HomeMy WebLinkAbout99-9097
BUILDING PERMIT
)25 .~
BUILDING
35. ~
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 788-6611
'/7. ~
PLUMBING
Permit
09097
Date /2/ It( 19'1
, I
~ f. P..9
MECHANICAL
Sewer Conn
Water Conn:
IJ _ · . J '
Property Owner: ~, ~ VI'S
Job Address: S5)2 ,~~ .s......
Parcell.D, # 11-2b - J 1- (JO/o ~ 1l{200 -0190
Zoning: Energy Code: Radon Gas: b,~
Description of Work ,J'(w ~c2d ~-. K f~ J IJ u( se"'1 <:t
F,.-. c,~
Water Meter:
T,I.F.'s:
s'c."'...:.", L:.... L
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
.Lf - 2.s=- 6U.Jl
DATE
NO OCCUPANCY BEFORE C.O.
DATE
Inspector
Permit Fee
- Signature
Company
Address
_ Telephone#
3~9k d
t,~ ~
Valuation or
Contract Price
J S i ~;2tl. 9Z'
r
City License Registration #
State Certified License#
<.f/3 - 7~~- .!L3~ R-
Ow",(1r
o...u '^ e.r
OLAJ""er
a..o .'\ e/
Tp. Servo
Rough In..:J,J,at"J) tifiitJ
Meter Can
Const. Pole
Pool
Pre-Meter
Final
PLUMBING
SLa 11-'2/-99 ~
Tub Set 2..../ -Ot::)
Water
Sewer
Final
MECHANICAL
BUILDING
ELECTRICAL
Breakers ~
Ducts Insl. 'Zr J....fNJ) U )
Compressor
Final
FRM.
Insul. CL
WL
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25,00) shall be made for each trip for each trade:
a, Wrong Address
b. Condemned work resulting from faulty construction.
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g, Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same,
DAVIS RESIDENCE
5522 - 18TH STREET
BEDROOM ADDITION
:)~.l"t:.t:.1
t'Kil;t;.
rv'Alr~ OR L;V;t~G .AR;::A
638 I $
40.00
OTHER AREA UNDER ROOFi
I $
I
i 5.00 I
. O"T'"I Ir-r-'\
In!:.!"';
VALUATiuN $ 25,5ZU.OO
FEE SHEET $ 150,00
ADDRESS $ -
.
DRIVEWAY $ -
BUILDING: $ 225,00
CREDIT: $ -
BUILDING LESS CREDIT: $ 225.00
ELECTRICAL: $ 35.08
PLUMBING:I $
MECHANICAL: $
RADON:I $
TOTAL $
47.50 I
25.00
6,381
338.96
SEWERI $
WATER: $
TOTAL: $
. I
3/4" WATER METER:' $
- I
T I F '5 :1 $
99% $
1%1 $
TOTAL: $
338.96 I
.'
APPLICATION FOR PEma
CITY OF ZEPHYRRILL
BUILDING DEPAR
JOB ADDRESS
k:,-ti1 + H r:iDI DAtJ;"CL/fREkf~ P~~7(,~
l5.J c~P-- / tf fA. S T c:/E J:;J;ul<.. j) I LL-S:. -1-1,1 1<-1 DR
v /
BLOCK /C/.:z
199-~3jL~
OWNER'S NAME
LEGAL DESCRIPTION: LOT (S) /'l:2.C;':<( ~,~,
, t .
PARCEL ID # 11'2/0 - 2/- (;bID - 142DO . 0100
WORK PROPSED: [JNEW CONSTRUCTION ~DITION
SUBDIVISION
(OBTAIN FROM PROPERTY TAX NOTICE)
[JALTERATION
[JREPAIR
[J INSTALL
[J SIGN
PROPOSED USE: ~L FAMILY DWELLING
[J COMMERCIAL
[J MOVE
[J DEMOLISH
[JMULTI-FAMILY
[J INDUSTRIAL
[J# OF UNITS
[J SWIMMING POOL
[JMOBILE HOME
[J OTHER
BUILDING SIZE
CJ
AlELiJ I~E/7I?OCJI/Vv-+
~~~.,27'1 /C (-1/~
RESTAURANT & HEALTH DEPARTMENT APPROVAL
L-5A II. -+ Afl( I<-S E /<.y 4 s frr (!I( I.~ F,rJ.(!E
SQUARE FOOTAGE ~~c?' HEIGHT cf'o c,
DESCRIPTION OF WORK
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
~UILDING $A,Il.OA' /L--~ ~ CJO
/
~LECTRICAL ;%c)t~ 0/~1117 Jful(~
lB'PLUMBING
VALUATION OF TOTAL CONSTRUCTION
SERVICE
[3--' FLORIDA POWER
[J
W.R.E.C.
/
~"MECHANICAL
$
/7 ((-', c C'
I ..
VALUATION OF MECHANCIAL INSTALLATION
o GAS BR'OOFING 0 SPECIALTY
TYPE OF CONSTRUCTION: ~LOCK
o OTHER
[J FRAME
[J STEEL
[J OTHER
FINISHED FLOOR ELEVATIONS 5/1 /~/t-- 4"" IS PROJECT IN FLOOD ZONE AREA[J YES ri/~
f //<.."J;;'L (.. Rt.i. (L(
SIGNATURE
tfie (JOMPANY
r-, .' . TATE CERT OR REGI ST #
C~CV Iv G /L . '~<rP"" ~ ~OCESSING #
BUILDER
******************************************************************
SIGNATURE
0Ui/UEfl-, qt"~?c-
&J
.. A CERT OR REGIST #
, OCESSING #
ELECTRICIAN
******************************************************************
SIGNATURE
~. };r
/-, .... . T TE CERT OR REGIST #
C/W /lh'5f'L- Q ... ~-t&C ~ESSING #
PLUMBER
* * * * * * * * * * *.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SIGNATURE
J - i:<OMPANY.
/i , '~ STATE CERT OR REGIST #
L/{u Ii/ell- ~.:it'L- ~SING #
MECHANICAL
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A" NOTICE OF DEED RESTRICTIONS
. Tb~ ~ndersigned understands that this permit may be subject to ~deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the ~Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for the work" If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills"
C" TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D" CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of ~Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the ~owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the ~owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development"
Application is hereby made to obtain a permit to do work and installation as indicated" I
certify that no work or installation has commenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction" I also
certify that I understand that the regulations of other governmental 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 limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S" Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ~A" or ~A,etc"", it is
understood that a drainage plan addressing a ~compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
A permit issued shall be construed to be a license to proceed with the work and not as
authority to violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15"00" The extension shall be requested
in writing to the Building Official" An approved inspection must be logged during each six
month period, or the project will be considered abandoned"
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" JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A ~NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
acknowledged
19_
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
19
(name of person acknowledged)
Owho is personally known to me, or
(name of person acknowledged)
[1ho is personally known to me, or
o who has produced
(type
and whoO did 0 did not
of identification)
take an oath"
o who has produced
(type of identification)
and who Odid [):lid not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 600B-97 Residential Component Prescriptive Method B CENTRAL 4 5 6
Department of Community Affairs
Compliance with Method 8 Chapter 6 of the Florida Energy Efficiency Code may be demonstrated by the use of Form 6008-97 for single and multifamily residences of 3 stories or less in height, and
additions to existing residential buildings, To comply, a building must meet or exceed all of the energy efficiency prescriptives in any Q!!ll of the prescriptive component paCkages lI!!Q comply with the
prescriptive measures listed in Table 68-1 of this form, An altemative method is provided for additions of 600 square feet or less by use of Form 600C-97, If a building does not comply with this method,
it ma still com I under other section in Cha ter 6 of the Code,
BUILDER:
PERMITTING CLIMATE D D
OFFICE: ZONE: 4 D 5 6
PERMITNO,~ JURISDICTION NO,: ITTIID
1, New construction including additions which incorporates any of the following features cannot comply using this method: steel stud walls, single assembly roof/ceiling
construction, or skylights or other non-vertical roof glass,
2, Choose one of the component packages "A" through "F" from Table 6B-1 by which you intend to comply with the Code, Circle the column of the package you have chosen,
3, Fill in all the applicable spaces of the "To Be Installed" column on Table 6B-1 with the information requested, All "To Be Installed" values must be equal to or more efficient
than the required levels,
4, Complete page 1 based on the "To Be Installed" column information,
5, Read "Minimum Requirements for All Packages", Table 6B-2 and check each box to indicate your intent to comply with all applicable items,
6, Read, sign and date the "Prepared By" certification statement at the bottom of page 1, The owner or owner's agent must also sign and date the form,
_ Please Print
t5
/f d cf ;-('\::1/
5",',,(.(i c
Compliance package chosen (A-F)
New construction or addition
Single family detached or Multifamily attached
If Multifamily-No. of units covered by this submission
Is this a worst case? (yes I no)
Conditioned floor are~ (sq, ft.)
Predominant eave overhang (ft.)
Glass type and area:
a. Clear glass
b, Tint, film or solar screen
9. Percentage of glass to floor area
10. Floor type, area or perimeter, and insulation:
a. Slab on grade (R-value)
b. Wood, raised (R-value)
c. Wood, common (R-value)
d. Concrete, raised (R-value)
e. Concrete, common (R-value)
11. Wall type, area and insulation:
a. Exterior: 1. Masonry (Insulation R-value)
2, Wood frame (Insulation R-value)
b, Adjacent: 1, Masonry (Insulation R-value)
2, Wood frame (Insulation R-value)
12. Ceiling type, area and insulation:
a. Under attic (Insulation R-value)
b, Single assembly (Insulation R-value)
13. Air Distribution System: Duct insulation, location
14. Cooling system
(Types: central, room unit, package terminal A.C" gas, none)
1.
2.
3.
4.
5.
6.
7.
8.
15. Heating system:
(Types: heat pump, elec, strip, nat. gas, L.P, gas, gas h,p., room or PTAC, none)
16. Hot water system:
(Types: elec" !lat. gas, L.P, gas, solar, heat rec., ded, heat pump, other, none)
CK
1.
2.
3.
4.
5.
6.
7.
NO
6'1<(
?-
Single Pane
sq. ft.
6~t , sq. ft.
/D.)" %
Double Pane
sq, ft.
sq. ft.
8a,
8b.
9.
12a,
12b,
13.
14a.
14b.
14c.
15a.
15b.
15c.
16a.
16b.
R= :3 0 (0 i.{ Y sq. ft.
R= sq, f}.
R= 0 () U Co-r
Type: r ert-Y V' \\ I
SEERlEER: / () l V U
Capacity: 3.; I C/O ()
Type: 1/ ;f
HSPF/COP/AFUE:
Capacity: ~ y 0 ~
Type: 1: ( t' C -r-
EF: i C; I
PREPARED BY:
I hereby certify that this building, as
OWNER AGENT:
. DATE: 11- I~- 57
pliance with the Florida Energy Code,
DATE:
Review 01 plans and specifications covered by this calculation indicates compliance
with the Florida Energy Code. Before cons ction is completed, this building will be
inspected for compliance in a oroa ce wi ection 553.908, F.S.
.",,-
-1-
DATE:
Revised 1998
TABLE 6B-1
MINIMUM REQUIREMENTS
COMPONENTS PACKAGES FOR NEW CONSTRUCTION
A B C D E F
Max,%of glass to Floor Area 15% 15% 20% 20% 25% 25%
(/) Double Clear (DC) Double Clear (DC)
(/) Type Single Tint (ST) Single Tint (ST) Double Tint (DT) Double Tint (DT)
:5
C) Overhang 2' 1'4' 2' 2' 2' 2'
Masonry EXTERIOR AND ADJACENT MASONRY WALLS R-5
(/) COMMON MASONRY WALLS R-3 EACH SIDE,
..J
..J
~ Wood EXTERIOR, ADJACENT, AND COMMON WOOD FRAME
Frame WALLS R-11
CEILINGS CEILINGS UNDER ATTIC R-30, FRAME COMMON CEILINGS R-11,
(NO SINGLE ASSEMBLY CEILINGS ALLOWED)
(/) Slab-On-Grade R-O
a:
0 Raised Wood R-11 (ONLY STEM WALL CONSTRUCTION ALLOWED EXCEPT PACKAGE D)
0
..J Raised Concrete R-5
u.
DUCTS R-6 R-6 R-6 R-6 R-6 R-6
SPACE COOLING (SEER) 12.0 10,0' 10,0. 12.0 10,0. 10,9
~ Elect. STRIP 6.S' 6,S' 7.4 6,S' 7,6
W Gas/Oil (AFUE) MINIMUM OF ,73 (Direct heating) or ,7S (Central)
::I:
a: Electric EF ,90 EF ,90 EF ,90 NOT ALLOWED NOT ALLOWED EF ,90
w:E Resistance** (SEE BELOW) (SEE BELOW)
~w
s:tn Gas & Oil ** MINIMUM EF OF ,54 NATURAL GAS ONLY
r->- (SEE BELOW)
o(/)
::I: Other Any of the following are allowed: dedicated heat pump,
heat recovery unit or solar system,
Climate Zones 4 5 6
TO BE INSTALLED
6
l~' I %
DC: 0 DT: [Jl
1- FEET
EXT: R- .,
ADJ: R= $
COM: R=
EXT: R=
ADJ: R=
COM: R-
UNDER ATTIC: R = ~
COMMON: R-
R= 0
R-
R-
R=~ COND, 0
SEER = /c-> C/ 0
COP-
AFUE -
EF= I q (
EF=
DHP: 0 EF= -
HRU: 0
SOLAR: Fi EF=
Single package units minimum SEER=9,7, HSPF = 6.6,
.. Minimum efficiencies for gas and electric hot water systems apply to to 40 gallon water heaters, Refer to Table 6.12 for minimum Code efficiencies for oil water heaters and other sizes,
DESCRIPTION OF BUILDING COMPONENTS LISTED
Percent of Glass to Floor Area: This percentage is calculated by dividing the total of all glass areas by the total conditioned floor area,
Overhang: The overhang is the distance the roof or soffit projects out horizontally from the face of the glass, All glass areas shall be under an overhang of at least the prescribed length with the following exceptions: 1) glass
on the gabled ends of a house and 2) the glass in the lower stories of a multi.story house,
Wall, Ceiling and Floor Insulation Values: The R.values indicated represent the minimum acceptable insulation level added to the structural components of the wall, ceiling or lIoor. The R.value of the structural buiiding
materials shall not be included in this calculation, "Common" components are those separating conditioned tenancies in a mullilamily building, 'Adjacenr components separate conditioned space from unconditioned but
enclosed space, 'Exterior" components separate conditioned space from unconditioned and unenclosed space,
Floor: Slab. on-grade lIoors without edge insulation are acceptable. Raised wood lIoors shall have continuous stem walls with insulation placed on the stem wall or under the floor except Package D,
Ducts: "CONDO indicates that the ducts must be installed within the conditioned space; that is, the ductwork shall be located on the conditioned side of the insulation, Ducts in conditioned space are acceptable for any
prescriptive package,
Space Cooling System: Cooling systems shall have a Seasonal Energy Efficiency Ratio (SEER) for central units or Energy Efficiency Ratio (EER) for room units or PTAC's equal 10 or greater than the prescribed value,
Eleclric Space Heating Option: Heat pump systems shall be rated with a Heating Seasonal PeriOllllance Factor (HSPF) equal to or greater than the prescribed HSPF, Heat pump systems may contain electric strip backups
meeting the criteria of section 60a,1,ABC,3,2,1,2, No electric resistance space heat is allowed for these packages.
Electric Resistance Hot Water Option: For packages designated "Not Allowed", an electric resistance hot water system may be Installed only in conjunction with one of the .Other Hot Water System Options", See below,
Other Hot Water System Options: Any dedicated heat pump, heat recovery unit, or solar hot water system may be installed, Solar systems must have an EF of 1.5 or higher. Electric resistance systems having an EF of ,aa
or greater, or natural gas systems with EF ,54 or greater may be used in conjunction with these systems,
TABLE 6B-21 MINIMUM REQUIREMENTS FOR ALL PACKAGES
COMPONENTS SECTION REQUIREMENTS CHECK
Exterior Joints & Cracks 606,1 To be caulked, gasketed, weather-stripped or otherwise sealed, )(
Exterior Windows & Doors 606,1 Max ,3 cfm/sq,fj, window area; ,5 cfmlsq,fj, door area. ^
Sole & Top Plates 606,1 Sole plates and penetrations through top plates of exterior walls must be sealed. 'I
Recessed Lighting 606,1 Type IC rated with no penetrations (two alternatives allowed), mI
Multi-story Houses 606,1 Air barrier on perimeter of floor cavity between floors, NtJ
Exhaust Fans 606.1 Exhaust fans vented to unconditioned space shall have dampers, except for combustion X
devices with integral exhaust ductwork,
Water Heaters 612,1 Comply with efficiency requirements in Table 6-12. Switch or clearly marked circuit breaker (electric) y..
or cutoff (aas) must be provided, Extemal or built-in heat trao reauired,
Swimming 612,1 Spas & heated pools must have covers (except solar heated). Non-commercial pools must have a J/f)
Pools & S-oas I Dump timer, Gas spa & 0001 heaters must have minimum thermal efficiencv of 7S%.
Hot Water Pipes 612,1 Insulation is required for hot water circulating systems (including heat recovery units), X
Shower Heads 612,1 Water flow must be restricted to no more than 2.5 gallons per minute at SO PSIG, l'
HV AC Duct 610,1 All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, X
Construction, sealed, insulated and installed in accordance with the criteria of Section 610.1, Ducts in attics must be
Insulation & Installation insulated to a minimum of R-6,
HVAC Controls 607,1 Separate readily accessible manual or automatic thermostat for each system. 'f
-2-
,. 'n..."'.~~",-;?<,,~~.
i'1.A. 1.77 LAW.
F. 713,13
SEMINOLE FORM 408
NOTICE OF COMMENCEMENT
~~;:t:fo~lorlda } t~R~~AU IN DU~LICAn' 1I1111111111!~~~I~!~111I1111I1111I111I111
The undersigned hereby informs all concerned that improvements will be made to certain real property, and In accordance
with section 713.13 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT,
Description of property. .lc:-A... .;(~ .~q .~~, ~':;..;?/" .8!(.?~.k.., /.'I~... ,(';ly, pf4-:ph.ytrIJ/Us
,."."...,.8 #. .~~.DP/?,. .I,y..,.fl.d:r.. ,8~p/;;.",. Jr.,. P~F" ~r.".,...,..,..,....,.",.....,...
..... & JSJ~... h'"" li?~.J..~.. .Q[. .?/rSCo... .Cqy?1.o/.. .1./PI.e.t.p.~............:::.:...........
o Oene,e' de.e"ptlon of Improvements ...;VS "/.. . . T3.ffl. .li'= ~. .=. . 1?t1.{.. . . r;;$ ~. .!?~ <=. r.. . .
nowner '..."", ,&/d. T,.. .1It:=;/Q/,. j;)IJ.V/~..,...,.".,....".,.,.......,....,.,...,..,..,.".".........
Address".,. ~-?~c?Z-:.,.,. / ~.17?!?:t .Z.fF/:J.I1jR.!J./L/;,S?,., .7i?R-.lp A,...,....,...."..,.,......,.
~:n;;~~~;e;:.:'~::~~I~h:;:~':;::nm::~~,i. . . . .Ehy' >1 ~. . . . . J3rp~dy . .. . . . . . ... .. . .. . ..... . .. . .. . .... ..
Name".,.",..,. 0 t)~7Ic." J7?us7=., .~~/O&~~~...".".,.,."..,.................
Address."," ,c:/t?", @k-f), U!~,.. .!k:I:~4Y. ,&if/:f?:Pt1?/f"/!'/,. ~ 8?~..
Contractor, , , . , ,.G.lf! IY ~~, , , , , , , , . ,. , , . .. ..,. " ,.... .,. ,. '. , . ,. ,., . ,. , , , ,. , , , , . , , ,. , , , . ,. ,.,'. ".. '.. ~ ~~.C: C..
Address,....., .0"?.,~~".. ,1.f:.I!!, .~MR~t. ,?sphJt?.h/~(,<;;", .-r/D~/P/f:.,.,.....,..".....,
Surety (if any) """"""""""',.,.,',.".,.,',.,""'",..""""""""".,.,.,."",..",..",.",..",..,......,..",.
Address,..,..,..".....,.,."",.,.,...".,..,.,.,.,......,.....,....",."",..""".",.., ,Amount of bond $ ....,..."..,..
Any person making a loan for the construction of the improvements:
Name .......!Vb.. ,'.. .. .. .. .. .. .. .. .. .. ... .. .. .... ..... .. '" '" .. .... .. .. .. .. , ~~t: 37~ Rt~; ~:::
' 12/11/99 Dpty Clerk
Address ",.,',.,",.,""',.,',.,',.,.,.".....,....,",.."..",...,.,.",.".,..,.,.,.""...,."...,.................,.,... ,. .
Person within the State of Florida designated by owner upon whom notices or other documents may be served:
Name" '., ,C.~!t:~,R,;Y,~,~, "j)/t.t(,!~...,. ,."". ".""", ,. ,."". ,.", ,.", ,. ...", ,.. ,.."., ..,..,....... ,.....'..
Address" ,~~~ ~9..,." ,( ?r1,.,.~!?? f?FL, 2. ppA y~l(~,.. ,1%~; '?(f.,., :-?~~~t<-!.....
In addition to himself, owner designates the following person to receive {j copy of the lienor's Notice as provided in Section
713.13 (1) (h). Florida Statutes. (Fill in at Owner's option).
JED PITTMAN, PASCO COUNTY CLERK
Name ,..,...........~................, ___w.. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. A~/~ /~J:::~a. 1 P3f l 974 '
Address
....................................................................................................................... .
THIS SPACE FOR RECORDER'S USE ONLY
STATE OF FLORIDA
OOUNTY OF PASCO
, n:r:S IS TO CEi1'TFY TIiAT THE pv.....'-:-Ol"'" IS A
T"'lJr " DC.)'"' "r' . vnCu ,...,
n ,;;,1'" :d';'j;'" f'(,\P\'f"iCT'(- DOCUMENT
0'1 '\[:'1" i,' r~-, ".:', ,,":', ,t: ON FilE
I "-'I P")'~;4: -' IlCi,.. (;.--/) rN Tll:S .r\rFI C 1""'-5
LI~ "0 ir,.- :', <1, 'J' <., i I<t S MY
r >1..1, At(LI ,-'j~ d' ,Lt~1 --~W"l .
u '-.., I, I. 0,; i" OF
Sworn to and subscribed before me this """""',."""".",."",
.....~.~......day of "~,
,. ,.., '."~'A'" ." "",199..,g
. '" .(j/~....
Notary PUbIiV..."',.,""'"
D.C.
IAJW
Public. State of' Aorida
My Comm. expIres July 9, 2000
Comm, No. CC 568566
BY