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HomeMy WebLinkAbout02-0919 BUILDING PERMIT N~ 0919' c.I 0 eP BUIL'DI~G CITY OF ZEPHYRHILLS (813) 788-6611 35'~ PLUMBING Pmperty Owne' d, .!lCA./l^.rP ~41'" ~ ' \-1. p. Job Address: 3r-1.c;l3 ~~l'~ A\J€.... Permit ~ 3,. ELECTRICAL Date fd3-t"J::2 ,," ,AJ t?) . MECHANICAL Sewer Conn ~ 2 7~ ~ &0. Water Conn: 350" tyf) Water Meter: I f-o . IVO T,I.F.'s: j t/RtJ- e-o ~,;A;..Crn' flf'- .JAp.-, ,.,z/;. I . , (}() Parcel I. D. # Zoning: DescriDtion of Work Energy Code: M. \\. s-Ut ~. Radon Gas: City License Registration # State Certified License# ~() 'II FINAL ~ -;;2./-{1 ~ I')ATE d- -~ I. /).4- DATE Inspector _ ~'- p.'mitF~ ~ignatur . ~~ Company Address 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. Valuation or Contract Price )7elephone# ,f/.. ~-?S d-'~/rE~/.S-03 11 iv"", tl. Tecl1. 51 ~~ <; BUILDING lice . #'$lS- ELECTRICAL IllvJo-..J,. tec~ 57ff-r /:I:- :J.:2 V / PLUMBING /lce <t:t y 5- MECHANICAL Ftr. Pre SLB Lintel FRM. Insul. CL WL Tp. Servo Rough In Meter Can Const. Pole Pool Pre-MeJer Final.!';>' - t '1_ ll~ !Z ll.f SLB Tub Set Water Sewer Final ,f:J - ll)- D l. '(LtJ-{ Breakers Ducts Insl. com7sor Final .2 - I. 'l- tJ?-- f!j..(f Driveway f P-.:?-d./-O,;!, Af.'3o J.o(IJ~ ICt REINSPECTION FEES: When extra inspection trips are necessary due to any on~ of the following reasons, a charge of Twenty Five and 001100 Dollars ($25.00) shall be made for each trip for each trade: j?e5. ReCV.. :P5c/~ a. b. Wrong Address Condemned work resulting from faulty construction. Repairs or corrections not made when inspection called. Work not ready for inspection when called. Permit not posted on job site. Plans not at job site. Work not accessible. c. d. e. f. g. The payment of inspection fees shall be made before any further permits will be issued to the person owning same. Clrv OF ZEPHVRHILLS "NOTICE" OF ADD,ITION OR CORRECTION BUILDII4G DEPARTMENT I 0 : cr'7 J9.'n, ADDRESS DATE PERMIT.". 3'75/3 ~/Y\~"" a..x. 2-/9-02.. O?I,? THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job wall be accepted. , \\0 cu-l Ca-rn~Ot11 ~ ~~ Ao-b.n~...t ~ .~.AJ-:i.J.- I'Lt -+ __ \>... 'i ~ AdO 0,... _ _b ...... ~ I ~"" OCl~ "-.1<1 _ _ __....~ ^ _ ...... L Q _I'{{) n DO NOT REMOVE APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT DATE RECEIVED / - :z 3-0;7.. PLANS REVIEW FEE /5; t'lJLt:/ )ft.? i J ~ J ) JOB ADDRESS.. 375" J 3 JJJ/J/J)/~ I7vc- 7tf PARCEL ID # 3l.f- /~,~- ;2/- {)()/(7 - 0 I ,~'" I) OWNER'S NAME PHONE ,1/3 - 7JJ;;Z - J R /-; I, . SUBDIVISION ~'-rd,/!1 !Io -0Z{)I)S j);j){? (OBTAIN FROM PROPERTY TAX NOT~CEl LEGAL DESCRIPTION: LOT(S) BLOCK WORK PROPSED: ONEW CONSTRUCTION o ADDITION OALTERATION o REPAIR If!. I NS TALL /lIt~IL\Jk~ Os I GN o MOVE o DEMOLISH PROPOSED USE: OSGL FAMILY DWELLING o COMMERCIAL OMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL '~OBILE HOME o OTHER D RESTAU~T _ & HEALTH ,?PARTMENT APPROVAL DESCRIPTION~ WORK lru-lu, .. ~A < ~ Ii f/} BUILDING SIZE ~ ?c'/S 2.- SQUARE FOOTAGE J'It c.j 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. 171 M.-k I/v,~ 'f o BUILDING $ ~LECTRICAL ~LUMBING ~ECHANICAL C13tJ(J~ PERMITS REQUESTED (jd -(f(3- df7 -/I f{) VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o FLORIDA POWER o W.R.E.C. $ >c-)tJ(). C7J VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES o NO BUILDER COMPANY STATE CERT OR REGIST CITY PROCESSING # ELECTRICIAN "00........ ~J;;"''''''''O;;;~;;:'ii~?~::;ii~ SIGNATURE' # A ; 4- iL~ CITY PROCESSING # 45 , ******************************************~~:~~~~e, ,) COMPANy(1 ~~:fJ""7' STATE CERT OR REGIST # CITY PROCESSING # ?-.'d. L\ \ MECHANICAL PLUMBER SIGNATURE ***************************~********~**~****~**:f/ . COMPANY /.~~- x:;jI.L/J A/71 ~<-et..r;.:;-.::J I STATE CERT OR REGIST # (!/J(lO 397~ 6 ~ CITY PROCESSING # 'Ie; . ************************************************* 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 perm2t 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 CO ENCEMENT. JOBS UNDER $2 500 IN YALUE DO NO NEED TO RECORD AND POST A "NOTICE OF COMME EM NT". , ..'. SIGNATURE: CONTRACTOR ~~~~~Y O~FFLORIDA -fhl/SKY>ttJI h The foregoing instrument wa~~OWledged Before me this ~day of , .J2 ~a by (! J,J4I>Jp.c:, ~,/)?IJ/YI ( J I? , ,~ (name of person acknowledged) ~ho is personally known to me, or and whoO did of identification) take an oath. Owho has produced ~(type of identification) rvid not take an oath Si Sign Name t Na~'::"." . (;\VCcDMISP.dcat7D61is~ed ;*;:*i June 25, 2004 '-iJj"j;.....WI{ eONDED THRU TRm FAIN INSURANCE. IN<: "..RF,,\'i. PROPERTY O\VNERS AUTHORIZATION FORPERl\1ITS TO Whom It May Concern: 1?ohe~ 18~\ I ~C0 I, , as owner of the property located in County, Florida and more specifically described as: 1-01- 74-, G ~ J..!o-r-L ~2U11.5; S /1J I -PeLs-co C-otJA-L.-..ty \ 1= L herein grant permission to to obtain all permits and utility taps necessary to expedite the delivery and set-up of a manufactured hOV owner's Signature ~-;--Il@. Date /2- -;2-7 -6/ Social Security Number ~ M- ;Z / ~ Drivers License Number Rif 06 - /7-z -3 L/-. - CJ 9,30 . STATE OF F7cr/d ~ , H/115boY(J~h Kober + 8a.l ( COUNTY SIGNED AND AFFIRMED BEFORE ME (affiant) THIS ~ '1 DAY OF OUbnhev ,2001. N~~ ~~~\;r.~~~ B. P. Carpenter MY COMMISSION EXPIRES~*f )*] MYCOMMtSSION# CC925616 EXPIRES ~~.:(l'f" ]o'RIl2S 2004 '. .iif.,r.."1$.~' BONDED THI!U TROY FAIN INSUIlANCf,INC. (SEAL> ~ ~ )- - ~ :i ~ l ~ \.- ~ ~ ~ '-=> a: This Inslnlment Prepared By: DAVID DOWNER 111111111111111111111111111111111111111111111111111111111111 2001178884 Address: T......land ......1lCl.. S_icet, Inc. 2700 WttUIIlI.... St.. 210 Maitland, Fl327111 Rept: 151529115 DS: e.. 12/21/81 Ree: 6.ee IT: e.ee --- Dpty Clerk JED PITTnANf: PASCO COUNTY CLERk 12/21/el : 24P1lI 1 0' 1 OR Bk 4 11 PG 417 Notice of Commencement ~"--, To whom It may concern: The undersigned hereby informs 8Il concerned that ImJlfO\lementl wit be mad. to C8ItaiII'8II property, and in acccrdance with section 713.13 ot the Florida Statutes, the follOlllfng WormatIon fa stated In thl, NOnCE OF COMMENCEMENT, Logal Description of pI'Opei1y (include SIrwt Ail1.ii.... if C"sl~~~~ 7841 GReeN SLOPE DRIVE, ZEPHYRHILLs, FL 33141 LOT 7~ GRAND HORIZONS.LA~ TO THI! MAP THEREOF AS RECORDED IN PLAT BOOK 34, PAGE(S) Ill, PUBU" RECORDS OF PA8"O COUNTY, FLORIDA. . General dlllCl'iDtion _ 9tirnproyementl SINGLE FAMILY OveulHG Owner ROBERT L BAll AND RUTHE E. BALL. HUSBAND AND WIFE Address 3510 MARUNE PIKE DR, TAMPA, FL 33718 Owner's Interest In site of the Improvements Fee Simple nUe hokler (If 0'* thllll owner) Name Addresa Contractor: Address STATE (;F F'_"riILA COUNTY OF PASCO THiS I~ TO CERf!FV THAT THE FOREGOING IS A TRUE AND CORRECT Gap', O~ THE DOCUMENT ON FilE OR OF PUBLIC RECORD Iiv !1-.ilS OFFICE..JJ'~SS MY HA fvD OFFICIAl CI-',I rH/S~OAY OF 2 -/0/. , AJRK OF CIRCUIT COURT ~-- fJEPU~ CLERK Palm H.rbor Marketing, Inc., d... Pan Harbor Hom.. 805S.F~~d Plant City, Ff 33118 Surely (it any) Addresa Amount of Bond: S Any person making a loan for the conftucIIon of the Improvemenll: Name TRANSUHD FINANCIAL SERVIce, IHe Addresa 2700 WESTHAU. LAN!, SUITE 210,IIAITLAND, FL 321.1 Person within the, State ot Florida designated by owner upon whom notice. or other documents may be served: Name JE BY Address Address 32711 0."" / ~.~ ~ Who ,is/are personally known to me I ~o hatlhave ........&.0-.1 Drivers U.t"~r"IAL t1l1cation and who' [I did [ ) dip not fake a oath. ................ =-~ . SUBSeR/SEDANO SVVORN BEFORE ME THIS 20th day otDecemb.r, 2001. .. i\~ O. ~ F1nocm.doc KATHERINE A. WILLIAMS Notary Public, State of Florida My Commission expires, Dec. 6, 2004 Com. No. CC968627 05-15-01 Notary Public 9Z'd vQIR'ON 'VI~NVNIJ nuv'~U~UI w\lnn.f- Inn, .n.,..,~,., LoT IS S'OO" o3'5~~ W 10,00' '2 - c..J o \.9 f- \.2 l- -z. - ""Z BE.i\RI~~s eA.5Eo oN W. r- ill t1 4b'Rlv..L A'5 I ~ ~ IV -61":S""Cl~'L W lJJ ~ ~ :i -0 ill ~ LeG..Ei-\D -, <t: -:. C~~TE I< L (Nt:: ..,.. ~ to- 3: RIW::~I<:;'Hr of VJA.'( ~ 0 · = SET ~B" IRoN - --.,9 1Y 1'0 t:>"lCS 5\~ctl l-- ~ pcp: PE~I\NE.i-lT ::J Lf) - /J Coj..lT~L ~DINT \) ~ uJ. I -z:: ":J CU~"E. ~ "Z R.I\DI UCS-: 5,00 \ \JJ [;E"l..TA "'~OC3"I09" ~ LE~~TIi.:= 39,S3' CHDlZ,O ~ ~5, S+' )' if) J [J ~ Z <::(, -l "QO LOT 13 ~ ,/ J o J Ul o o r;JJ . 7. 5-DC>- 4-0' o3'~W 44-,14-' o N NEU kOM AVENUE:.. 401~lw '2D'~Vt;M6tH Pcp 0'\ LS4'lBl" CERTIFIED 'ID: ROBERT L. BALL & RUTH E. BALL TRANSLAND FINANCIAL SERVICES ATIORNEYS TITLE INSURANCE FUND, INC, GREENFErDER, MANDER, EI' AL LEGAL DESCRIPI'ION: wr 74, GRAND HORIZOOS - PHASE I, AS RECORDED IN PLAT BCOK 34, PAGES 99 - 102, PUBLIC RECORDS OF PASOO COUNTY, FLORIDA. Flood Zone Y ... As PerF.LR.M. Panel No, 1'20"2"30 - '2.9 0 D NORTH POINT I LAND SURVJMNG, INC. 1035 S. FLORIDA AVENUE, SUITE 215 LAKELAND, FLORIDA 33803 (863) 683-6353 FAX 683-5262 3'2-1 I hereby certify !hat the abo'Ie COtTeClIy reftects lhe results recent survey made under my d"rection and Ihat Ihe data shown is true and COITIlct III the best of my knowledge ief. This survey meeIs lhe minlmum technical standards, Florida Chapter 61-Gl '. Florida Statutes. Lot Survey Field Date 1l-'2.B-ol Field Dale Field Date Foundation Anal PATRICK J. O'LEARY, PROFESSIONAL SURVEYOR AND MAPPER PLS 415130 Florida Reg;stration No, LB 6892 NOT VALID WlTI-Iour TIiE SIGNATIJRE AND THE ORIGINAL RAISED SEAL OF A FLORIDA UCENSED SURVEYOR AND MAPPER. ._------~---_.__._._-----~_.~'-------------_._---.-_.__........_--_._.~.._-------_.- 1tL{ ~Lf [;> , ')\ 00 3" lot~ Ct- eo1f~- ~....JI- - rJfLW () L:c: s J(~\..I\~ I ! I Ji 3' w"",lt{ I~' -, , ! , \ , Lo+ ~-,.., 75 I -5';}. &)-\1 ~ - ~\ ! \ ~~ I :: J &v~/v G-<t.~~ HoC'!... 2.0..,) ~JS-13 LAf\,d,;, 4-Ve.. -'~.'-'-."--'----'''''''''------'----, ~~ ~-- -_..------_.-..__.~ '" .\,11 :... ~ '" .- i5 P~~~~j~f~~~~~~ 1LJ!~l>!O "'...~7'P! 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[ ffi ~ V' ~ 1l!>'JU~!>' ABS PAD . _ Lee, CAPACITY o 13'x21o' ABS PAD , 23'~ Lee, CAPACITY ~ STABILIZER SYSTEM KIT 82f33 ~ .:. .:. ~ ::. ~ 55~gb ~~~~g LEGEND , ~"'x~"'ABSPAD ~ .rJ; 13"x~6' ABS PAD . CoALY 'l\NC~ PAD ASSEMBL Y SINGLE STACK BLOCKS. MAX LOAD, 4800 LBS DOJ8LE STACK BLOCKS. MAX LOAD, %00 LBS ~ STABILIZER PLATE 13'x~6' ABS PAD ~ ~ l 0 j i OJ ~ ~ ~ ~ ! Model Number: 5203 ~t ^1lI",~,on ~ olPiIlm r ~ z ~ i Ii 0 Serial Number: 913356 H""'" 0 ~ ~ S Homes ^ I\.) J ~ i ~ BUlL T BY '"' ~ I ~ ~ ~ Palm Harbor Homes Alummum Tt;ch Systems ~ n 605 South Frontage Road ~ '< Plant City, Florida Plant City, Flonda 33566 ""'''''''''-'.,"- .-.'..-..-.--.---..-....---.---.--. ----- .-.-.-----...--- n o r C ~ Z If) i I i:) I ~: ~ "-JI";",, i , o. i o' ~ 1) .;:. '" '" I 1- Z __ S....m , '" > Ii 1 I . q o ..... I~ f' , , , , , , , , .... " ~~ .... .... " (J> "';- -' ~ ~! (J>, N ...., N ' I N '" 1) ;p,,- =3(Q) ;;0 31 if (') I ~ a--8 lN~Q~ eN .0' I ~if:::: ~ :::0 ::::~~~ i ~I m-j 1~''''8 " --'> a. 5" J'V. :::oCc;~c;c;()~_..J.... I I I i ,--- -, 1 I Z ~~~ i > ~ ~ ~ ~ rl~ :::0 ~u () i' i ~ *~~ ~ i :::0 Ai ~ i -d fT1 ,. ~ j Iii h~;n ! I ~!~I: ~ ~~~~f ;0 ~ r,,<:: '" 01 () C~~"'"'"'"'VV "'. Z I" C~~I~"!"< ~~'!~. 8 :I~;! ~ "';-1> L~ o -;,,~ i :::0 ~I~~ ~I~~ , i 20, . " . "'. ;0 !. a "'_ Cl . '" ~ ~ ~ I' (J> N&~ ~,~... -"-.""- .~_... ..-......---- ------.--- -_._------_.-._..~ ~ 1!~I~III~i '.',..J _: IC:!'-' .:;! 1\)1"'. '.,1 ," ~-I ""I ~I~ % ,~I'jl !:i- 1:;1 ~ i--;, SER# DEALER: GRAND H RIZONS CUSTOIIER: BALL 13'-4" 13'-4" 30.53 t1Si4 "'"' I ~ I '/ EGRESS '" ~ Co ~ h V) 0; :~ ;:;j ~ 1'-" I~ :t co I~ 8 :t 0 0 ~ G IDS (154) r- . "'- '... N- ", co:S; ',,-"< VI" c', . =0, ",0 " ,-< 0 ", ~ "', '" " " -------(j) ----;>.17 - /~r IJ / ~ () / ck,' 10 ,/' /ffi/ /' 10 .=21~ ,,/ ~ n J: " 55~ ,., " Vl~ ::! c~ "," ,-< 154 '" ~ di n I! I I I 1 I : I I -'.. i I I I I , ~I ~ '" Vl ~ co '; 8 "':t VlO CQ ""~ .-<."" '" .;:. I co 1_,." N~ /:6 Co ""~ -;'It, l-; ~ " ....... 24 ~ '" ~ j " .'i.."1 ; I lCl .,. I(JI ~ CD . , . , ~ ; EGRESS ~ G (f.\ ~'.' -----l 3S'53@. --.--. "" ~ll ~'\., 13'-4" 13'-4" ..-- . . \ s.:;- " .'0- "". ~ -1'''- z ~ > ~ '0_ Pem~it Number Parcel Identification Number J.of7t/- P/M ~ Jt/-JO~ 19-/~"2-. .---' " C~ Aluminum T ectI SystGmI. Inc. ta) SouIh FronIIIgill fOld PI!ft Cly. FL 3I3fieG ft::~ t, '.f~":~ ..~ ',I' iIf lv ""'" "'" "III "'" "'" "'" "'" "'" "'" "'" "" "" 2002024332 Rcpt: S6S679 R.c: 6.00 DS: 0.00 IT: 0.00 02/14/02_____ Opty CI.rk 'i~~ 1~~~~"Art : ,~:~O fOUNT:, C'iERK OR BK 4860 PG 321 Prepared By,," NOTICE OF COMMENCEMENT State of r/~ ~, oft County of fl&...'D The undersigned hereby gives notice that improvement(s) will be made to certain real property, and i~ a.;cordance with C1at-'ter 7~ 3, Flc:-ida St~:::te2, !~~ f0!!OWipg !n!0nTIation is !,Tovided in this Notice of Commencement. 1. Description of property (legal description of the property, and st~;:t address if available) 31S/3 - ~/titJ v/ S /tve - i_~ I- 'J t/ - (;!rMtt/ /lOA!." Z-cIJS , R.-e.p ..11 jAilA1.4J ('q{. :3.3 s'l / 2. General description of improvement(s) /1 J, A J.' tJ/',(CV(J.() E ;r/U#1, /1 aM t/- c.: (2P1t'r" ,e.. r" ~, / 3. Owner information Name&:y~ hbrl).c#s Telephone Number r/3- 7J,7-3~61- E,cl-SO 3- Address?t-~J-H'eeJ1 S/tfJe lJe, Fax Number l "4Jtll",~.J/;..u., I W. :3 ~cf/ 4. Fee Simple 'fftle Holder (if other than owner shown above) Name Telephone Number Address Fax Number 5. Contractor Name ,A '.!~r~~c; Aluminum rectl Syst8flll. Inc. 806 50IAh Fronlllge Aoed Plait City. FL 336ee Telephone Number Fax Nu:nber 6. Surety (if any) Name /. Address Ai )1- Telephone Number Fax Number Amount of bond $ 7. Lender (if any) Name / Address V h- Telephone Number Fax Number 8. Persons within the State of Florida designated by Owner upon whom notice~ or other documents may be served as provided by ~713.13(I)(a)7., Florida Statutes. Name I )! Telephone Number Address Iv fr Fax Number 9. In addition to himself, Owner designates the following to receive a copy of the Lienor's Notice as provided in ~713.13(l)(b), Florida Statutes. Name Address Telephone Number Fax Number ~ L---- 10. Expiration date of notice of commencement (the expiration unless differe date is specified): Signature Sworn tS/"l~nd sUbSCribed~befO:j me this cg day of ~v ' 20~. by ()~' +- L . . who is person Iy'know to me OR v produced .'( 64 .. r-:~;}. 34.. D93- 0 as identification. SieO~ seal to appear below) ,"1!.:ii\li\Y:~ B. P. Carpenter N :"\ MYCOMMISSIONI CC925616 EXPIRES ~~ ......~ June 25, 2004 '~I1r..r,.'lI'- .ONota THRU TROY FAIN INSURANCf,INe.