HomeMy WebLinkAbout02-1418
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N!
1418
IJ3' t9i)
ELECTRICAL
(813) 780-0020
72' ,S-o ~O' e-O
PLUMBING MECHANICAL
Date
?~26"r() :J..
111'trO
BUILDING
Property Owner:
Job Address:
Parcell.D. ,
Zoning:
Descriotion of Work
'f;ch MeP d DeJo.~ 5f,'kJ
@I() 7 5, " II by fA t. '>' cJ,.r.
Sewer Conn I ;t71' ~
Water Conn: . '3StJ. (!M)
I Co., e-o
Water Meter: CI
...{1'V 3
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.
DATE
Inspector
p~rmit Fee 6:f/{J~ 5"~
~Ignature _lu-\..JI _..
Company
Address
~Iephone# (fl.3) 7t';l.-CtV-YtY'
Valuation or
Contract Price
/b2. 8 / ~tf() . &U
City License Registration #
State Certified License#
(].(, ST~ CL'W'\ '51-:
2- {.//I Is cree
~?(
ELECTRICAL
('A fl'C; b...i, A~.: ,!dcz/u' 5 I~~
'/7'" /f., d % 17' .
MECHANICAL
PLUMBING
Tp. Servo SLB 10-/5-0:z. Breakers .
Rough In 1/1- :Ji-O 311J~ Tub Set ./ I ~ 2 r.; ~ 3 fill Ducts Insl. L- ./"/-2 1/-0 '3 /I(r'CJ
Meter Can . 1?.f.A( Water '/".1-/1-'3 TZL.!1 J~Compressor
Const. Pole h:o<'t -Q2 ~l7 Sewer v' ] ../1-13 RL.~4"'\-l10 Final
Pool Final
Pre-Meter ,/'1- IJ..J f?(lfj-,p7J
Final
Driveway /,-:2 7-t'3 R(.'tJ~ Jf
,n on ' Lf ~ c; 02... 2-: 2,{' j1tM'fI .f::-;{- ,
~Q,J( ~ - rl-I~-ol.f!5() T j () -;1 I --- tp '-i-(()/03 &-;'3 c> J<A-fh1 ,fdt-
RE1NSPECTION F&s~when extra inspection trips are necessary ~Je 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:
BUILDING
I' fJoJVl
Ftr. t/
Pre SLB It:./ P - 22 - C 2 Rt'(
lintel ./ 11-7-tH- RL4..lfJlJ
~
FRM. L/ !-2Jf,() '3 j.tfo
Insul. CL V / - U -03 Ifj'D
WL
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.
Kes, 'P(>-(
../f}~
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k-ssu-elJ
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The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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PASCO COUNTY, FLORIDA
Builder Name/Owner Name 1?l~~C~\C~ +'DQhvc... 5!; 1~5
Permit No. Il.! ( g-
Date Permltled ~ 07--
Control #
County Parcel No. ..__...._______.______
SubDlv: s:.!~~~ 01/<:: s .
Address/Location ---(gLQ~_5..L!J. e-v D..!..~KS_ jIy '-'_'
---------
ClasslflcatlonlType of Use ._:S F '0
0__..__-------.---
TRANSPORTATION IMPACT FEE
Rate:
//
Exempt [] Yes [~o
Sq Ft Unit: _
How Determined
-----------.---.---.----.-
Impact Fee Amount -!i---L-:.l~o . 0"=' _
Zone No. T AZ:
----- ------
SCIIOOL IMPACT FEE
Account (056) Single-Family Detached HOLlse
(057) Mobile Home
(058) Other Residential
1123) Cglle,Gtfun Fee
Exempt [J Yes r~No How Determined
AmoLlnt $ --J+..~_J~~__..___
------------~_.-
--------.------
PARKS AND RECREATION FEE
Land Account ______ _._. Land Credit _-=~fld'TC)faT------
-----
~-
Recreation Account____n______yeere-atTO;:; Credit
-----
-------------.-..----.---
Zone
---
Recreation Total
.~-
----------
/
TOTAL AMOUNT
_L__.____________
Exelllp~/[J-Yes [J No
How Determined
_-.-c::::.::_.____.....-...._ . :!Io. ____--
~~~~~~~o~~tE___~~~ Land To!al
Facility ACCOIl~~-~ _ Facility Credit ________._ Facility Total
~--'
sxan1l5{/ [I Yes [] No
r...---.-
------.---.-.--.--------.------
-,.~-_.._-~._.-._-_._--
l'low Determined
'fotal Amount
RESOURCE FEE
TOTAL AMOUNT
--"'-----
ERU
----.--------
--......_-...._."'-~._-_..~~.-----.-..........-... ~
Prepared By __ _.H__H__.________________.___ Checl<ed By
-.-.------..-----.--.
NO CERTIFICATE OF OCCUPANCY Will. BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL .rHE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
AclHlOwledgement below does not Imply acceptance of concurrence, but simply reeelpt of a copy of this form, placing
the building permit owner on no lice of this assessment and the condlllons of payment for same.
----.---.--------------------
DATE ( r,
Jt V) ot.J\)....(3L~Sl.I.: '1, V :u--g
RECEIPT NO. (J,J ._J ~OA TE
'-"~--------
I f V} L. RElfD ey--~~----
~->r3Y _ . ~~_____
G.L. Steve
6107 Silver Oaks Dr.
SQ. FEET PRICE
MAIN OR LIVING: 1,747 $ 50.00
OTHER AREA UNDER ROOF: 562 $ 25.00
OTHER: $ -
VALUATION $ 101,400.00
FEE SHEET $ 486.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 789.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 789.00
ELECTRICAL: $ 123.00
PLUMBING: $ 72.50
MECHANICAL: $ 40.00
RADON: $ 23.09
TOTAL $ 1,047.59
SEWER: $ 1,278.00
WATER: $ 350.00
IRRIGATION: $ 1'7~ -
TOTAL: $ 1,628.00
WATER METER:
IRRIGATION METER
SUB-TOTAL $ 2,855.591
SIF'S: $ 1,694.00
97.5% $ 1,651.65
2.5% $ 42.35
T IF'S: $ 1,480.00
99% $ 1,465.20
1% $ 14.80
TOTAL: $ 6,029.591
CITY OF
ZEPHYRHILLS
"NOTICE"
OF ADDITION OR CORRECTION
, BUI.LDI,NG
DEPARTMENT
9! 1ft?
I 6/0'755 ~H1 tJaA a, ftzlt)2- HI;; I
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
wI! I be accepted.
,
DO NOT REMOVE
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OFFICE HOURS 8 - 5 MON.-FRI.
. AFTER CORRECTIONS ARE MADE CAll
INSPECTO:88-66 WJCTION
II is unlawful tar any Carpenter. Cantractar. Builder. or alher pe~na, 10
caver or caUM to be covered, any part ot the work with flooring, lalh, earth
or other malerlal, until the proper Inapeclor haa had ample time 10 approve
Ihe installation,
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APPLICATION FOR PEma'l'
CITY OF ZEPHYRHILLS
BUILDING DEPAR'l'MEN'l'
l C~ Y'-:;?-~.?<
DATE RECEIVED ? - I - {J;;"
PLANS REVIEW FD
OWNER'S NAME ~\CJ-\At~ ?- Def>/2.A SlllfS
JOB ADDRESS c'ID7 ~ujQ DA,(S De..
LEGAL DESCRIPTION: LOT (S) I ;?5 BLOCK SUBDIVISION SJLvEYZ OA.:k':5
PARCEL ID # O?J~;JD",/;)J -OId.O- OOOOO-I.+Sl> (OBTAIN FROM PROPERTY TAX NOTICE\
PHONE (g 13)7 k 2- - 9 II- V 7-
WORK PROPSED: }BNEW CONSTRUCTION
OSIGN
PROPOSED USE: ~GL FAMILY DWELLING
o COMMERCIAL
o ADDITION
o MOVE
o ALT ERAT I ON
o DEMOLISH
o REPAIR
o INSTALL
OMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK (loV5T2..vc..-rrO.u
ca I V' "I I
BUILDING SIZE ;;;11!:. ...,
Of JVeJ.:) ee>1.[)E.0 c. e
SQUARE FOOTAGE ;;;:3 oq
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
J2! BUILDING $ I ~ 3 I (0 S?o - VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL Zoo AMP SERVICE ~ FLORIDA POWER 0 W.R.E.C.
o PLUMBING
.
o MECHANICAL ,$ VALUATION OF MECHANCIAL INSTALLATION
o GAS o ROOFING o SPECIALTY 0 OTHER
TYPE OF CONSTRUCTION: ~ BLOCK
FINISHED FLOOR ELEVATIONS
o FRAME
o STEEL
o OTHER
IS PROJECT IN FLOOD ZONE AREAO YES 0 NO
~uam6patl'r\ou)(:>e
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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 RESPONSIOILITIES
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
licE!nsed 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.
Furt:hermore, if the owner has hired a contractor or contractors, he is advised to have the
cont:ractor(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 ce'rtify that I, the applicant, have been provided with a copy of ~Florida's Construction
lieD 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 pr.omise 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 accurat.e 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 Treat~nt, 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 Reriod, or the project will be considered abandoned.
WARNING\TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PA.YI:'lG ~CE FO~ IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
I/lITH YOUR LENDE OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
.~:~o, ~':j~UE 0 NOT Ncr RE::::S: A "N:::::;;:'
:HtSNATlJRE: 0 ER OR AGENT SIGNATURE: CONTRA TOR
:,)'ATE: OF -FLO~:ffiA NEW.Hr"JV),p5f1I....c:.
COUWry OF '''-D,'' K. I VI ( h,~ vy""
7~e toregoing in~~rwrient was_acknowledged
STATE OF FLORIDA
COUNTY OF
The foregoing inst~ument w~ acknowledged
?~C()
CITY OF
ZEPHYRHILLS
BUILDING
DEPARTMENT
"NOTICE"
OF ADD.ITION OR CORRECTION
DO NOT REMOVE
/ 31.3 ~
I ~~ ~ ~~# I
~/OI'J ~I Oa.ha AM.. /...1:;4-01 j4/~
THIS JOB HAS NOT BEEN COMPLETED The following additiqns or corrections shall be made before the job
. will be accepted.
,
~
:t- B.llMJ. zrU.~ ~ ~~rvwj ~J
It is unlawful for any Carpenter, Contractor, Builder. or other persons, to
cover or cause to be covered. any part of the work with flooring, lath, earth
or other material, until the proper inspector has had ample time to approve
the installation.
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR RE-INSPECTION
INSPECTOR (!ij) J/dlJ
OFFICE HOURS 7:30 AM - 5 PM MON.-FRI.
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DRC#2000-
Phase I
Please submit fur approval one (l) set of construction prints and the fullowing
information on this checklist. The Design Review Committee (DRC) shaII have thirty
(30) days after the proper submission of all required materials to approve or reject such
plans. A written reply will be given to you from the Design Review Committee to the
owner of the lot as well as the builder ofthe home.
APPLICATION TYPE
K New Home Construction
Speculation (SPEC)
Pre-Sold
X:'
Changes to or Re-Submission of plans- Previously submitted plans that
were granted DRC Final Approval are changed from the original
submission.
Air Conditioned Space 1-7
! /4 ( Square Feet
Covered Porches/Decks l (;7 Square Feet
/' '(
Garage "-- l ~,/'...... Square Feet
! 1"-"
..,
Other 5"i Square Feet
Grand Total
-; 3-Q
, L.
- J
Square Feet
SITE PLAN (I copy)
Site plans should include pad elevatiol\ sidewalk and drivew~y location,
drainage flow and setbacks. Sidewalks are to be located in the r,ight of way
(ROW) between the property line and the street They are to ~ the length
of the lot along the lot line extending four (4) feet into the road n~t of way.
As a reminder, the owner of the property is responsible for. th~ DI1amt~nance
of the sidew3:lk and driveway as well as the entire area WIthin the nght of
way.
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DRC#2000-
SIL VER OAKS DESIGN REVIEW COMMITTEE
NEW HOME CONSTRUCTION APPLICATION
GENERAL INFORMATION SECTION
~
Date of Application: t. / I
/ .,--7
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--=-
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Lot #: " '::..- ':)
Phase:
Address ~tD7 SiL--Jee OAcs Drive
Commencement Date: _/ --! _ Completion Date: --! /
Owner of Lot:
KICHA-S2..b ~ l>8si2A- S:.TJ LE3
Name
&03_ q2-~ - r?3S:7
Phone Number
P.o. bOy: e:,rsl)
Mailing Address
I-tAMnoi....J
City
N.l--{,
State
03S~
Zip Code
o 5 IU./~ OA-tCS.
Address of Home Under Construction
f2 . 7-t::~4'{12- ~(LLS {:.( 33 s;:L{ /
Builder:
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Name
,~ ';':f',.\ ':::.: \'f~'C17 (.,,- <B (3 7g2-c,C/-tf-2- COC022/39
Phone Number License#
37 (PSI ~ T1.+- AvE.
Mailing Address
?'~"{ R-.LJeLL'-
City
FL 33$4 2-
Stale Zip Code
All construction within Silver Oaks must comply with the terms and conditions of the
Silver oaks Master Declaration of Covenants & Restrictions, and easements, recorded in
the O. R. Book 1704, Pages 0376-0415. These documents establish the Silver Oaks
Design Review Committee (DRC). This committee is responsible for monitoring
construction within the Silver Oaks CommWlity. The DRC has established this Design
Review Application for New Construction for all construction in the Silver Oaks
Community .
~
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Signat'l1re of Builder //
Date
7/ ~/ Iv 2-
Date
3
DRC#2000-
PHASE II-RESIDENCE EXTERIOR MATERIALS AND COLORS
TIllS MUST BE SUBMITTED WITHIN SIXTY (60) DAYS OF COMMENCEMENT.
EXTERIOR WALLS:
Brick:
Color:
Stucco:
X"
'-
Color:
Stone:
Color:
-... -
DRIVEWAYS AND SIDEWALKS
Concrete: X
Color:
Exterior
Windows: Materials ~i..;V'/\ {~/\'\
Fascia: Materials: Ll..L..Vy\ I "-'....r,.\. ,~
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Color:
Color:
.... " "
Roof: Materials ~;,!e t), '(1, i
i
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-
DeckslPatios: Materials L.c~.C,2.~\ r.:=-
"T: 3.. D.~
Color:
Color:
Pool Enclosure:
., l.,"""
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Color:
All pools must be screened in if a pool is to be installed. Fences are not allowed to
enclose the pool area. Please check with the City of Zephyrbills and or the Florida State
Statute regarding any other laws or ordinances regarding the installation of a poo1.
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DRC#2000-
PHASE Ill- LANDSCAPING PLANS
SILVER OAKS MINIMUM LANDSCAPE REQUIREMENTS
Please submit a set of landscape plans as outlined in the rmmmum landscape
requirements.
All lawns must be fully irrigated with a separate water meter. Floratam sod (St.
Augustine) must be used and placed around the entire lot to include all the sides of the
house as well as the right of way between the property line and the street.
1. Landscape requirements. All residential lots both single and family as weij. as
multi-family shall be landscaped with trees, shrubs, ground cover and St.
Augustine sod. All shrubs and ground cover beds shall receive a 3" layer of
mulch such as pine bark or cypress mulch. All free standing trees shall be placed
in a minimum 3' diameter muclh area.
2. Landscape Budget. The minimum budget for landscaping (not including sod and
irrigation) shall be $1,000.00. This budget shall consist of a mixture of plant
material in the sizes listed below. Some adjustments of three (3) gallons to one
(1) gallon quantities may be necessary and will be reviewed by the Design
Review Committee during the review process. All materials shall be planted on
the front of the roadside elevation. Units with road exposure on more than one
elevation will require additional plant materials.
A. 1 each 15 gallon site tree 7-9' each 1 and a half calp.
B. 3 each IS gallon specimen 3-6'each.
C. 35 each 3 gallon under story (Hedges or mass) 16-30" each
D. 50 each one (1) gallon ground covers (mass or edging) 1-16" each.
E. 5 cubic yards pine bark, cypress or pine straw mulch
3. Landscape Plan. A landscape design shall be submitt~d forThisapprolanval ~ :ac~ l~t
as required by the Design Review Committee check list. p s m ca e
the location of existing trees to remain on the lot and those to ~ removed. I~ shall
include the quantities, common name, container size, overall SIZe and locatIon of
the plants on the lot. d dards d
All materials must be Florida # 1 or better by Florida grades an s~an , an
4. shall be installed according to proper and accepted horticultural practIces.
K<OLL-1P.5 LA~OSCA-PJ'o~
Landscaper
\2 \C t.-\AQj) ~ 0E6eA- Sf! lE3
Owner
B515 GAu-.. ~L"iD
Address --z.e0.i 'l~ u-S
tltf.-17~r;
Phone Number
\Zc6 \
Lot and Phase
5
MAP . OF BOUNDARY SURVEY
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August 8,2002
Richard & Debra Stiles
6107 Silver Oaks Dr.
Zephyrhills, Fl. 33542
Dear Mr. & Mrs. Stiles;
We received the Silver Oaks Design Review Application dated 8-1-02 on 8-8-02. We
have reviewed the first two parts of the application concerning your building a house
in Silver Oaks.
After careful consideration the Design Review committee has approved the first two
parts. The Design Review Committee will retain the original application and
drawings for its records. Defore beginning landscaping you will have to submit a
diagram or plan of your intentions to landscape your property.
If you have any questions regarding this matter feel free to contact me at 813-782-
1383.
We appreciate your cooperation in submitting the application to the Design Review
Committee.
Th~yo.u ~ /,
('~ //(a~/
Charlie Mackin
Chairman, Design Review Committee
CC/Design Review Committee Application2002-112/112A
Silver Oaks Board of Directors
1111111111I11111111I1111111111111111111111111111111I11111111
2002118648
permi t No.
Rcpt: 607506
DS: 0.00
08/01/02
NOTICE OF COMMENCEMENT
Rec : 6 . 00
IT: 0.00
Dpty Cl.rk
state of
-
\-t..-Oet DA-
County of
PA.sc 0
THE UNDERSIGNED hereby gives notice that improvement will be made to certain
real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement:
1. DeS'~rip\:ion of property: Parcel No. 03 -'~~-dJ.I-O I~O- r:x::x::x:x::>-{~
(Pt 0, S/LL)~ DAtoS D~
(Legal description of the property and street address if available)
2. Gt::Bt!J:.al DescJ:ii:>tion of Improvement
Co0~l'evCT I O}.J C;:- tV€:I--J et:.-:s ( De)...:C E
3.
O\'lner Information: Name elCI..fAe...b ~ C>E'"8eA $,1 L-t 5
Address.,p.O 8o't. ,,~O City HA.mP'J"'V,J
State Nt-! o.3~'
Interest in Property:
Name of Fee Simple Titleholder:
(If other th~n owner)
JED PITTMANj PASCO COUNTY CLERK
08/01/02 0 :1~m 1 of 1
OR BK 502'1 PG 1621
City
State
Address
. -,.,
R }4.
/t L C Te~~ e..o j '.5T n .'c.-r-t 0;..)
Contractor: Name Ln' .:::>\ I -.Ie:::;.. IV """"-I
Addres~ '37~St ~1t1 AY City U-Pr....J\.(ef-l.tt.(..5
State Fe... 335#.
5. Surety: Name
City
State
Address
Amount of Bond: $
6.
Lender: Name
I
II
City
State
Address
7. Persons within the State of Florida designated by Owner upon whc)tr
notices or other documents may be served as provided by section
713.13(1)(a)(7), Florida Statutes:
Name
City
State
Address
8.
In additio'
Owner designates
of to receive a copy '..>f the
Lienor's Not~c as prov~de ~n Sect~on 7 3.13(1)(b), Florida Statutes.
9.
1':X1' 11 t1 L i,OIl utt Lo 0 ' Nutleo of CUllIIIIOllC01ll01l L I (Lhe e~1.)lratloll da La is 1 yeal
f=i.:>r.l the ciate oi'r cording unless a difi~rent date is specifi~d.)
..--
Signature of Owner:
Sworn to and subscribed before me this I. q7} dc~:~(.~'f?::~][;.'I4e___
,:: ...,.'~~" '.~. '. " .:.~
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Notary Public: /b)~JJ./
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