HomeMy WebLinkAbout01-0257
BUILDING PERMITt42
0257
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
'J"- QO
ool~' -
Date
'-Ij'&/Ol
BUILDING
EL~TRICAL
PLU~ING
MECH\NICAL
Sewer Conn
Property Owner: Fa c.)..r
Job Address: S '1 2 '7
i?\'~, S
~~, (( Jet oJeI.
Water Conn:
Water Meter:
T.I.F.'s:
Parcel I. O. #
Zoning:
oescriotion of Work
Energy Code:
S'l-.rqq_ ;.~
Radon Gas:
e.~.;'S+.'...~ po rc ~
FINAL
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Inspector
City License Registration #
State Certified License#
" dI> c-
Permit Fee J. \" ". -
Signature ')~~~~ ~
Company
Address
Telephone# of ~O -( ~ ~ s
Valuation or
Contract Price
Ow (\) tI((
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
BUILDING
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Twenty Five and 001100 Dollars ($25.00) shall be made for each trip for each trade:
a.
b.
c.
d.
e.
f.
g.
Wrong Address
Condemned work resulting from faullty construction.
Repairs or corrections not made whlim inspection called.
Work not ready for inspection when! called.
Permit not posted on job site.
Plans not at job site.
Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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APPLICATION I'OR PElUaT
CITY 01' ZEPHYRHILLS
BUILDING DEPARTMENT
~~~'~~~+
DATE RECBIVED
PLANS REVJ:EW I'D
~I ,1
OWNER'S NAME fam; wheeler ~ y{;IJlJtJE ~. /./e'(/ZlE5 PHONE 8/3- 7g-j).~7?'6g:
JOB ADDRESS .:51;<5 FOI2, J(ttUft 120.46 ZePH'fICtlIt.L') 71 33-'416
~rfs. O~ ' I
LEGAL DESCRIPTION: LOT(S) / - ~ BLOCK q
, n. .~~ -~} ; ,
PARCEL ID #
SUBDIVISION
it', t~ .; -, ~ r<i
(OBTAIN FROM PROPERTY TAX NOTICEI
WORK PROPSED: DNEW CONSTRUCTION
D SIGN
D ADDITION
DALTERATION
D DEMOLISH
D REPAIR
.f 1
D.INSTALL.
...,.'..1',
D MOVE
PROPOSED USE: DSGL FAMILY DWELLING
D COMMERCIAL
, .' ~
OMULTI-FAMILY
D INDUSTRIAL
0# OF UNITS
D SWIMMING POOL
D M~Bi:LE H9ME
D OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK ?1Jf$//76 Lor- ;:::p
BUILDING SIZE SQUARE FOOTAGE ;2.:300
HEIGl!T.
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FO~S. !
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. L -,,'
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
: !
PERMITS REQUESTED
ozt BUILDING
o ELECTRICAL
D PLUMBING
D MECHANICAL
$~QIJ
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o FLORIDA POWER
;'''r;' I
D W.R.E.C.
;'.;
$
1; """'''1':'''
VALUATION OF MECHANCIAL INSTALLATION
D GAS
D ROOFING
D SPECIALTY
D OTHER
.....;;.. ,....
TYPE OF CONSTRUCTION: 0 BLOCK
~ (
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
l, ,. r
IS PROJECT IN FLOOD ZONE AREAD YES
'O'NO,
)'~ :!,'
BUILDER <C~~-
)
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
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ELECTRIC
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SIGNATURE
COMPAN
STATE CERT OR REGIS
CITY PROCESSING
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
" !
SIGNATURE
**********~*******.***********************************************.
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
MBCRANICAL
*****************************************************************
f' 1
OTHER
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
******************~**************************************..****..
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CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to ~deed restrictions" which
may ~ more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ~wner has hired a contractor or contractors to undertake work, they rnay .be requtrl~d
to be 11censed 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 misderneano~
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 indiqating .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
*Arrny 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,::PElrmit:~;:.'
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.
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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. 'JOBS1UNDER
$2,500 N VALUE DO NOT NEED TO RECORD AND POST A ~NOTICE OF COMMENCEMENT".
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AGENT
SIGNATURE: CONTRACTOR
acknowledged
19_
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
TATE OF FLORIDA
COUNTY OF
The foregoing. instrument was
Before me this _____ day of
by
acknowledged
, 19
.,"til.t-.
(name of person acknowledged)
Owho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
of identification)
take an oath.
o who has produced
(type of identification)
and who Odid []did 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
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An Equal
O~~~
Ronald C. Johnson
Chair, Polk
Monroe MAIM C_lCIer
Vice Chair, Citrus
Sally Thompson
Secretary, Hlllsborough
__Ie Eo Du_
Treasuret'. Plne"as
Edward W. Chance
Manatee
Thoma. G. Dabney, II
Sarasota
Pamela L Fentress
Highlands
Watson L Hayne.. II
Plnellas
Janet D. Kovach
H IIIsborough
Heidi B. McCree
Hlllsborough
John K. Ranke, In
Pasco
Eo D. MSonayM Yarcara
executive Director
Qeaa A. Heatb
Assistant executive Director
wnnam S. Bllenky
General Counsel
Protecting Your
Water Resources
South\V~st Florida
Water Management District
~''',_~
- -.{ -r~J* -' (.,'::"'_:t,a~
........~~...~fIJ.':,;;r.. . - ~~---~ .~~""~.~c-~:~:.:.:#":;;.:;Jo,J ~
2379 Broad Stre Jrooksville, Florida 34604-6899
(352) 796-7211 or 1-800-423-1476 (FL only)
SUNCOM 628-4150 TDD only 1-800-231-6103 (FL only)
World Wide Web: http://www.swfwmd.state.f1.us
Tampa Service Offtce
7601 Highway 301 North
Tampa, Florida 33637-6759
(813) 985-7481 or
1.800-836-0797 (Fl only)
SUNCOM 578-2070
Bartow Servtce Omce
1.70 Century Boulevard
Bartow. Florida 33830-7700
(863) 534-1448 or
1.-800-492.7862 (FL only)
SUNCOM 572-6200
Venice Servtce Omce
115 Corporation Way
Venice, Florida 34292-3524
(941) 486-121.2 or
1-800-320-3503 (FL only)
SUNCOM 526-6900
Lecanto Service OffIce
3600 West Sovereign Path
Suite 226
Lecanto, Florida 34461-8070
(352) 527-8131
SUNCOM 667-3271
April 4, 2001
Tammy Wheeler and Yvonne B. Menzies
35203 Highway 54 West
Zephyrhills, FL 33541
Subject:
Notice of Final Agency Action - Approval
Environmental Resource Noticed General Construction
Project Name: Coral Isle Pools
Permit No: 47022053.000
County: Pasco
Expiration Date: March 16, 2006
SeclTwp/Rge: 11/26S/21 E
Dear Tammy Wheeler and Yvonne B. Menzies:
The District acknowledges your intent to use a Noticed General Construction Permit for the
project referenced above. Plans and information received will be kept on file in the Brooksville
Service Office in support of this determination. The proposed construction must be completed
before the expiratiqn date indicated above.
The proposed construction is subject to general conditions of Rule 40D-400.215, Florida
Administrative Code (FAC.) and the specific conditions of Rule 40D-400. 475(1)(d), FAC.,
(copies enclosed). Deviations from these conditions may subject you to enforcement action
and possible penal~ies. You are responsible for conducting construction in a manner which
satisfies all criteria,
Final approval is contingent upon no objection to the District's action being received by the
District within the tirtle frames described .below.
You or any person whose substantial interests are affected by the District's action regarding
a permit may requ~st an administrative hearing in accordance with Sections 120.569 and
120.57, F.S., and Chapter 28-106, FAC" of the Uniform Rules of Procedure. A request for
hearing must: (1) explain how the substantial interests of each person requesting the hearing
will be affected by the District's action, or proposed action, (2) state all material facts disputed
by the person requesting the hearing or state that there are no disputed facts, and (3)
otherwise comply with Chapter 28-106, F.A.C. Copies of Sections 28-106.201 and
28-106.301, F.A.C. ~re enclosed for your reference. A request for hearing must be filed with
(received by) the Asency Clerk of the District at the District's Brooksville address within 21
days of receipt of thi$ notice. Receipt is deemed to be the fifth day after the date on which this
notice is deposited in the United States mail. Failure to file a request for hearing within this
time period shall co~stitute a waiver of any right you or such person may have to request a
hearing under Secti ns 120,569 and 120.57, F.S. Mediation pursuant to Section 120.573,
F.S., to settle an a ministrative dispute regarding the District's action in this matter is not
available prior to th . filing of a request for hearing.
. -
Tammy Wheeler and Yvonne B. Menzies
Page 2
April 4,2001
Enclosed is a "Noticing Packef' that provides information regarding District Rule 400-1.1 01 0, FAC., which
addresses the notification of persc;ms whose substantial interests may be affected by the District's action in
this matter. . The packet contains guidelines on how to provide notice of the Districfs action, and a notice
that you may use.
If you have questions, please contact Marilyn J. ~traub, at the Brooksville Service Office, extension 4373,
since~Q ~ ~
A. Pa esma ,." Director
Brooksville Regulation Department
APD:MJS:elb
Enclosures: Rule 40D-400.475(1 )(d), F.A.C.
Exhibit A
Noticing Packet (4~.00-O39)
Sections 28-106.201 and 28-106.301, FAC.
cc: File of Record 470~053.000
USACOE
Arthur C. Baker, P.E., Westcoast Brokerage and Environmental Consultants, Inc.
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
DATE RECEIVED
PLANS REVIEW FEE
OWNER'S NAME _F r Qd er ~ c...k.. W'l \ Ke l'\ S
JOB ADDRESS U, \ L\ ~ - \ ~ -t.k. S.\- I
.
PHONE I ~ ~ . 402..9
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID # Ql.'1tp.1.,\. D'<:1D.DOCJtO. D~SO
(OBTAIN FROM PROPERTY TAX NOTICEl
WORK PROPSED: [JNEW CONSTRUCTION
[J SIGN
[J ADDITION
[JALTERATION
[J REPAIR
[J INSTALL
[JMOVE
[J DEMOLISH
PROPOSED USE: [JSGL FAMILY DWELLING
[J COMMERC IAL
[JMULTI - FAMIL Y
[J INDUSTRIAL
[J# OF UNITS
[J SWIMMING POOL
[J MOBILE HOME
[J OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK ShL'Y\.3\e -=Re rorrt-
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
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.
33'2.5""". DO
PERMITS REQUESTED
~BUILDING
[J ELECTRICAL
$
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
[J FLORIDA POWER
[J W.R.E.C.
[J PLUMBING
[J MECHANICAL $
[J GAS ~OOFING [J SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
[J OTHER
TYPE OF CONSTRUCTION: [J BLOCK
[J FRAME
[J STEEL
[J OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
BUILDER COMPANY t>O..u..t L\r ~n ()Qr---=Kb~~~:f:\\'\C..
I STATE CERT OR REGIST # C.C. 0 ~~ 13Y
SIGNATURE~' ;-::7<Ji'--kQ p.u CITY PROCESSING ij 2 IS 2 ,
******************************************************************
ELECTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
****************t*************************************************
PLUMBER
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
***********~******************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
***************~*************************************************
\....UNV.ll.lUN::i U~. I:'~HM1'l' AE'f<'lUAVll
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 cormnencement.
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 cormnenced 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 tc
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 cormnenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for
period of six months after the time the work is cormnenced. One 90 day extension of time
may be allowed fOL 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 si
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, CONSUl
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".
~~~~,~/~l~:GENT s~~~~^-
STATE OF FL..oBIDA STATE OF FLORIDA.-... A <-
COUNTY OF ~85CO COUNTY OF ,..... o...JC.O
The foregoing instrument was acknowledged The foregoing instrument was acknowledged
Before me this~ day ofAonl , ~I Before me this 13--day of Apnl , 1!o~
by by
(name of person acknowledged)
Qwho is personally known to me, or
(name of person acknowledged)
[1ho is personally known to me, or
~
Dwho has produced
(type of identificatio
~id not take an oath
~
o who has produced
(type
Ddid not
of identification)
take an oath.
acknowledgement
re of person taking acknowledgment
.."eo. Suzanne Douglas-Allen
;fiv,.
~ ,... My CeAlAlissigR CC974?nR
ty .r Bi'~~r~206:tamped
'd ,;~~
Name typed,
Name
111111111111 11/1111111 11111 1111111111111111111111111 "" nil
2001051203
NOTICE OF COMMENCEMENT
County of ~ 'Sc. 0
State of Florida
Permit No.
Key No.
THE UNDERSIGNED hereby gives notice that improvement will be made to certain
real property, and in accordance with Chapter 713, Florida State Statutes, the following
information is provided in this Notice of Commencement:
1. Description of Property: Parcel No. 0'2.. 'llo . '1.. \. D I q D . 0 aOOD . 04 CV 0
2. General Description of Improvement ~ h I ~~ \ e. ~ e. fbO-P
3. Owner Information: Name M(. r-f -ed W l \ ~ ~
AddresS~I4.~ lbi-V\ ~fee~ City?e.pInl.\,rh,115 State n
Phone No.8Io-18~-40a.q Fax No.
R 4. Contractor: Paul Schapltr, 11250 US Highway 98 South, Dade City, FL 33525
~ -
.....'. ..I'-
5. Surety: Boyett Insurance, 14114- th Street, Dade City, FL 33525
6, Lender: Name/Address:
7. Persons within the Statlt of Florida designated by Owner upon whom notices or other
documents may be served as provided by Section 713. 13(I)(b), Florida Statutes.
8. In addition to himself, Owner designates Paul Schaper ConstructionIRoofing, Inc. of
11250 US Highway 98 South, Dade City, FL 33525 to receive a copy of the Leinor's
Notice as provided in Section 713. 13(I)(a)(7), Florida Statutes.
9, Expiration date of Notice of Commencement (the expiration date is 1 year from the
date of recording unless a different date is specified.)
Signature of Owner: X'~.J1t:"'L_~n ~ _
Owner Printed Name: K ~Y.p~ 7'^ " r ~;t C 111// I A- ~''1-) S'
ID: 'tV L/;l 5'-- rl. If j -~ / Ie'" t) Personally Known
Sworn to and subscribed before me this~day of (lfU--'JJ
Notary Pllblic:._ J~ d ~.u, ~
(Type, Print, or Stampe ofNotary1
200/,
,..'.... s
"~, uzanne DouoIaS-A11ert
t.:My CommiSSIon CC87..208
0)...... ExpIres 'Jctober 25,2003
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