HomeMy WebLinkAbout00-9377
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
09377
'I/Y/oo
q~ .':'9 (;f1!'d' . ~
BUILDING
2s , ..;B LruJ: j,.
ELECTRICAL
Date
~ ~ .
') ~ , (.....~.~
PLUMBING
'1 ~.~ (_U)..:Jr
MECHANICAL Sewer Conn
Pmp,rty Own" A of V 1-.,.+; H 1-kc.J l-l. ~ Y f k..,.r [a ~ '0
Job Address; <7 C ~ ~ (( g 'vd '
Water Conn:
Water Meter:
T,LF.'s:
Parcel LD. #
Zoning: Energy Code;
DescriPtion of Work (! en " 'oiL;''+'' C., ..(....;J
Radon Gas:
Re [:o-&ttIA,;/c..Ic.'\
0101'1 .
FINAL
5-~""tp0
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
City License Registration #
State Certified License#
Permit Fee
i Signature
. Company
Address
'1 Telephone#
I . "" ~.
:r& ~~~~
Valuation or
Contract Price
15 I 000 t..e
,
~;l- b'6:;~ ~9Z~
B~~I~ (19.. r to
A f>c,. E If: (.
(tv f OlE A ~ ( (....
fJ.v I'~ tf"e ct,.
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
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 I 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.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
DATE RECEIVED ,$ - 1- v ()
PLANS REVIEW FEE ""
--
OWNER'S NAME /J/?_/ff ~# .fj'.(#I1S; i/I/t 6v; .J!im~.AC ~~~
JOB ADDRESS hJO ~.-?U :$,till) fE?.AlY~#/~
,
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
(OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: DNEW CONSTRUCTION
o SIGN
o ADDITION
!RALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
o COMMERCIAL
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
DESCRIPTION OF WORK
CJ RESTAURANT & HEALTH DEPARTMENT APPROVAL
~tV~"""'5 .7'P ~IIN.&>A'?/',1 "7B),J)G.
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
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.
I!f BUILDING
$ I ~ I ODo
,
PERMITS REQUESTED
VALUATION OF TOTAL CONSTRUCTION
[!? ELECTRICAL
[3'" PLUMBING
~MECHANICAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o GAS
o ROOFING
o SPECIALTY
o OTHER
~
VALUATION OF MECHANCIAL INSTALLA~.- )
( 1(01--, /)q9-~ i
o OTHER q& ~
o STEEL
$
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
FINISHED FLOOR ELEVATIONS
IS PROJECT
BUILDER
SIGNATURE
~
COMPANY
STATE CERT OR REGIST
CITY PROCESSING #
******************************************************************
ELECTRICIAN
SIGNATURE 1/'/
COMPANY ~~ ,
STATE CERT OR REGIST #
CITY PROCESSING # /'lfi.. ~AI ~~r I~
******************************************************************
PLUMBBROfL L
SIGNATURE /' ~i ~
COMPANY ~~~ ~7P-A~ (~.p
STATE CERT OR REGIST # c..'F- C C~'3:,::SHk)
CITY PROCESSING #
MECBANI~.(
V
SIGNATURE
* * * *,* * * * * * * * * * * * ** * * * * * * * * * * * * * * * *' *.* ~ * * * * * M * * * * * * * * t1~
COMPANY 'PAP , ~,//J.AJtV/~
" hi STATE CERT OR REGIST # eM -~ny ~<::;;; Lj R
4V1 CITY PROCESSING #
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A. . NOTICE OF DEED RESTRICTIONS
The undersigned 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. Envirop_~ental 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
$2, IN VALUE DO T NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
-t OlONER OR AGENT .; (J SI~TOR
STATE OF FLO~A
COUNTY OF ~,-~~--
The foregoing ~inst ument wa~kno~}edged
Before~e, this day of lL.LA..rc!1, ~..lQx)
by If-'! b -e,- LJ..Lf) 1-1
jname of person acknowledged)
~o is personally known to me, or
~ has produced VII'yer"'S rp
(type of identification)
and ~d no e an oath.
STATE OF FLORIDA ~
COUNTY OF . ;--- (J_.5 ~O
The foregoing instrument was acknowledged
Before me this .!1L!!-day of /J?JfA' , 1'3 ~
by a-flfiRL-E'S 'P/YJ.t..e
,(name of person acknowledged)
~ is personally known to me, or
C
t
..........,ttU 111,1.
pr . tl
MY COMMISSION # CC 575608
EXPIRES: AlIgUSI11, 2000
IlGndId 11uu NuIaIy Publlc UncIIrMIItrt
Name t # .. :.\>M"Ji~SI6tt# a~8UlJRES
;:1;'''., . ~ February 22, 2004
"~.,;iF; ,f"lf,:" BONDED THI!U TROY FAIN INSURANCf, INC.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
DATE RECEIVED
PLANS REVIEW FEE
OWNER'S NAME
;fp~f..J#-~fTAor ?1i.&rt~ PHONE
~.fO ~A'U 72.l?1/ 12H'~~ #p /lg~ ~ep.
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: []NEW CONSTRUCTION
[] SIGN
[] ADDITION
[]ALTERATION
[] REPAIR
[] INSTALL
[] MOVE
[] DEMOLISH
PROPOSED USE: []SGL FAMILY DWELLING
[] COMMERCIAL
[]MULTI-FAMILY
[] INDUSTRIAL
[]# OF UNITS
[] SWIMMING POOL
[] MOBILE HOME
[] OTHER
BUILDING SIZE
o RESTAURANT & HEALTH DEPARTMENT APPROVAL
'f},cIbVA "/1#$ 7# ~.....,..... .:If}J?(f
SQUARE FOOTAGE
HEIGHT
DESCRIPTION OF WORK
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
[] BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
[] ELECTRICAL
AMP SERVICE
[] FLORIDA POWER
[] W.R.E.C.
[] PLUMBING
[] MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
[] GAS
[] ROOFING
[] SPECIALTY
[] OTHER
TYPE OF CONSTRUCTION: [] BLOCK
[] FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
BUILDER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
**************~~**************************************************
ELECTRIC~/.~, '~
". -\/1 \
SIGN~___~/l Y~~J-.-~ ~\,
COMPANY /l;P~ GEt7&c,
STATE CERT OR REGIST #
CITY PROCESSING # ~;1~
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
**********~*******************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A. ,NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to ~deed restrictionsH 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 SectionsH 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 GuideH prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the ~ownerH, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the ~ownerH 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 ~AH or ~A,etc.H, it is
understood that a drainage plan addressing a ~compensating volumeH 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 COMMENCEMENTH.
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)
C1ho is personally known to me, or
o who has produced
(type
and whoD did 0 did not
of identification)
take an oath.
o who has produced
(type of identification)
and who Odid Diid not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
permit NO.___
NOTICE OF COMMI'llCEMI'llT
\\,\~,\,\'''~\'''~\''\~''\~\\\\\
'2.0000'2.191, \
It ~,396164 Rec ~ \0 . S0
~c'~' tl~ 0.00
OS~ 0,00 Op\~ Cl.r~
03/01/00 ----
JEO Ptll"'R~, PRSCO 1,COUN't8'(~C\.:4ER~
03/01 100 1!'~Vftl
OR 8\( 4~~" PG
prepllr'ed UY:
_ ,\,,,i5 Instrument ____
.Nllme:___ ____
f\ddresS:--- ---
S'rf\'rE OF ~'
COUNT' O~. , will be ..j. '0 c.c,.in cc.l
i that improvemen 1 '
'rilE UNDERSIGNED herby giveS not ce 11'1 Florida Stntues. the fol OW1.ng
dance with Chapter' J.
proper'ty. and in aceOr I i Notice of commencement.
information is provided in t\ S' if
property. und street addreSS
1.
DescriptiOn of property:
(legal description of
nvailab1e)
b~
3.
Gener'al description of improvement:
j'riUII'"..v ,,' 1-..",,,,.....1 ~.(I>'
Owner informatiOn ~ r }...-: ,_..,
a. Name and addr'ess: IJDI&11.~:rf' ;1I,(AI.?II" 'dM /t'!~If'~
1R,;t. ,.~~# W/JIIA"
b. In';~"' 1n pco?'c'Y'?" ~HU. ~40~. - Iq/l,we-,tl/uJ".
c. N... ~~ddC'" of f.. ,1.pI. ,"l.bold'c (1f o,h'c ,h.n own.c) ,
~'-
2.
R
4. Contractor: (name and address)
~U4 ~~~r#3llt.~/#,.) (. ~c..
.Ht 1I#1l11.A'.f' /1114;#6
##I"'NI;'~ /~~S; ,fpAI'"
::1 J. '1/~
5. Surety
a. Name and address:
7.
Persons within the State of Flor'ida designated by Owner upon whom notices Or'
other documents may be served as~ovided by jj.ection.113.1J,J,l) {a)7. Florida
Statutes: (name and address) ..~Il:r ~IIC1f'/' il~ ~ .1...
'/flY ,NU "".11/&11' f-,;AJr-
~ GAIJ. "8l.rlrI. -;I'#fJlNIL'~ ~~
In addition to himself. Owner designates the following person{sl to receive
11 copy of the Lienor'S Notice as provided in Section 713.13(1) (b) ,rlorida
Statutes: (name and address)
flIa
~
b. f\mount of bond $-----
!
,''1(
,.
6. Lender: (name and address)
8.
Expiration date of notice of commencement (the expiration date is 1 year froDI
t date of rec ing unless a different date is specified)
9.
Ko6el- -r7). ?lA. c h f,' ~
/
(Signature of ned (Print Owner" s Nau,e)
Own.c'. Addce." '7 050 C, ALL R I tJ b Z' R ~ 'I ihi(\ ~ r:- c.
~ J
'T'" focegoing 1n. ,roa.n' WM acknowledg.d b.foce a. ,hto ~ -.::L-I ~ hy
~b",(f Jj,chh who i. ~ '0 .'/who pcoduc.d J)r..Ier:5
-rO
'1-
.. 1d.n,,}\,,"On ond who did no' ,.k. on o"h.
Coun'Yof t:u-o-I'A- C_'..'on .Cl ,5 ??0 0 f'
r/ /I J,5l, tl~ 0
, I
My commission Expires:
SUSAN L. BENNm
II:{ COMMISSION' CC 575608
EXPIAES: AuguIl11, 2000
1IondICI11\IU NulIIY NIIIC lJrIdllrMllBI1I
All Information Must Be Typed or Printed Legibly
to comply With Recor'ding Requirements
f f\.O~\Opo.
S' po. ,E. 0 Of ~ po.SCO ~ fO~t.GO'
COU~~ 'S ~o C'i~~~ 6~~~~~OCUt.\~
"0 co~~V:.C'f, CO ," '~I-\'S Off'C~~
~~~~ ~~~~Co~;~~~~ St.~'-_ ~~
This Instrument Prepared Uy:
. Name:
Address:
11111111111111111111111111111111111111111111111111111111111I
2000027911
Permit No.
Rcpt.: 396764
DS: 0.00
03/07/00
Rec: 10.50
IT: 0.00
Dpty CI.rk
NOTICE OF COMMENCEMENT
JED PITT"AN~ ~:~CO COUNTY CLERK
~~~~0~~i4m ~G 874
STATE OF ~C::A
COUNTY OF
TilE UNDERSIGNED herby gives notice that improvement will be Dlaje to certain real
property, and in accordance with Chapter 713. Florida Statues. the following
informa tion is provided in this Notice 0 f Commencemen t.
1. Description of property: (legal description of property. ~nd street address if
available)
.d- ~.,..,t
2.
3.
5. Surety
a. Name and address:
~U4 ~Nr~IIt.??~AJ (" ~c.
.H-f ~~Il~I.II'S" ~V4#gl
#>>IAI~;1'4 1/!8M'~S; ",a~/'~ :7~"1/'"
b. Amount of bond $
~A
~
G. Lender: (name and address)
8.
Persons within the State of Florida designated by Owner upon whom notices or
other documents may be served as~ovided by ~ection_713.1JJl)(a)7. Florida
Statutes: (name and address) ...6Ilr KIIC.JI'/, Ilr: ..1...
'IIh ,NU M4p/f!A4 e~AJ"-
~ lllIU ':8J.III). -;'EI"#IANIL'-~ ~~
In addition to himself, Owner designates the following person(s) to receive
Ii copy of the Lienor's Notice as provided in Section 713.13(l)(b) ,Florida
Statutes: (name and address)
7.
9.
Expiration date of notice of commencement (the expiration date is 1 year fron,
t date of reco ing unless a different date is specified)
'1-
.;kdD. ~f vt
(Signature of ner) (Print Owner's Naule)
Owner's Address: '/0.'50 c.. ALL R I tJ b
Ro j, e/- /7:>_
<lA.chl,' rF
.i
'l.efj~I(~
~ .I
The foregoing instrument was acknowledged before me thiS~/--7--/ Od by
~b-erl ~chf,- who is personally known to me/who produ.::ed U(I'v'erJ
-:;:0
as identi)1cation and who did not take an oath.
County of f-/a.<J.,~ Commission 1/('/e--,5 ?!Ft, 0 f"
r /11/05 dO ()
My Commission Expires:
All Information Must Be Typed or Printed Legibly
to Comply With Recording Requirements
SUSAN L. BENNETT
MY COMMISSION' CC 575608
EXPIRES: August 11, 2OllO
IIandId TIIIu NalIIy NlIc lhI8MIlIn
/
''I
...
LEG A L
ZEPHYRHILLS COLONY CO LANDS
ING H OF DAIRY RD R/~ AS NO~
122 & TR 103 EXC W 187 FT OF E
OF TR 10Q ALL EXC US HWY 301
FOR P08 TH ALG N LN TR 105
100 FT H OF tiE COhO T!{ 1 ()~ TH
LN lR 10~ 100 FT W OF NE COR
103 S89DG 55' 34"C 48G.69 Fl
~;U<"[iG ~~,' 2.1'(" 172.01 FT TO!/
TH roLG H LN f.:/W SOCDG 10' ~5'\.I
f:EI~iC :.j L~'; Dt-:;~C;!-tT~~R'!, !~:r..' F.:/;.J
~5:-~.0<1 F1 10 SH COR Tf,: 1:.'2 TH
COR TR 120 TH N89DG 58' 31"~
fU~ TIl ALG [ U~ r,/~ j~00DG 1 fI'
LESS ThAT F'T 1\;: 1:2:.:' L ':'IfH; ::'10
OR BK 4324 PG 875
2 of 2
o E S C RIP 1- ION:
P8 1 PG 55 FOLL OESC PROP lY-
LOCATEO 1RS 105 106 1]9 120 a
267 fT UF N 172 FT & E 10C FT
F/t-.; ALL rll~A COM N~ COI-;: T~' 1 \-)5
S89DG 56' 33"C 5~3.35 f1 TO Pl
NCCDC 09' 03'[ ~JI.~~ ~1 !~ N
11;: lCI~ TIl ~U:: tl L/~ TF:S lOll B,
lH S:}COC ]0' 4~"w 1/2.00 rl TH
LN C>;'i;-::~' KG I.:/;,J ~S HO\.l '-GCI'ITCU
1 ~ :3 7 . ::::. F 1 T 0 ~; U4 T R 1:' 2
T;~ r,! C lJ u: h/l-l N8?OC :.9' 30' H
N00US 0~' 03"C 316.21 rT 10 S~
645.:11 1- r:o E LN us Hl-i'f 301
~'!C'F :,,(,.';.80 Fl 10 f'Ot::
F 'I ~I ;-!rc souTH Lll~t: S[C
STATE OF FLORIDA
COUNTY OF PASCO
THIS IS TO CERTIFV THAT THE FOREGOING IS A
TRUE AND CORRECT copy OF THE DOCUMENT ON FILE
OR OF PUBLIC RECORD IN THIS OFFIS7QESS MY
H AND OFF CIAL SEAL THIS ~AY OF
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C CUlT COURT
EPUTY CLERK
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