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HomeMy WebLinkAbout03-1950 BUILDING PERMIT CITY OF ZEPHYRHILLS Permit N~ 1950 (813) 780-0020 /If) .60 BUILDING ,35'~ ELECTRICAL Date ,q -025'- 03 PLUMBING MECHANICAL Sewer Conn Water Conn: Property Owne'. ~;:Q ~~ JA.<<. P Job Address: 3 'I JJ V ~ . Water Meter: T.I.F.'s: Parcell.D. # Zoning: Description of Work Energy Code: 5c J"LU"V\ ~Y\ 5Y Radon Gas: 7.7[[ J-- Cu~ NO OCCUPANCY BEFORE C.O. FINALS- - /.2 - 03 DATE Complete Plans, Specifications and Fee Must Accompany Application. C.O. All work shall be performed in accordance with City Codes and Ordinances. Inspector DATE ;f L t( d /lcFO City License Registration # State Certified License# ,;J&, Permit Fee >Signature /3 ---- fI, ~ Company Address ~Iephone# 71"2 -I 00t Valuation or Contract Price /:J 710. d-e> . Bill ~, BUILDING II~ f}~'(. #0 IR'7 ELECTRICAL MECHANICAL Ftr. ./'3-.2ft- t:3 ~1..'1jJP"bTp. Servo Pre SLB /lj-/-tJ3 ~l.rllf:rt Rough In Lintel Meter Can FRM. Const. Pole Insul. CL Pool WL Pre-Meto/ ' . fl.'-Y Final J >/f 2(, ? Driveway ,/4-(-0} j 1-150 I I e...(~cd 5L."0 /L{-/-O'; :ri SLB Tub Set Water Sewer Final / f I / ( 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. 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. CITY OF ZEPaYRHILLS PERMIT APPLICATION BUILDING DBPARTNxNT 5335 8~ STRBBT ZBPHYRHXLLS, FL 33540 Phon.,B13-7BO-0020 FaxIB13-7BO-0021 DATB RBCBIVlID c2 -I Cf- V 1 PLANS RBVIBW FBB OWNER'S NAME &/ZII-IVt? /-kIZ ('Zo,A/ fILl! p. JOB SITE ADDRESS )7 ~3o NEvlcotVl /lve. PHONE CONTACT 7J>z - J 06 Y LEGAL DESCRIPTION: LOT(S} BL0CK to I 70 SUBDIVISION ~ /Jo/ll CtJA" /1'11)1', PARCEL ID # 3 <-f - 25- '2 (- . OO{ 0 - 02cr 00- oozro (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: ~W CONSTRUCTION o COMMERCIAL (j;f'ro)DITION o ALTERAT ION o REPAIR ~NSTALL o MOVE 0 DEMOLISH DMULTI-FAM!LY 0# OF UNITS o MOBILE HOME o INDUSTRIAL o SWIMMING POOL o fJ l.-I/ In 1/11 t./;n. OTHER Os I GN PROPOSED USE: ~ FAMILY DWELLING DESCRIPTION OF WORK SQUARE FOOTAGE HEIGHT BUILDING SIZE 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 ~UILDING ~LECTRICAL $ I z..r7 I:{ C. /-0 VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o FLORIDA POWER o W.R.E.C.&vl~ ~/~P o PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALTY . 0 OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER IS PROJECT IN FLOOD ZONE MEAO YES o NO FINISHED FLOOR ELEVATIONS ~~ !~, ~J ~OMPANY-'3t{+ c O/IJ'7T1luc..7 I a/v cr: C.2"vJrv.Je Fe, STATE CERT OR REGIST # Ci3(o 57'1crz. CITY PROCESSING # ~G, BUILDBR SIGNATURE . ****************************************************************** SIGNATURE fL A,'~ COMPANY /Jq~ FL--Ec Tilt c STATE CERT OR REGIST # CITY PROCESSING # I~?' ELECTRICIAN ****************************************************************** PLUMBER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************************** SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # MECHANI CAL ................**................**.....****..**.......*.******* COMPANY STATE CERT OR REGIST # CITY PROCESSING # OTHER SIGNATURE .................**.***.******..*****.***...***.****..*********** \ CONDITI0NS OF PERMIT AFnDAVIT * A. NOTICE OF DEED RESTRICTIONS .' The undersigned understands that this permit may be subject to ~deed restrictions" which may be more restrictive than City regulatiQns. The undersigned assumes responsibility for compliance with any applicable deed restricti9ns. B. UNLICENSED CONT~CTORS AND CONT~CTOR 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, 613-788-6611- 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 tbe 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 "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 Tanka *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 volumeH will be submitted which is prepared by a professional engine~r 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 requi~ing a correction of errors in plans, construction, :or violations of any code. Every permit issued shall become invalid unless' the work .utho~ized .by.uchperlllit 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 ~RO~ERTY. 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 ~OST A "NOTICE OF COMMENCEMENT". SIGd:l~ ~~E1JA~~ ./iw..4~Jl;f!h ;. STATE OF FLORIDA V,[IS COUNTY OF ---Lr cO The foregoing instrument wa~.acknowledged Before me this N day of tt7}g.U/i.../UI , 2..0 Q1. by &'f'Z..c""'G l3b;:./f E (name of person acknowledged) ~ is personally known to me, or Dwho has produced (type of identification) and who Odid rn:rid not take an oath ~A.~ Signature of person taking acknowledgment STATE OF FLORIDA /).l1c- . _ COUNTY OF r lI.;~ c () . The foregoing instrument was acknowledged 8efore~e this ,~ day of {:f1Jlulrfl'( , :2RJ:[} by ~@' ~~ ~name of person acknowledged) urwho is personally known to me, or Dwho has produced (type of identification) and whoO did 0Cfid not take an olth. ~A.~ Signature of person taking acknowledgement BI2-uc.E 11- - It 58 I:: L Name typed, printed or stamped -Pj' Bruce A Asbel ,~) MyCommissionDD11671O 0,,," Expires June 22. 2006 t5f2-Uc F /J. /J5/3EL Name typed, printed or stamped -Pj' Bruce A ABbe! ,CJ-: .: My Commission 00118710 0, ro.'of Expires June 22. 2006 ~ {3 ;-It c ~S.172.-,.Jl/f( 'r--:, ~ 7; 7tJ t\l il_\...)\l.~"-, ('r V , itliliUN~ ~~ SO. Fr. PRICE Main Other Area Under Roof Valuation: It... {74 0 .'2-0 Building: 142--. -5 0 Electric: ~1- -:) \:) Plumbing: ,J /rr :hanica1 pI f1 on: '7 t.'1 '8 ~fvr~ $ J 1/?, I~ i6 ~ch~Ol Impact ,,\ I ees. IV t1 Connection Fees: rJrr i:=- ~~ 02/05/03 WED 14:29 FAX ~137823966 GRAND HORIZONS HOMES B&H CONSTRUCTION OF CENTRAL Fl... INC. FREE ESTIMATES 4025 MOR:RIS BRIDGB ROAD 1-100.224.1206 . ZEPHYRHlLLSJ FL. '33543 . L..ICCI'Soe.d . BOfldcd · ltIslJl'cd .. SkirtinJ · Step.! · RClClCn Addition" · Ahuninuim . Cor'/c:r~c l...or i :Ii, S",bdiyj,iOlt 3 7S30 HE~,tG./II'I &6 I I L..pLO S~~ bSe~ '&1'1 Color Tr;", Color Beara Color All dumiJ'lwn roo& in~lu~: Plll1. Tritn. O~ncr, Down. s.powl.S ).v Post,. 2~" Beams and shingle FlNhin.. (~~~) D-pVIJJJ'i1Yt LonllcJl&fSq Fl X '.03 - 3.." I' .D:..PvlI.J.I]r ~1J..7a:Iq PI x '.OJ - ,.., _P&tIS_PI Loona-Scr Pt x 3.03. 3.e1 _PIIlS_'J L.CftB_Sq F't x 3.03. ),41 I '1.IUlcc----..---.--.---.-!1.!:l-LIF x 4.00 Gvncr OIl HoaIe--'-~UF x 4.11 . IOa.bh:BamwordonPronll* ,I3J." J.... rl~ 244 SM a.m - --- .J.LJ.h x. 3.50 oJ.;.:l ~ I,' , 2.(6 SM ikun-.---.- LIF l( 4.'S i 2:...1 SM Bcam----...-....-.- 7'E"" 1.IF x S.I S t"'f:lt.30 I ld SM Be4m--.--....... _lA II 6.'~ I 2l<9 $M 8.-m..--.---.---_LlP~ 1.~ I <'1<10 SM ~_.-_n____LI1~ 10.,1 I I ! I I .", SCREEN ROOM WALLS up KJ' Jl.. .fI4+..1J,.+ _-1M.VF JC 26jJ Scree" OooIlncludCl: CltJlet Uld Thr"'olcl-.~.--.- LlJ? x IS.IO a.blt Fill Ooa. ,ide).-- lJI1lt 1).7) Lnsul"lecl Kick PI.u~.--- -UP x. ).30 ! FVl 8~ ("ot ~).....__.- Up]!; 51.20 t:I-,~ L J 8S,H> I UTIL.ITY ROOM W AJ..LS i W.lh..a;.. J.!l. J.h+ _. -1.B:.....VF lL )0.19 I 2... Sl'II.:S.t 16" OC 5~ed Oaor IIl\d I Wizldo'JI--L-VF l( J)1.21 Sinilf: Win4ow(!~'>--...L-lAx SI.4a Sut Shjcld--..-m---- ..i1....-U1 . 4.S6 j Mi,,: I I 1 I I I 1 I I ! 1//, /. '2. U,. , "h~ r L ,~ VINYL ROOM WALLS ~'inyJ Well +... + .. UF x 4S.1cS IMide Ki..Jc P1at;:.":::-'-=- -L/F % .s~9 - Lap Top insidl ud OIJJ--- -LA X 13.13 I:'lori<1& <ilw-..--..---. UP x. 9.15 1nsul.tc Top IIld 80"0=- ~ X 4.90 Oocn u,c1uck (1) 2 Track ~ Thr.hollS and CI~--- eA a; I j I, St' 6 -. ~H ~II nOI be r.J)Otl,lIlllc for any Iqb in VTNYL ROOMS X III 001 (;/?Aud tI{1P~a,~.1 a.re 1--t~-t:13 2.&6 6.24 17.1 IS 80.01 , ALUMlNUM TOT A.I.. CONCRETE AND 8PJCK WORK 'tuo SI'bo---a.tX~. .&4Sq fit )( :l~ 16 '.cio Slab--.L.i&,l -.&L,.S1" lC ~.16 Pario SI____~JL .~Sq" x 2.16 P~tio $J~- _x_- _Sq Pt x 2.16 S/Ct. Wllk'-- Lx1!/.".L~ Pr Jf 2.' 6 Dr-i"cw.Y-~x4."~SqPt. 2.J6 Ori'r''lfty,fJ.irix4, -..4.LSq ft x ,~., Jf.Ibed UriJi~ ".__, IlZu..L.. .-. '2.40 It.-iMd 'alio 6 C_x_ "_Sq Fe x '.02 Raised hcio' C_x_" ~Sq Ft. - 1.02 OVIt , p. .. ,. c___ · LI1 x ~.I J "'COl.. bl: ltIilsfOl'oed--:l[.vr ]I; ).11 FQCllct 12xJ2ltelnbeed- ..!8:).n .I $.61 FOOCII:6 Skirtin,---&?1.6rUP x 2.70 I Tred Srcp---..-.-- _EA ~ tSl.90 2 Tr.d sr~----......-- EA)l. 1)1.1(1 J Trull Sr....----::z:u.. x206.11 4x4 Sloop.------~.--..~A )L 219.'" Brick SIWtift, M..x S HI'" Over , ,.,. ft ,.. ~I_ _l.IF)( 1.90 SpJiI Brick Air Sl.ack.---- VI' x 9.~O Split Brick So1id------.n~tA .. 1069 Over S per ft p<< co""J"--~ .I 2.1:' Fill DIrC-.---- - .....f-LcadJ x 100.00 PrCO'..._,._-_._-~ ......-----.- 100,00 MiK: GLASS ROOM WALLS W.11$ + + + · L/f' x Jl S)'~.~ x::.. Sq ft_, upS~m" ~~ fiNld ~1iD1 - - _Uf x se.p JWlift, LUF x Oara,. ~.,..."- x eA Jl; ~ Nt .'Yr o iii'. Door K..d,,- -x -EA x ~J/...L. ,441:"" OVllle Door Opccr-- -x-fA x 'Mice:- . SIG(,!: .1 R~ t. L.uc'3n~cL:: D^TE~_~r-D 3 .~IUI\ FAX r<rllS.6Sg.s~ Pc-r.nll' FOR ENQINEB~G ~~U.I ...1 'N Or~ 'MI'toIli, ..... _...wa .,. "...,..~ .... _...., A 1Jlof~C& ou.Aoa., I.J~ ,.., ~ ril Ira a_ e.a .llllr.C>\i4 ._ft. . ~ Io.NJII\W. rDCINT ....01 MJ'B or I ,yo "UI..-..y'. ,.. U'......,;. to ",,0..-. g"'~1 /~ ~LA, IL I ?(}'f$",2ifl :IV "~ ..''/ 4!J!i _ ./A I, ~~ /9'- ,~ ~ .~/.A,ll; ~ -M~ tJ~,,~ , LI~ ." II "1~ ~ eV"" ~I ~.!) ~~'"~ , /~IZ7 :'''Ifo,.,,tX> I ; ->~Y7.,r6 1;;~ ~ ,j~ :l.~~OO i /J. 7'O,~O ;;) l'd liolOi:t.':f ....,~ : ~ Eo.:~-G?';- J LEONARD G. "GEOFF" WOOD. P.E. 4034 THE FENW A Y MULBERRY, FLORIDA 33860 (863) 646-5517 Date: 2-7-03 B & H Construction Zephyrhills, Florida Re: Address 2003 Jacobsen 37530 Neukom Ave Zephyrhills, Fl. 33540 Mod # CL 5571 B Lot # 26 Dear Sirs, This letter is to certify that I have reviewed the above referenced project to determine the structural adequacy of the existing structure to receive the attached structure. The proposed structure is roughly a 12x14 Shed and a 12x39 Carport, and a 12x13.5 Riased Screen Room. The existing mobile home, to be considered an adequate host structure, should be blocked and anchored in accordance with the manufacturers suggested and permitted set-up permit. Therefore, it is my opinion that the marriage of the proposed structure with the addition will not compromise the structural integrity of the host structure, if the addition is constructed as per the attached aluminum engineered drawings. As always, should you have any questions, please feel free to call me at any time. i;;((t!:~ 4034 The Fenway Mulberry, Florida 33860 l. ," f~ >1 6,0 ' . . I ~ tf' , If;' I r- IJS~/O'--;;' .27 ' ' >c.~e61./ /(~II( J I ( ~ IJ1 .; "IJ~~/3.r' ..... .. I I , , I /l7r;lJi/E I6N~ / , I I' ... I 1'1 5#c-cI , I J ~ 1>< I ~ :l-- 58 x. :1.)(7 "" I 3~ '" / foE: ~/I ..... 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':::J Z .J:J] '"' ~ u - :-:-: < -- 0:: :.; - - ~~ ~ V')~v -v _ :;:;,gc :....,z 08 'j - ~ ~.~ :.r.1""'\ Q.,~ '-' ~~ z ~~~ 0::2;25 o . u.- "<1' ~~~ 00_ ~ < < Mf- - ~ 0 1l1! ....,0.. ...., ~~~ ~ N N >< >< ~ ~ -~- S3 nrv ^ ilI0t:IH I~I IJ ./: ~ ~U"; ~: ~ 3 ~ 0 '..:J - 1- w 0:: - 1- ;z. u><o:i' :/)000- :::J;;;~CIJ ~wc...P ....; CIJ :I r-;Z C:::::li-_ Leonard G. Wood PE # 47377 4034 The Fenway Mulberry, FI. 33860 I. <; ~<5~ ~3h o Gl._ p ~:~ ~~~ 0<0 - .. ~8~ 'S~~ ~. s ~~~ ~ ~ ~. ~~~~ ~\l,~(y) .~ ~ ~ ~ z o r- , . '-' '.:.J ,/'; t:J ~ > 5 3 ~ ....J -' <( ~ ""' ., ...... ./? 2J;"" ...1 .) "" ..105 0\01(... :?~~ 8u2 '_~I.~~;~, f ~~ ~ ~ .~ ~ . (j ~ ~ ~~ ~ ~i ~. ~e ~ ~~ . . ~ 5~~' t:1 ~g ~ ~ I t ~ ~~ I ~~ ~~~ ~ '"', U.M~ S'3 rw ^ J..H 0 rID{ ~~ ~~~ ~e{ ~g~ :;' ~ "< ~8 0 ~~~i:~ ~ -o~~~ h~~~ ~ ~~8~~ ~ V) Leonard G Wood 4034 The Fe PE # 47377 Mulbe nway rry, FI. 33860 ~ ~~,~ ~ L<t ~~ ~8 o ~ _I ~ S .., '"" ~(2; !~ <" ~ j --sc ~~g ,.,I " " ..(~~ \~~ ,... ,... 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I .. .1 '1 I :, ' ' a - : 't z o I- ~ C Z ;:) ~~ e ~;ii i ~ ft~ii i ~ !8~;~ ~ ~~til ~ ~ ~~;..! w ~~!I~ ;: I ~ w ~ ~ . ," "r 10' . . ....: ..J: .... .... .', " ., ,. . .:.,,:'l _ '. -:L.t.JJ' . .... ,'.'. a :9 " a-" s: s: s: CI:lGl~'<:t\OOO 000\0 .8 - ~i '0 ~ ~ \0 s: s: " " ~I/")\OOO" " ~all)'<:t~~ ~o on. _..._ ._.......,_....~.......-:.:-....~. .,. ~. - I ~. i ~J I; ;, al) Ii J. U II iil 11 \1'~ ~~~ ~~~ "-'lab i - i e , ,. (1M') ('"I~ n t i I~" ii~ I~; il JJ ~~I !~i i~1 '-1& - I M N ,,---.. !i ~J Ii ! lL! II ~, ~ ; I ~! i ~ ~ 5 5 ,. ~ ... ~ ~ ~ ~ . ~ ~ b~ ~ I ~ ~~ iif~~ ~~ ~...~I::f.} ~ ! 'I~ ~ hbj ...J This space for use by Clerk of the Circuit Court only. 111111111111111111111111111111111111111111 1111111111 11111111 2003052221 STATE OF FLORIDA COUNTY OF PASCO THIS IS TO CERTIFV THAT THE FOREGOING 1$ A TRUE AND CORRECT COpy OF THE DOCUMENT ON FILE OR OF PUB, Lie RECORD IN THIS OFFIC~ fNESS MV HAND A~CIAL SEAL THIS CIJ . DAY OF J- 2 .fV3 JEO PITTM~~ CIR~UIT COURT BY ~ DEPUTY CLERK Rept: 666135 DS: 0.00 03/25/03 Ree: 6.00 IT: 0.00 --- Dpty Clerk JED PITTMAN1 PASCO COUNTY CLERK 03/25/03 0 : 1aPm 1 of 1 OR BK 528 I PG 656 t'jOTICE OF COMMENCEMENT State of Florida The undersigned hereby gives notice that Improvements will be made to certain real property, and In accordance with Section 713.13 of the Florida Statutes, the following Information Is provided In the NOTICE OF COMMENCEMENT. 1. Legal Description of property (street address required): '37(;30 IV f U/(otll/l... flV f . Lo r "2 4,. 1'1 - 2-5'-.2.--( - 001 0 - b 2- ?oo - 0 C 7 Cc 2. General description of Improvements: --1J L-V,1/! ( NJI1/( f Ael.:;;' G~ 3a. Owner Name: G /ZIt-N{) /'-4., {l{ Z CJ /1,/ /J1 )1'. /.? I . Owner Address: r-,t ~ ~ Gf-f~;V SL-a/,t: DfZ, 2r;iW't!L(-I-r U 5 r:::-L. 33 ';4/- (1~6 0 3b. Owner's interest in site: 3c. Fee Simple Tille holder (of other than owner) Address: R4. Contractor Name: B-tH (QlVsr(2v(..:rlo!v of=- f'.r/Vrf2A-L ,:::"'L, Address:tfOZ") IUO/llU5 f?tllD6t i<Jl. "2{.;f}Ii'l/lfhu,; F-"L, '3J5Lf; Phone: 8'/"J- 7fz:.. - / CUI 5. Surety Name: Amount o.f bond: Address: Pho.ne: 6. lender Name: Co.ntact: Address: Phone: 7. Person within the Stale af Florida designated by owner upo.n whom notices or other documents may be served as provided by Section 7.13.13(1)(a)7, Flarida Statutes, Name: Address: Phone Number: 't. '~.. ., 8. In addition 10 himself, Owner designates lhe fo.llowlng person to receive a copy of the lienor's Notice as provided In Section 7.1 3.13( 1 )(b), Florida Statutes. Name: Address: Phone Number: \ 9. Expiration date of Notice of Commencement (explratlo.n date Is one (1) year from date of recording unless a differenl dale is specified). STATE OF FLORIDA ,:4c H- t:tpy L, lzef&atgeature of Owner The foregoing instrument was aCk,nOW)edge before me this ----12/c I-J.-AilO 1---, gC/-teEZG' produced PFe5o/VA- LV-( klvov/y'v (Driver's License #) 2-S- date of /J1/';;u:./r , 20~' '), by who. (Is) (are) personally kno.wn to me or as Identification, who did/did not take an oath. ,-;'/') :) I j.-vtVe-{ ;:;. i&U Signature. Notary Public ~a\. BruceAAsbeI ,~ .: MyCommissionDD118710 or,..'" Expires June 22. 2006 "(A copy of any bond musl be pttached at the lime of recordation of this Notice o.f Commencement)