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO
i DEPARTED "_ ? CI ORDER AS OUTLINED ABOVE.IT IS AGREED THAT THE SELLER WILL
— REFRIG.---_----�_ CITY.____ `� REPLACED).
TRAVEL U YES No RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL
TIME E'• I CIS- FINALAND COMPLETE PAYMENT IS MADE,AND IF SETTLEMENT IS NOT TRIP t
•RECOVERED? QTY. ,P MANTLED? MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE CHARGE
YES NOM_ YES NO SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES
ENDING R'. E REFRIGERANT DISPOSAL RESULTING FROMTHE REMOVALTHEREOF. TAX
a RECYCLED? QTY-Y— ;N:
fYES NO
START- ❑ OUR
RECLAIMED? QTY.__,— RECOMMEND:'
TO MILTS YES NO
ES �, RETURNEDTO
i A, THIS SYSTEM? QTY.
A- YES NO ' D
I X /HR.= A•- DISPOSAL _ ___ AUTHORIZED SIGNATURE
i — ABOVE�®RDREDWORK HAS BEEN COMPLETED AND I ACKNOWLEDGE RECEIPT OF MY COPY. DATE
OWNER'S INITIALS '
j X /WR.= NON USABLE QTY.-__-- ACCEPTED DECLINED
I TRIP T,- YES NO
CHARGE a DISPOSAL f,CP
I
Superior
Energy Management
Residential/Commercial
HVAC
7135 US Hwy. 19 • New Port Richey, FL 34652 • (727) 312-5550 • (727) 312-4539 • Fax: (727) 312-5434
Lic.#CAC1817514
Authorized Agent Forgers
I, Heath Allen Pe'ry, ai;thorie tirev following per soya to -1 permits
under License# CAC1817514 Gregory HsiAC L LC DBA Superior Energy
Management LLC. This letter supersedes alai others
Scott Perry
Jennifer Rego
MARY KOLOWICN
Melissa Brown o Notary Fubk,State of Florida
commission#FF 939593 19
My c�mm.exoires Dec.
Rest Regards,
Heath i n Perm
AUTHORIZED AGENT
AFFIDAVIT
I rtejt- �e�`� hereby grant authorization tol`,�OM v►Lv1
(Contractor) 1 (Authorized Agent)
to act in my behalf with the Hernando County Building Division while conducting activities related
to obtaining permits. These activities specifically include signing all documents requiring signature
of"contractor".
VvtLI�LGt� L�d_s to be considered an agent of my business and
(Authorized Agent)
therefore the signature of said agent is binding and causes me to assume all responsibilities
connected to or associated with the signature as they may relate to my contracting business.
rIP
I rzf1,1 Nff Vi relieve the Hernando County Building of,
(Contractor)
and agree to hold the Hernando County Building Division harmless from, any and all responsibility,
claims . ing from or related to the Division's acceptance of the above agent's
sign for permit-related a ities. I further understand that it is my sole responsibility to grant
and a minate an uc aut -arid o ensure that the Division receives timely notice of any
t e a '
V__
gnat of o ct t Signature of Agent
e AC. M 5-1,
State Certification or Registration Number
County Certification Number(if applicable)
**PLEASE NOTE: BOTH SIGNATURES MUST BE NOTARIZED**
Notary for Contractor's Signature: Notary for Agent's Signature:
State of (,C1 County of Lmn State of 1D,D6 County of L rpQd0Q
The foregoing.was acknowledged before me this 1 12> The foregoirig was acknowledged before me this
day of r, _,by�� d of , 00 ,by
who is personally known l who is personally known to me,or
ttb me, rwho produced as who produced as
identi ation. Identific t]on.
Notary I? turENotary Public State of Florida Notary Pub] Melissa Brown
Melissa Brown My Commission GG 204483
My Commission GG 204483 �M1 Expires 04/08/2022
�i Ex ire
Print,Ty ' r f Print,Type, a
*The original of this affidavit should be kept in the possession of the above designated"Authorized Agent". This affidavit
need only be produced to Hernando County when signing documents in the presence of a permit representative. When you
sign a permit application be prepared to produce this affidavit, it will be copied and placed in the appropriate permit
application.*
**The Division,at its discretion,may require a contractor or license-holder to personally apply for or obtain a building permit
notwithstanding any authorization allowing another person to apply for or obtain any permit on behalf of a contractor,qualifier,or
license-holder.
_ Revised 10/2015 contauth.sop
l lili�l IllII i�ill Illll Illil IIIII lilil llslf illll I�IIf IC�111i1
2018101487 '
Permit No. `P� ParcelIDNO v 1 JO1 r��J`��� Q 1�
—ii NOTICE OF COMMENCEMENT (ept:1966023 Ree: 10.00
State of F o `CJ G County of 'PQsee))S: 0.00 I T: 0.00
D6/15/2018 C. F. , Dpty Clerk
THE UNDERSIGNED hereby gives notice that Improvement 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 ,n �+ �1^�
1. Description of Property:—P7ar(ce�l Identification No.\m I teU dQ I e- Ry ScJ�L C 1 G j��I i� 1n `�L V 1 ' 1''�e^,`, r CA
Street Address: ! `1 —1 ��r n t f ! f ►I (1 r L W�
2. General Description oft1 Improvement e l�3Q Q Un
1 �T Old
1��n 1`t�U ir l I PKa r�- HULA S.O'NEIL,Ph.D.PASCO CLERK & COMPTROLLER
3. Owner Information or Lessee information if the Lessee contracted for the improvement: _D6/15/2018 10:066am 1 Of 1
Gar C� a •2IU`^ OR BK 1-9+71 41 PO _3218
3 y L e J N
Address ✓1 J�`' a LCity State
Interest in Property: C /o or ! I t Y 1,C- 1.Q.1 QI_"Qn
Name of Fee Simple Titleholder.
(if different from Owner listed above)
Address �,�i_ e( `-• City State
4. Contractor. r\
I i VY' 0 5 H W Li 6 ' N - tNk* r c heu L
Address _ City State
Contractor's Telephone No.:_0��-1) 31 )— 5 5
5. Surety:
Name
Address City State
Amount of Bond: S Telephone No.:
fi. Lender:
Name
Address City State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes:
Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of_
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
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 INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury,I declare that I have read the foregoing notice of com a er ,a that, a f��tts fate ere'n a true to the bes)
of my knowledge and belief. � � % �} � � / T
STATE OF FLORIDA 7 / (o CJ
COUNTY OF PASCO
gnb(ure of Ow r a essee,or Owners or Lessee's Authorized
Officer/Director artner/Manager
Signatory's Title/Office
The foregoing instrument was acknowledged before me this day of J()r) 20 JB by
as (type of authority,e.g.,officer,trustee,attorney in fact)for
(name of arty on behalf of who strument was executed).
Personally K ` .I P, d Lai4Identification L9 Notary Signature `s
�i �� p (�
Ty of I nl t Produ¢� L Name(Print) Me_ 1 SS Ct p► LL-n
t' ` OAW I Notary Public State of Florida
Melissa Brown
q IL ;' ' .0 y;Q Q My Commission GG 204483
y ?o�n ' Expires 04/08f2022
.0�% •. Ole
wpdat� �• tmP.-9 ty D53048
V
STATE QFF COUNTY OF PA��O '
THIS|STOCERT|FYTHATTHE FOREGOING|SA
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OROF PUBLIC RECORD|N THIS OFFICE
%T/N MCIAL SEAL THIS,