HomeMy WebLinkAbout01-0152
P,oP."" Own., 6. " 5"+0" e G.. f ; ~ ) C r f .
Job Address: lo~ ~lf ~cI .
Parcell.D. # 07-2(. r 2/- 0010- 01~i>D- {)o2.0
BUILDING PERMIT~~
:::~;t:J /2 i 101
,
Sewer Conn ;)55"'. ~
~ r? .'
Water Conn: /00.-
0152
711.~
BUILDING
50.09
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 788~6611
r-- oV
,,:>~.-
PLUMBING
?S.~
MECHANICAL
Water Meter:
T.I.F.'s:
Zoning: Energy Code:
DescriPtion of Work J ^ ~ :/J, ~,.... D cI el
Radon Gas:
l1\{.~
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
~'mit~ If ~~ 19- ~ S2.
.- Slgnatu~(1__
Company
Address
Telephone# 3S2. - sz. 7 .. 1.3 c1'f
~~:'5 vJ~ tCa~l
I Db PLUMBING 19 to
SLB 5-/ -of s ~
Tub Set
Water
Sewer
Final
Valuation or t"1 v
Contract Price 120 I 7' O. e
City license Registration #
State Certified license#
..~ jVlD./ l<. Co'p
BUILDING 10 c.f
Fe.,
~ II,'" CYI M. ti?/I.,f<.., I (~.
MECHANICAL 10 J
ELECTRICAL
Ftr.
Pre SLB
lintel
FRM.
Insul. CL
WL
Driveway
9~~ -'-AIt-L
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final ~
~ f2tNil :J.12 .~ I It:!i:Y
Breakers
Ducts Insl.
Compressor
Final
~2,D\
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Twenty Five and 00/100 Dollars ($25.00) shall be made for each trip for each trade:
a.
b.
c.
d.
e.
f.
g.
Wrong Address ,
Condemned work resulting from faulty construction.
Repairs or corrections not made wh~n inspection called.
Work not ready for inspection when I called.
Permit not posted on job site. '
Plans not at job site.
Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
FEB-20-01 TUE
I
11:17 AM EHRMAN SYSTEMS ENT..INC.
-"ro \?o'f'>> \ "(~f"1 ~\-t..J.:~_
352 567 7459
P.01
~
r'.a.'~d In#
Tax Fnlin '*
'Do .L& ..,l' WI 0 VoI500 002D
UU~'JW~'l'g t<<'11IIII 11111 """MIIII'" 11I11 IIlllnl
Rc:pL = ."."1~.
D$t 0.00
NOTICE OF COMMENCEMENT 0U20/01 ___..___.__
flteo, ....
IT: 0.00
Dltly Cler-k
ST^TF. OF FLOIUDA
~UUNTY OF PASCO
.rED P ITI"AN...t PASCO fOUHTTt CLERK
02/20/0 . at. I 201BA'" . 706.1 .
OR 81< 454 "0 ~
THE UNDERSIGNED hereby gives notlee that improvement will be made to COrtain real property. and in
a.c(X>r'cJ~f1<;;Cl vvfth Chapter 713.13. Florida St;ll:tltes, the following informacion Is provided in this Notic:ft nf
CQnUn~ll~m.nt
2. General Oes(;riptfon of Improvement:
RtMODEL INTERIOR
I. Des(;f'iption of property: (IeIQl description of prn(W"!rty. :'lI1.-t ~h'~E>t addren If aV3.113bJo)
61411 Gall Blvel. Zephyrhllla. FL 33!W0
NOtn H Va OF TRACT:ZS L VINO EAST 0' US )01 LESS Tr-tE EAST no f rAND
Lt:.... I Hto WEIST 160 n. ZEPHYRHILLS COLONY COMPANY LANuS
PLAT BOOK. I. PAGE 55. ,.Meo eoUtIITY PLORIOA
3. Ow-ner Inrohna~lon;
CAPSTONE CAPITOL conrOR4TION
POBOX 1504
NASHVILLE. TN 37~02. 1504
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4. ContMllctnr:
8_ Nl'\m~ ~nd Address:cIiNTRE-MARK CQRPORATlO....
10li~1 HWY ;l01. DADE CITY. FL 33S2&
b. Phnne, number: (JS2) 567-1349
5. Surety:
a. Nallle and address: NlA
b. Phone numbor:
6. lender:
a. Name and address:
b_ Phone number:
(;. F&lX numbar: (optional. If service by fax Is acceptl'\blfl!) (&. 5) as 1-8095
7. Penions wl~hln the State of Florida designated by Owner IJpnn whom notices (.". uther documents may be
$f'!rvp,d .... p.-ovld@&J in Section 713. 13( I )7., Florida Statutes:
l'I_ Name and ackIress: PASCO REGIONAl. MEDICAL CeNTER
C/O LEGAL DEn
I:J 100 FT KING ROAD
Dacle city, FL 33US
b. Phnnfl! numbe....: (35:1) 5:11-1100
c. Fax number. {optional, ir serviQt by fax Is acceptable)
8. In addition to himself, Owner designates the following person(s) to N'!(':p,ive a COpy c.>r the Lalnor's Notice as
provided in S_lon 713.13(1)(1.>), Flc;orida $t:atUles:
8. Name and address:
l.I. Phone number.
c. Fax number: (option;ll, If service by f...x is acceptable) ~ 13) 831-8095
9. Ex:plratlon dat:e of Notice of Commp,nr""'lllf;>nt (the expiration d;:\to is one year fl"Orn the dat.e ...r , "''"ur ding
Llnlelt$ a different done Is spcc~fJed)
Swo,.n and subscribed beforo me by
,." u'-'ut.:ed :a
_f~~~~.~f:l ---J 2001
s............ of -ry--:$i14:/!"tJ-L2-#-
Prin~d name of Notary .f1.t1 fe.key A. fzje-~
Comml5slon -x Ires - - f( - 0
,p"" ~ ~ "- POIII.II
"~...... .. MYtclNMI$SIOHtOOt14G!W
axPllE8: NInaIIy 2t, lOO4
r-~fI' .....1MI......-,._
A..\lIl~~ ~,~~~.
as identffieation. and whu did
A~bt-~\J ~1~1-C.'-(
l.l\iiC.-H.,,~ );1.,,( }-"i':_
.;>,.~ ,eo ...;;. ,,"~.#J-1. _ MC;Ilu..~L- e~#-"-r;;;;.:!..
Sea.:
Centre-Mark Corporation
6748 Gall Blvd.
Medical Office Renovation
SQ. FEET PRICE
MAIN OR LIVING AREA 4,480 $ 27.00
OTHER AREA UNDER ROOF $ 15.00
OTHER
VALUATION $ 120,960.00
FEE SHEET $ 533.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 799.50
CREDIT: $ -
BUILDING LESS CREDIT: $ 799.50
ELECTRICAL: $ 50.00
PLUMBING: $ 55.00
MECHANICAL: $ 35.00
RADON: $ , 44.80
TOTAL $ . 984.30
SEWER: $ 2,556.00
WATER: $ 700.00
IRRIGATION: $ -
TOTAL: $ 3,256.00
WATER METER:I $
IRRIGATION METER $
SYB-TOTAL $ 4,240.30
T IF'S: $
99% $
1% $
I TOTAL:
. .~}-
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10221 Hwy 301
Dade City FL 33525 (352) 567-1349
SCOPE OF WORK
Remodel of Senior Activitv Center for Pasco Relrlonal Hospital
Provided to the City of Zephyrhills Building Dept.
A. Wall between businessffice and current Senior's Activi area
1. Penetrate wall and insWI 3' -6" x 6' -8" One hour fire rated metal door, meW
frame, and hardware similar in design to existing hardware and keyed accordingly.
2. Repair and patch floor area.
3. Paint door and jamb same color as surrounding wall.
4. Repair drywall and paint in area of penetration as necessary. Paint to match as
close as possible.
ew Exam Room 7
1. Remove existing carpeting
2. Cut concrete floor for sewer line tap and plumb for exam room sink.
3. Run hot and cold water line overhead.
4. Build wall out 3 W' at cabinet area to allow plumbing chase.
5. Patch floor where cut.
6. Paint entire room (one coat on existing painted surfaces, primer plus two coats on
new drywall)
7. Install 110 volt GFI receptacle at cabinet location
8. Install exam room cabinets.
9. Install exam room sink and fixture trim, matching existing hardware as close as
possible.
10. Install VCT type flooring and new cove base.
11. Room left broom clean
C and D New Exam Room~ 8 and 9
1. Remove existing carpdting
2. Cut concrete floor for sewer line tap and plumb for exam room sink.
3. Run hot and cold water line overhead.
4. Patch floor where cut.
5. Patch drywall as requined
6. Paint entire room (one coat on existing painted surfaces, primer plus two coats on
new drywall)
7. Install 110 volt GFI receptacle at cabinet location
8. Install exam room cabinets.
9. Install exam room sinld and fixture trim, matching existing hardware as close as
possible.
10. Install VCT type flooting and new cove base.
I
11. Room left broom cleajn
I
I
Site De~elopment
I
General Contractor
Custom Homes
Steel Buildings
DeslgnlBulld
Off: (352)567-1349
Fax: (352)567-7459
Lic# CGC 043354
E. Exam Room 10
1. Remove existing carpeting
2. Remove existing wall hung workspaces
3. Install new partition wall divider between Exam Room 10 and 11.
a. Frame using metal studs 16" O.C.
b. Wall to extend fr~m floor TO existing drop ceiling.
c. Move existing light fixtures to accommodate wall location
d. Wire for wall rec~ptacles per minimum electrical code
e. Place sound-deadening insulation in wall
f. Drywall both sides
4. Separate light fixtures and install individual room switch
5. Install existing door from room where new hallway "H" is to be
constructed
6. Cut concrete floor for sewer line tap and plumb for exam room sink.
7. Run hot and cold water line overhead.
8. Patch floor where cut.
9. Patch drywall as requited
10. Paint entire room (one coat on existing painted surfaces, primer plus two coats
on new drywall)
11. Install 110 volt GFI receptacle at cabinet location
12. Install exam room
cabinets.
13. Install exam room sink and fixture trim, matching existing hardware as close as
possible.
14. Install VCT type flooring and new cove base.
15. Room left broom clean
F. Exam Room 11
1. Remove existing carpeting
2. Remove existing wall hung workspaces
3. Install new partition wall divider between Exam Room 10 and 11.
a. Frame using metal studs 16" O.C.
b. Wall to extend from floor TO existing drop ceiling.
c. Install two new lay-in type light fixtures
d. Wire for wall rec~ptacles per minimum electrical code
e. Place sound-deadening insulation in wall f. Drywall both sides
4. Remove two existing partition walls
5. Cut concrete floor for Sewer line tap and plumb for exam room sink.
6. Run hot and cold water line overhead.
7. Patch floor where cut.
8. Patch drywall as requilled
9. Paint entire room (one Icoat on existing painted surfaces, primer plus
two coats on new drywall)
10. Install 110 volt GFI receptacle at cabinet location
11. Install exam room ca*nets.
12. Install exam room si* and fixture trim, matching existing hardware as close as
possible. i
General Contractor
Site De~elopment
Custom Homes
Steel Buildings
DesignIBuild
Off: (352)567.1349
Fax: (352)567-7459
Lic# CGC 043354
13. Install VCT type flooring and new cove base.
14. Room left broom clean
G. Exam Room 12
1. Remove existing carpeting
2. Remove existing cabinets and fixtures
3. Patch drywall as requited
4. Paint entire room (one coat on existing painted surfaces, primer plus two coats on
new drywall)
5. Install 110 volt GFI receptacle at cabinet location
6. Install exam room cabinets.
7. Install exam room sink and fixture trim, matching existing hardware as close as
possible.
8. Install VCT type flooring and new cove base.
9. Room left broom clean
H. New corridor
1. Remove existing carpeting
2. Remove existing door fot use in Exam Room 10
3. Remove wall section at eixisting hall
4. Penetrate separating wan between suites allowing for new hall access between suites
5. Modify "Specimen Lavatory" wall to accommodate S '-0" hall width (or as close as
handicap code will allow regarding clear space in front of water closet).
6. Install new partition to allow a minimum hall width of 5' -0" clear
a. Frame using me~al studs 16" O.C.
b. Wall to extend fltom floor TO existing drop ceiling.
c. Wall to be placed to allow existing light fixtures to remain in place
d. Wire for wall re~eptacles per minimum electrical code
e. Place sound-dea41ening insulation in wall f. Drywall both sides
7. Install emergency lighting per fire safety code
8. Install strip-type floresceht light in storage area
9. Patch drywall as required
10. Paint entire room and existing "Specimen Lavatory" (one coat on existing painted
surfaces, primer plus two coats on new drywall)
11. Install 2 sets 5'-0" x 6'-8" birch bifold doors for storage space access a. Doors to
be stained and finished to match existing doors
12. Install VCT type flooring and new cove base.
13. I 1. Room left broom clean
I. New Lab Area
1. Remove existing carpeting
2. Penetrate separating w~ll between suites allowing for access between suites
3. Utilize work space andl kitchen cabinetry and fixtures from Exam Rooms 10,
11, and 12 for use in lab 4rea as possible. Total cabinet allowance for lab area
is $1,800.00 including on~site labor
4. Cut concrete floor for ~ewer line tap and plumb for sink.
,
General Contractor
Site De elopment
Custom Homes
Steel Buildings
DesignlBuild
Off: (352)567~1349
Fax: (352)567-7459
Lic# cae 043354
5. Run hot and cold water line overhead.
6. Patch floor where cut.
7. Patch drywall as required
8. Paint entire room (one coat on existing painted surfaces, primer plus two
coats on new drywall)
9. Install up to three 110-volt GFI receptacles at cabinet location
10. Insta1l3-way switch for lab room lights allowing on/off from either access
11. Install VCT type flooring and new cove base.
12. Room left broom clean
J. New Public Bathroom
1. Remove existing carp~ting
2. Cut concrete floor for sewer line tap and plumb for water closet and sink.
3. Run hot and cold wateir line overhead.
4. Patch floor where cut.
5. Patch drywall as requited
6. Paint entire room (onel coat on existing painted
surfaces, primer plus twd coats on new drywall)
7. Install handicap-type water closet and wall hung sink
8. Install required
grab bars
9. Bath fixtures, trim and hardware per existing "Specimen Lavatory" as close as
possible.
10. Install VCT type flooring and new cove base.
11. Room left broom clean
K. Waitine: room area
1. Remove existing carp~ting
2. Remove South wall between suites allowing for access, leave header to
accommodate ceiling tilellocation
3. Patch drywall as requited
4. Place new 8' high divHier wall and ~ door with 7" wide top
a. wall will not extep.d to ceiling
b. door frame to be fuetal, knock-down type
c. door will be wood - finish to match existing doors as close as possible
d. door will only be [ower half - no upper portion
e. Owner or Ownet's representative to locate wall position.
f. Drywall finish
5. Paint entire room (one !coat on existing painted surfaces, primer plus two
coats on new drywall)
6. Install VCT type floorilng and new cove base.
7. Room left broom clean'
L. Hall Corridor
1. Remove existing carneting
2. Create new N/S hall dorridor between exam rooms F and E
3. Patch drywall as requfred
4. Paint entire hall (one ~oat on existing painted surfaces, primer plus two coats on
new drywall) :
5. Install two new lay-i9 type light fixtures - connect to existing corridor lighting
switch.
General Contractor
Site De elopment
Custom Homes
Steel Buildings
DesignlBuild
Off: (352)567~1349
Fax: (352)567-7459
Lic# CGC 043354
6. Install emergency lighting per fire safety code
7. Install VeT type flooring and new cove base.
8. Room left broom clean
M. Existine: Nurses Station
1. Remove cabinets an~ soffit area
2. Modify remaining cquntertop and cabinets for 5' -0" hall
3. Patch drywall as req~ired
4. Paint entire hall (one I coat on existing painted surfaces, primer plus two coats on
new drywall)
General Contractor
I
Site Development
Custom Homes
Steel Buildings
DesignlBuild
Off: (352)567-1349
Fax: (352)567-7459
Lic# CGC 043354
CITY OF ZEPHYRBILLS PERMIT APPLICATION
BUILDING DEPARTMENT 813-788-6611 FAX: 813-788-1516 ~ - ;:2D-O I
DATE RECEIVED - -
PLANS REVI:D I'IlJll
11 /ra$~~ 1<.&.~'O.o~)
OWNER'S NAME{lAPSfPt'lE.. (1APtTDL LC~ l. J./-e s. Pt rltL ~ONE
JOB ADDRESS ~ 7 &.( 8 ~ ~ tL n LVi:>
LEGAL DESCRIPTION: LOT (S) -rRAe.T 2S BLOCK
PARCEL ID # 0 z,. '2.." 2., 00.0 e> z.$i:)C 002.D
SUBDIVISION ~,., a,~ Q, U+AJbS
(OR~~TN FROM PROPF.R~Y ~~X NO~Tr.F.)
WORK PROPSED: DNEW CONSTRUCTION DADDITION ,2!J.ALTERATION D REPAIR D INSTALL
DSIGN DMOVE D DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING DMULTI-FAMILY D# OF UNITS D MOBILE HOME
D COMMERCIAL D INDUSTRIAL D SWIMMING POOL DOTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK ~~aCI2JllL. '-RE.~obS'.L - A't>t> ''S'~l<~, I~" I r t.UATI.It ~le5~,...
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.
PERMITS REQUESTED
D BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
D ELECTRICAL
AMP SERVICE
D FLORIDA POWER
D W.R.E.C.
D PLUMBING
D MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
I 'J t!7
/&1~
5
D GAS
D ROOFING
D SPECIALTY
D OTHER
TYPE OF CONSTRUCTION: D BLOCK
D FRAME
D STEEL
D OTHER
YES D NO
FIHISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE
SIGNATURE
k:;O-t
~, :.' ~ _ ' - " \:." ,'~ r,' >y;~;~; ~1:'.,;"' ,~: 'f,'; ~: _~.: .'h' ,-::, ::',';,.:;: '1';:~~-1':,'?/ ': ;,."~ ': '. .;, r~ -~'~~,\"~j \~ ':' :);~-' ::. '~';:"::'>'t.' .,)
Q~O~~QB".II.I,~QIf
~~ COMPANY (l.A)lYf.m~ (!.,,~
.. STATE CERT OR REGIST . ~ e ~3.:S'l
CITY PROCESSING
~ ~ . /)A7i~
************************************************ *******
BUILDER
ELECTRICIAN
SIGNATURE !~~) '0-
COMPANY f'u E'I!.~Ti&~
STATE CERT OR REGIST # F~OOo4.0L.\ 0
CITY PROCESSING #//o/~
V'
******************************************************************
(L
COMPANY LU. (.L,,4-ms l1..uW\~'Nc,
STATE CERT OR REGIST # oo97~S-
CITY PROCESSINGtY /CJ JD
********************************************~******************~
MJIlCHANlCAL~~ COMPANY _"'UlR/)NhI~ _7'1l:"~S
. - . _~ __ STATE CERT OR REGIS * MC!O.a9SIrcl.
SIGNATURE ~_______________ CITY PROCESSING # ~
*********************************************<t*~~tf*~ ~T~ ~O
PLUMBER '_. J .
SIGNATURE ~~jr-lL~
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. 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
of identification)
take an oath.
o who has produced
(type of identification)
and who Odid [}iid not take an oath
o who has produced
(type
and whoO did Odid not
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped