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HomeMy WebLinkAbout03-2104 .~ I CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 2104 Permit Number: 2104 Permit Type: ADDITION/ALTERATION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: MOBILE HOME SUBDIVISION Square Feet: Est. Value: Improv. Cost: 11,501.66 Date Issued: 5/28/2003 Total Fees: 170.00 Amount Paid: 170.00 Date Paid: 5/28/2003 Phone: Work Desc: SCREEN ROOM ,SHED AND CARPORT Address: 37645 LORENA AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: GRAND HORIZONS Parcel Number: 34-25-21-0010-02800-0121 GRAND HORIZON M.H.P 37645 LORENA AVE ZEPHYRHILLS, FL. 33542 B & H CONSTRUCTI L ACE AIR CONDITIONING & ELECTRIC f-) 03 /( / l' l\fJo T1S R UGH PL PRE-SLABI'~ ...y-q /fro CONSTRUCTION POLE I 2ND ROUGH PLUMB DUCTS INSULATED LINTEL - PRE-METER I WATER i FINAL MECHANICAL FRAME I MISC i SEWER : MISC INSULATION WALL : MISC ; MISC, 1 MISC, INSULATION CEILING ' MISC. .1 MISC. MISC. DRIVEWAY ./ (, .../.f.O? (.{'40 ! MISC. MISC. ! FIRE DEPT, FINAL REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) 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 "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." -'.. Complete Plans, Specifications and Fee Must Accompany Application. ___ .__.___ All wor:.~ shall b~ performed in accordance with City Codes and Ordinances .________ NO OCCUPANCY BEFORE C.O. ---~---.- -- -_._~ I~T~~~ATURE .. - ~M. CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER aITY OF ZEPHYRHILLS PERMIT APPLICATION BUII,[J!NG I>BJIi'ARTMIllN'r 5335 Bth S'rRHlE'I' ZHlPHYRHU,I,S, P'L 33540 PhoneIB13-780-Q020 ra~1813-780-0021 lJA'rB1 RIllCBltVIlJD ......../f~ ,q~~~_ h PI,ANB R!llVIIllW Jl'1ll1li.__U_"__". _'_ O\'INER' 8 HM1E__~!2Irf~,._.i-/-.9-~l...-( Zt)~_.J!!.:Ji,-~ .___.______.____... PHONEJ (XJN'1'Ar~'~.~!~='!~~_:: !e.~i ,TOB SITEl ADDRBlSS..~'lJ.g_lf ~._ ~1-!;J!.IJ.___,9y~___. L!!E_Iz. L__.__,..____._____.___,__....,_ LEH1AL DBlSURTP'l'IOll, LOT(S) BfDCK SUBDIVISION ~tJ_/jO'I!!_ZO~/Yll...-i,p WORK PROP8ElfJ I lM1~ElN CONSTRUCTION PARUElIJ ILl # -:>4-2'5-2-1- 0010 - 02[-000 -O/~I (OBTAIN FROM PROPElR'rV 'PAX NO'l'H~El) ~_._--.._--~~-._-----~._._._.._-------~-~-~-----~_..._~-------~._'_.._-------_.-...-~-~._.__._.._--_..._-.._--_.~-.. f1f1\f)D 1'1' ION o AI/1'ElRATION [] REPAIR IJorht8TAJ;I, []SH1N PRtWOSEJI1 USE: I r~IJ FAtHLY fMEJLI,THr..l [J MOVE: o DEl~10l,ISI1 [h1UI.'I' I "FArYirr,y [)# OF ONI'I'S o SW tr1MIHG POOL (] M08 u'El lIot1El [~I'H ElR ,4Lu.l1IIJ()JA. [J CDt1MEJR(! TAl I o INDlJS'l'RIAL 8UIL,fHNG EllZEl CJ ~URANT & J.!ElN.mI DH:P~ElN'I' APPROVJI.l, ~ ~ ~ OF WJRK _I'C(/:fc__._f!-oa.VVlI-__ Sl:;~~ cARI~J!:_~___. ______._._. 532.. .------.----.~...-_-,__-'_u._.__,____.._.u _.__. __, IlESCRIPTION ._-------~-----_._-._-- SQUARE FOO'1'Ar3El HEll GH'l' REBIDlllNTIAJJI A'I"1'1\CH (2) PI,OT pr~AllS & (2) SETS OF BlJIf,lHNG PI,ANS & (1) BEI'l' ElNElRny FORMS. C0f\1MBlIWIJH,I A'I"l;ACH (3) SE'l'S OF BU1LDING PLANS & (1) SElT ElNE:R(3Y FORMS, PROPERTY SURVEY RElQUIRED FOR ALL NEW CONSTRUCTION. FERMITS REQUESTED [l(81 J I J ILl I Nr3 P.rELElC'J'RlCAl. $_11501 . (gCo VALUATION OF TOTAL CONSTRUe'l'ION - -------_.____ At1 P fl El R V I C EI o FUJRInA POWElR [] W, R, El, (~, willE Sf/Eo I.] P I.tJt1B ING IJ 11ElUH1\.N WAr, $.- ~--, - VALUATION OF tllElCHANCIAIJ U1S'1'AI,l,A'I'TON [] (3AS rJ ROOFING [] SPElClIAUl'Y [) OTHER TYPE OF CONSTRUCTION: [J BLOCK [] FRM1E (] STEElf, [] OTHER FIN ISHElIl Ff.(XJR Elf JElVA'l' IONS r S PROcTElC'f' IN FLOOIl ZONEl AREA [J YElS 0 Nt) BUIf"l1BlR 81GHATl1REl -,----~-i2_'----~______._____ CClt1PANY ~.~.1LCJ~(y$ Tg:,~",rX-E~'Ht)j:::_.~f~ ' 8'I'A'I'B1 CElRT OR RElGI8T # .C.E{;Q?7.f:L<f.~..._.._____ CITY PROCESS ING #..__~_______________.._..,__.,.-'-.._ /t/t*** "'** /t** *** *** ** * *** **** * * **** ** *** ** * * * * *** *** ****** * * /t** * **** 1iJr.RIC'l'RI crAll ****************************************************************** cor'lP AN Y ~.-_Ji0f..C:.!l1.{S:,_...___...___ ___"._ ._,__.. STATE CElRT OR REGrST U (Try PROCESS INt3 #____.If'7~..==~~~=:~-:~_~_.~~~_-=-~.~ 8 W1IA'l'IlREJ _...._ ~ /1 I?On ...---...... ---_._.._~----~~_._---,-------_.- PI,UMBBlR _.._.__...__._~-~~._----_.- ----- (!OM P ANY ---..---.--._________________._..__,__..___. .._________ STATE CERT OR REGrST # _______.___,.____._...,_.... CITY PROCElSSING # 8 IGNA'l'lJRBl --.--- ....---.------.___.._ .__.u_.___________ MBleHANI CAr I ****************************************************************** ----_._------------~-_._--..,--_._._--- COlvlPANY ___.____.____._ "_'__. .__._____._...._.. '''._ STATE e'ERT OR REGIST # CITY PROCESSING # -------...--.--.. --.--. ._~+ _._---~.~-~- ----~-- -.-. 8 T GNA'l'tJR El -_._-~..~-._-~._--.._-----_.~._- ._, ._..~--_.-. ***************************************************************** o'rHBlR ----_._~_._.._------ Cot'IPANY S'J'J\1'El C!ERT OR REGrST W-.-------..-.----- .,---.--.- CITY PROCElSSING # -----..--..- -.-.'--.----------, ----_.._-------~---_._._---------- S I<3llA'l'I1REl ***************************************************************** --'_-,._"__..._. c _._ __...__._.__~_...__._. _ ___~. ._____" __~_._. CONnI'rIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS 'fhe undersigned understands thqt this permit may be subj ect to "deed restrictions" wbich may be more restrictive than City regulations. The undersigned assumes responsibility for' compliance with any applicable deed restrictions. B. UNLICENSED t~ON'l'RAC'l'ORS AND CON'l'RACTOR RESPONSIBIJ,ITIES If tile 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 110t licensed as required by law, both the ovmer and contractor may be cited for a miademeauor violation under state la\l. I f the owner or intended contractor are uncerlain as to vlhat licensing requirements may apply for the intended work, they are advised to contaot the city of Zephyrhills Building Depa,r;tment, 613-766-6611. Furtherloo):e, jf the owner has hired a contractor or contractors, he is advised to have the contractor (s) sign portions of the "Contractor Sections" of this applj,cation for Hhich they vlill be r.esponsible. If you, as the owner signs 'IS the contractor, YQ\,! are indicating that you, rather than the contractor, are responsible for the work. If the contractor \oIishes you to sign as contractor that may be an indication that he is not properly licensed alld is llot Ellltitled to permitting privileges in the City of Zephyrh1.11s. C. 'I'RANI:ll'OR'l'ATIOH IMPACT FEES AND UTILI'I'Y CONNECTION FEES lJ. CONS'l'RIlC'I'UION LIEN LAW (CHAP'l'ER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien La\ol - Homeowner's Protection Guide" prepared by the Florida Departmellt of Agriculture and Consumer Affairs, If the applicant is someone other that the "owner", I eerity tllat I have obtained a copy of the above described document and promise in good faith to deliver .1 t to the "owner" prior to corrunencement. E:. cOWrRAC'I'OR' S/OWNER' S AFFIDAVI'I' I certify that all the information in this appl,ication is accurate and that all work will be done in compliance \oIith all appli.cable laws regulating construction, zoning, and land development. Application 1.s hereby made to obtaln a permit to do work and installation as indiaated. 1 certify that no work or installation has commenced prior to issuance of a permit and that all work \Iill be performed to meet standards of all laws regulating construotion, City codes, zoning regulations, and land development regulations in the j\lrisdiction. 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 mllst take to be in compliance. Such agencies include but are not limited to: *Depat'tment of EnvirolllTjental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Sens1.tive Lands, Water/Wastewater rrreatment *Soutllwest florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses "'Army Corps of Engineers-Seawalls, Docks, Navigable Waterways *Uepartu~nt of Health & Rehabilitative Services, Environmental Healtll 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,ete.", it is understood that a dl:'ainage plan addressing a "compensating volume" 'will be sUDmi tted v/hich is prepared by a professional engineer registered in tile 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 tlJe technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requ.1.ring a oorrection of errors in plans, oonijtruation, or vio~ations of any oode. Every pfu:mit iSfjUed shall become invalid unless the work authorized by such permit is oouullenced Hithin Si.K months of issuance, or if work authorized by the permi.t is suspended or abandoqed 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 extellsion shall be reques~ed in writing to the Building Official. An approved inspection must be logged during each six month period, or the project vlill be considered abandoned. WARNING TO OWNER: YOUR FAILURE '1'0 RECORD A NO'rICE OF COMMENCEMENT MAY RESUW' IN YOUR l'AYING 'l'WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN ~'INANqINq, ~qNl.?UI/I' WI'l'H YOUR LENDER OR AN A'r'rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. .JOBS UNDER $2,500 IN VALUE DO NO'l' NEED 'I'D RECORD AND POS'l' A "NOTICE OF COMMENCEMENT". ---~-~f-L?~ S 1 GNA'l'URE: \,AWN ER OR AGENT S'l'A'I'E OF FLORIDA P COUNTY OF ____ /15 Co 'l'he foregoing instrument was ackno~-.rledged BE:lfor~ me this ,2-'5~ day of ...fJeg~, ]c#7.003 by~u..6 ~Fr:73F (name of person acknowl,dged) ~o is personally known to me, or STA'l'E OF FLORIDA COUNTY OF 'J'he forego.1ng instrument wS!~okrlO\oIledged Before me this 25'" )iay of 'E/I I .~3 by ,GiEb CSFrr>E , (name of person acknowledged) ~ is personally known to me, or PASCO and who[] did ~ Dwho has produoed (type of identification) ~ not take an oath. 4. ~ Dwho has produced JJ;ype of identifiGatlon) and Hho Ddid fBfld not t,ake all oath ~~A-~ Signature of person taking acknowledgment Signature of person taking acknowledgement ______J$J?::~( E Jl~tJ <5 BI3 L Name typed, printed or stamped :l'J' Bruce A Asbel \.'Y': .; My Commission 00118710 0, r.'./' Expires June 22. 2008 g(2 V C. ~ /1-, If filE L _____.__.____, Name typed, printed or stamped :l'J"'- Bruce A Asbet ;,~ .; MyCommisslonD0116710 ~ 01 r.d' Expires June 22, 2008 ,AL~lAl\.~#l'\ I ~~ SQ. IT. Nlain Ollie:- Area Under Reor h.iUllilon: I ~ 5D(. ~ , tSa H (CIN :>lR ~L 11 ~Y.J 376 Lf) UYl-liNfL AV. PRICE Building: /35.00 ,- :::....~ '3)~ Electric: Plumbing:: vV l/t Mechamcl1: N 11'7 ~on: rJ/~ ~ciwoi Impacr ,J fA- :"ees: C.mnection .:;'%S: ,.J I J4 ;=- Imp-dCt tJ Itr ~()O, ~-o B&H CONSTRUCTION OF CENTRAL FL. INe 4025 MORRIS BRlDGE'ROAD fREE ESTIMATES ZEPHY'lUDLLS, FL. 33543 ]-800-224-1206 Li__.. hct.d. ~. Skinfft,.,.. ItOca Addicioru. Ahllft~. ConcrC\e 37' l/ S ,./. 0 yo f!.'V1,a Ii IJ'$;:~I Lot 1.3./ ,J Lap 10 -.-tl/ ~1l1Ac& Pit) Color T rIm Color 9carn C ofor All IlwnipUft', roofi ",elude': PaDs. Trill. Ouatr. 0-..- spouts J~ POSIt, 1)(4 ..... ~ PIMIsibt ~~/Z~~J" Date '(-7-(}3 ::r a ~t<J \, S-<--"'"'" GLASS ROOM WALLS Well.. . + + .. 1.1F x 04576 .. s,..;.. J8;ii;fed -;- =- ,sq Ft 2:.6 x.., St4iq u.. L ---mt..LIf. 6.24 HlDcI~' .. _LF x 17.16 StIIp ........----..LJA )( 80.01 OInpDGof - _1l_.!A x~ 0...-:00. IWK-_~EA x_ o.n,. Door O"...-------_EA x_ Mile: - ..tt.PIdSA._F't1AlU1Z.Sq)ll x '3.01-333 _Put__f't ~S1 PI x 3.01.. 3..S,3 _Pas_A Laaa-Sfa PI)L 3...3.53 _PIDS__P'r~Sqftx 3.01-'.1' Va'~-- ..a....1JF x ..05 <Naer on ao.~ '.!J!'LJA x 4.1' (j~ BanI W<<Jc ClII P'ft1D& tc.d J31..5f 2x4 SM a.m ~LIP x ]"SO 2x6 SM ae.n -" J 111 x 4.1$ 2x7 SM Jeua.. f,l lIFx S.J,S 2dSMB.nI--- VFx t,,15 2161 SM '8caI--. -lJf x 1." 2lCtOSM~ -. -UFx 10.11 SCREEN Il00MWAUS lap KJ' -1.... iJ.. ~ J.J.. + _ - ~LIf x 2631 Sa-eea Door 1nchlde:l: Closer Md nr.bo14 ~l/F x 1$.&0 O&blc Fili ....: ,.. 1Jf x 1'.11 m$uIetod Kick P-. -tIP x :1.30 - Fan Be:Im (Die wirtd)o ~. '7.20 UTlU1"Y ROOM W AUS w.usL'" L .. L + L- .JJ::..J,/P x 30.., 2x4 Studs 16" OC Shed Doer 1In4' I Wmdow-- / Uf xl'7.2. Single Wm~(!xh)-- "- !Ax 'UI BUSSftidd-, ~... 4.56 Mix: VlNYL ROOM WAllS Vinyl Wall + + + · l.Jf x4S.16 LnsicM Kic:k ,....-=- -:- -=..- LIP lit J.2I LapToplnsj.U<tOut -JAx I'.'" Florida Olw- <r - LI'F x 'IS WuJ.lCTop~~-- lIP... 4.,0 Doors inclu4e (1) 2 Tndl: ums Th~ld.M Cloe<< -M x lJl.~ &tJi will nO' be ~J.1br mlelb in VINYL: ROOMS X ALUMlNVM TOT....L , CONCRETE AND BRICK WORK h&Jo S~ ..Lxa... - ..3Itz- Sq Fl . :2,16 Patio S1Q-"I.Z..:Jl.16... - -aSq " x ~, 16 hdoSMb--_J(_-_SqF'I~ 2,16 hcio St.O__ _x_ - _Sq Fl x 2.16 $We w...--- x - Sq ft ~ 2,16 DrI~/i X:1[-~SqFlll .1.1(, Driwwt.YFlairL~- _Sq Fr x ;.;-1 ~ UIiIIt)'--"_' I~" ..15..-4" 1Il n...O ...... htio, e- 0-"1.14- Jt:LSq 't x ..02 ""'* '. 6 C- _x_ - _Sq ff . 3m 0.' ,..,..-",,-&..!.- -...c!L.l.If x j, I J v.... -klJ ~"""-..l2-LIF . ),1& P.... I2xJ2 RM1broed---JL.lIF x S.67 '--~-.f!)Jf x 2.10 I T're.dSfcp---- EA :ll 6&,90 , 2 nws.p , I!A x 137,80 ] TIw4 s..p LEA x 206,11 o6x4 SIoap _f.A x 219. 7! -erick SkininJ M.x 5 Hi&h 0Ytr 5 ,. tt per coune-- lA 1Il 1,9Q Split Brick Ail $IecIc- - LIF lit 9.~O Splic 8rick Solid......... .:iZ:lIF x 10.69 -owr , lI'I't\ 'P'f coun.--~LIP II 2, I) FiU Dire.... -'---~- ..J.J.oeds l( 100,00 ~ -. -. --.., ,.. --- 100,00 Mbe:', sloN'~~17- Ub 0.lNCRETE DATEIr'~3: 'aeUMrNuM PAXTO 11S-6S8S ~~T 'OR. ENOINEElUNO TOT A.L ~ ~ -A.;''''' -w..,........ tw _~. A PDI~ CKAl.oa.r IS"'" '*..... ..ill .. .-..s ".1/ ".ilI ___ iao..-. NIJIfU-'I. rDCDCTAQl~TI.rI"'" ~'. "11~ II> ~~I, l '<:j ~ w~oo' II e~-Lo-V 1/5"tJ I. (,{" ! LEONARD G. "GEOFF" WOOD. P.E. 4034 THE FENW A Y MULBERRY, FLORIDA 33860 (863) 646-5517 Date: 4-18-03 B&H Construction Zephryhills, Florida Re: 2002 Jacobsen 37645 Lorena Ave Zephyrhills, Fl. 33540 Model # CH 3 4463 B Lot # 121 Dear Sirs, This letter is to certify that I have reviewed the above referenced project to determine the structural adequacy of the existing structure to receive the attached structure. The proposed structure is roughly a 12x27 Carport a 12x12 Raised Screen Room and a 8x8 shed. The existing mobile home, to be considered an adequate host structure, should be blocked and anchored in accordance with the manufacturers suggested and permitted set-up permit. Therefore, it is my opinion that the marriage of the proposed structure with the addition will not compromise the structural integrity of the host structure, if the addition is constructed as per the attached aluminum engineered drawings. As always, should you have any questions. Please feel free to call me at ay time. lAta! 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Ch."too~ 16 <0 <0 I W ,...., <0 I ,...., co <0 I CO en <0 I OJ ~ t:jitt;j$~ J LEONARD G, 'GEDFF' 'w'~OD ENGINEER Lorona.rd G, 'Wood, P,E, 1147377 403-4 Th.. Fornwo.y Mullaorrry, norlda. 33860 Torlorphonor/F"a.x (863) 6-46-5517 Molallor (863) 287-7073 MAXIMUM TRIBUTARY WIDTHS OF BEAMS EDGE BEAMS AND CENTER BEAMS BEAM SPAN CURVES - 110 MPH WIND VELOCITY ~z jW C1.~ C1.L... o f-~~ ~j ~lIiCl.. CD. ex NO ~~:2 Ol~ W.....CD ~)(O .)( 0 f- N.....L... "'0 ~IO CD. ex ::::lWZ OVl~ O::::lCl.. i!: j K!. w(,) ZO ex O. UlD ..... ::I", ~~ ::C. U'" ~~ f-..... ~... La.. 00 I- - ~~ 0 -~ Z ,., :2 ~ ~ 0" ~Z :2 ~ -::::l ~:! ~ ~Z~ z e _~cJ ~ Il1La..O W N 0 :J: .. i U _Cl.."'f' Q.. :J N . 0(,) N ~>~ I-La..~ .. 1-0"1 ~ ~" . ~d ~~~ Q.. W O:J: ..... W :J: U I 0 8;8 (,) ~ It) . :2 :~H IO::J el~ :2 z::J ~~ .. -z ~2 ~~~ oio -~' e ~ ~ WW ~~~ -- CD ::J ;s W exti ex ex ~ ex ee :J: ex ItlU ::J:old ~..,~ ... ~~~ ...x ~!I . . ~'Cl.. ~8 ON ~. ~ ~~~ -- . 4fI )e)( ~~ ~~ . . ..J::l)( .. 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STATE OF FLORIDA COUNTY OF PASCO THIS IS TO CERTIFY THAT THE FOREGOING IS A TRUE AND CORRECT COpy OF THE OOCUMENT ON FILE OR OF PUBLIC RECORD IN THIS OF~ITNESS MY HAND AND ~ SEAL 2TM DAY OF JED PITTMA~ CIRCUIT COURT BY DEPUTY CLERK 11111111111111111111111111111I1111111111111111I1111I11I11111 200309!5873 Rcpt: 684!518 DS: 0.00 0!5/29/03 Rec: 6.00 IT: 0.00 Dpty Clerk i'~2~~~1J1Ar0 : :':;0 fOUNTJ, C1.ERK OR BK 5375 PG 1436 NOTICE 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): 3'7 It, 1ft' ~ oUN Ii .(}vt - Lor 1'2- J 3<f-;:2-c;~71- fJD10- D2f'cJO- 0/2./ 2, General description of Improvements: //Lv/Yl (jVl//Y1 P/J-C/C A G;! 3a, Owner Name: ClZlflVfJ HofLIZo/V m-H.f. Owner Address: 7lc4S ~J?t."'f.IV SL-oPE DI2., ZE{J1f rtz. HI U1 fL. ,>J 541- 1~C,o 3b, Owner's interest in site: 3c, Fee Simple Title holder (of other than owner) Address: f:t~~';l:: I~'""",::.l . ':' .'..~. . , ::~~ Contractor Name: J5 f.11 r av;; i(lUc.. r / o;J /IF CFIV T}2/tL.- P L- , Address:'fOZt;;'/YlOiZI2<5 Bfl06f,p. 2t<YIfl(k!-/-I/L(,$ ~l..- s35'-f3 Phone: f/3-7J-'2 - 10(, <-( 5, Surety Name: Amount of bond: Address: Phone: 6, Lender Name: Contact: Address: Phone: 7, Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by Section 7,13,13(1)(a)7, Florida Statutes, Name: Address: Phone Number: 8, In addition to himself, Owner designates the fo.llowlng person to receive a copy of the Lienor's Notice as provided In Section 7,13,13(1)(b), Florida Statutes, Name: Address: Phone Number: 9, Expiration date of Notice of Commencement (expiration date Is one (1) year from date of recording unless a different date is specified) , STATE OF FLORIDA {Lf..lv#ll '6F^,T Th1-!0r.e~oj~9 ~~slrument w~_s ac~n5l~!edge before me this r Ie /-11'+/21:/ l, !Zr>i-/15826 produced ,/>625(':/l/14!... '- If N./$ vV/'-' (Driver's License #) "a -'- I date of /V1A l( ,200 J , by who (is) (are) personally known to me or as Identification, who did/did not take an oath, 1h~ 1.1- U~ Signature - Notary Public i~' ~ Bruce A Asbel ,~ .: My Commission 00116710 01 ,.:" Expinls June 22, 2000 (A copy of any bond must be attached at the time of recordation of this Notice of Commencement)