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HomeMy WebLinkAbout04-2930 '-' I I CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 2930 Permit umber: Permit Type: Class of Work: Proposed Use: Square Feet: Est~ Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: __ Da.e Paid: Wor Desc: 2930 RE-ROOF ROOF REPLACEMENT NOT APPLICABLE Address: 4801 AIRPORT RD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 115,641.00 4/07/2004 528.00 528.00 4/07/2004 RE-ROOF Name: FOXWOOD CONDOMINUM Address: 4801 AIRPORT RD ZEPHYRHILLS, FL. 33542 ~___L__ Phone:___________~_ i i J ---.- - . -----'----- -,---_.__.__._~---~~---- --~----~._-----_.._---_._--- REINSPElCTION 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 -"Warn i ngto owner: Your falluretOrecorct a -notice of commencement .may. result in your paymg twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney _~!~~~econUng your notice of commencement. II _ '- Complete-Plans, Specifications and Fee Must Accompany AppllCatio-n:-----~- --- ---- ___~1I vvork_~l1a~__Il~ pe_rf~_me<:L~rl~~ordcmc~ with City Codes _ and Ordinam:es ___ __ __ NO OCCUPANCY BEFORE C.O. ~~ ~ - -- -.----.....-----------..-----------.....------ --'--._'- C NTRACT SIGNATURE PERMIT OFFI . CALL FOR INSPECTlON - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8T11 St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED PHONE CONTACT FOR PERMITTING OWNER'S NAME --.iUY~~df ('~2>>m)"/'wru JOB ADDRESS 41~1 ~ /81 PHONE LEGAL DESCRIPTION: LOT(S) BLOCK PARCEL In # /.3. ~ '- .~/. 0130" 00100 . 1/30 SUBDIVISION (ORTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: []NEW CONSTRUCTION DSIGN D ADDITION 9ro..TERATION D REPAIR D INSTALL PROPOSED USE: []SGL FAMILY DWELLING D COMMERCIAL D MOVE [] DEMOLISH ~I-FAMILY D# OF UNITS o INDUSTRIAL D SWIMMING POOL D MOBILE HOME o OTHER DESCRIPTION OF WORK o RESTAURANT & HEALTH DEPARTMENT APPROVAL A..t..r~P I g7~ IS ~~) ~ HIt ,(,f.J;t:,'H (lot>F/~~ BUILDING SIZE SQUARE FOOTAGE t 1""7;)0 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. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. [] BUILDING $ //.)'; 'lit tIJ1 . PERMITS REQUESTED VALUATION OF TOTAL CONSTRUCTION D ELECTRICAL AMP SERVICE D FLORIDA POWER D W.R.E.C. D PLUMl3ING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION o GAS IM1illOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: D BLOCK D FRAME o STEEL D OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAD YES 0 NO SIGNATURE OJ-6V q()liJTRAgt1!9;Ri$EeTIO~ COMPANY tfl2i STATE CERT OR REGIST # C c.c /3 :JSWJ> BUILDSR ****************************************************************** ELECTRICIAN COMPANY SIGNATURE STATE CERT OR REGIST # * * ** * ***"**** * * * ** * ** ** **** * * * * *** ***** * * * * ** * **** **** *** **** ** * * * * I PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # Ml!:cHANtro.r." " ****************************************************************** COMPANY SIGNATtJRE STATE CERT OR REGIST # ***************************************************************** OTHER COMPANY SIGNATURE STATE CERT OR REGIST # t., A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to udeed 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, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign pOftions of the UContractor 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 r~~ponsible for the wo~k. If the contractor wishes you to sign as contractor that may be an indica~ion that he i's 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 uFlorida'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 Uowner", I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the Uowner" 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 cqrnpliance with all applicable laws regu,lating construction, zoning, and land de~eloprrient'. "', , , Appli~ation 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 UA" or uA,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 period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAI.LURE 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. JOBS UNDER $2,50'0 IN-VALUE DO NOT NEED TO RECORD AND POST A uNOTICE OF COMMEN ENT". SIGNATURE: OWNER OR AGENT acknowledged , 2CL- STATE OF FLORIDAn COUNTY OF ~~ The foregoing instrument was~ackqpwledged Before m~ j::)J.is ~day of ~ , 2~ by A'Yr.,~ &;.IMt~ (name of person acknowledged) C1ho is personally known to me, or STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _ day of by (name of person acknowledged) Dwho is personally known to me, or of identification) take an oath. o who has produced 4/)L*'~'1~TN'<D (type of identification) and who Ddid Q:iid not take an oath Owho has produced (type and whoD did 0 did not Signature of person taking acknowledgement Signature of person taking acknowledgment Name typed, printed or stamped Name typed, printed or stamped . 59" Steat pI, FI. ~1Q P 813..62.1.1700 f 813-621.1881 lNWN.generaIAoDf\ng.cam \ M~h '\5.2004 Company: FO)(Volood CondOminiums : Address: 4801 Airport RPad unit 113 City/S~\t!lZip: ZephryhiUs. FI.. 33542-5285 ~tt8ntion: Jim Gahm PI1Ol\elfax: 813-18Z-2252 Cell 815 257.&300 Jab Name: Fo)t'NOod Condomln\ums Job Address: 4801 "'nJOr\ Road unit 113 Job City/State: lephryhillS. FL 33542-52.85 Job Contact: Jim Gahml )'1/11 IT' It:" f.V /U-IUlve,v Job Phone/FaX: 813-782-2252 &/3 - ptJ7 4v~R proposavcontract Scope ot Wor\(; 1. aASE'6ID' ROOF 'NSTALL T'ON RemO""'" .~"ng madJOed ....men roof a..-Iy, _- t\8sh1nQ6, and all"""" ...... meIBI-' ..... to ..e ~~ deck -,". flomo" and replace a...vI"" oidill!l" neces..ry to acc;es& "" baS' flashing membrane at tI'Ie walkways. Dispose of all debris generated from our yloft( In an approved landfill. _In'" job... In a ..fe. _. .... wo,..,.....wl<. ...- \IvQU9hOullbe """". of .... wOfI<. \IlsUlIlIy IfISlll'Cl'" plyWOod ded< ...._. Rep- il\y ....riotaled p-. dod< "'bskate.... n"" .fI"" .......... IOOd .... "'''"".... y; CO"',, unit.... 01 $1.50 po' ....... - -y: coxa' a .... c;os\ 01 $2.50 per $qu~re fool All unit prices are In addition to Qt. contraC1 price listed herein. lnotal a'" ...,., ~_ and GO _I'" .... .............. to ,1>0 ....."'" p!yWOOd "'- ...... b..ad headed cap nails. No\e: The atlachrnent pallern to meet current Factory MubJalguidelines. .n.... a 1/0- perfaot_'" ~ I..._n .,lIlem ov."'" en'" .... - uslnO hot aephaL The taper design Is intended to promote water NnDff to ell four sideS of the twilclng. In.... 0" <') ply ole FIRESTONE SIlS .....fled llaee S..... eel In a lull -pi.. of ..t aephall O'er !he ...... roof area.' I......'... (1) ply oIa FIRESTONE SIlS CAP ............ mo.ffied b\tUm8ft m-" set In a "'" moppl1'Q 01110' asphalt over the entire roof area. '"stall matching ceramic granuleS in t11e hot aspl'tslt bleedou\ to pro~de a uniform appearance. FI.... " .,..be. ......._. "'" ....... an' ..- using · FIRESTONf:S two ply - sysIO" consl_ of one (1) ply 01 a FlflESTONE ... BASE .....Ih modlllod .......n ............ and .... (I., 01 · FIRESTONE SBS CAP 1/.."..1.... modi'" _.n """"....... eadlset in -.. lull moPlllngs a111O' asphalt. ., A... B. C. A. 6. C, O. E. F. G. '\ 2. METAL ACCESSOR'ES " Fab_ and .nsta' n'" ... "",,bed ~) ....0 alumlnu" peri..... edge ....... and m\II finlsb OIIn.nuous cleat where reQuired. &. fa_ and i..... n... ........... ~l .0'0 alumlnu" p;t<h pen.. .n"" a two ............. sealer to complete the pitch pan In6tallation. C. Fabricate el'\Cl il\6tall new pre finished (.mIle) .040 aluminum countarftRhingS. O. Fabri- and ins'" _... t1nl.... (wI'Ie) .080 aluminum. r 110'" ..... Ale ..-_. E. StlIP-In .. __....... oompo"- ...... FlRESTONE'S _ended........... _I~. \ i 1. MECHANICAL UNITS .. C....nnedlnll and _n-'"'ll 01 "'. _nkal ""......... .... any oode ...... .........;0... <)on'" responsibility aM is not included In our proposed Sc.ope of work. B. P"""de and InstaIIl......n (181- """" Co""", Word ...... .Iumln." Ale ....... Flaehln'" Ogs Of.ach st30d using the Irrtegral lead boot flashing. page 1 of3 Of' I (Rev. 7103) TERMS AND CONDITIONS (re-roortl1l, Alpeil'S end seMce) I .; 4. WARRANTY A. Provide generslRaofing's two (2) year installers warranty. EI. Provide FIRESTONE'S Twenty (20) year aNOL" No Dollar limit labor and materials warranty. C. Provide five (5) annllal RoofCare inspection and preventati'.fe maintenance agreements. 5. JOB NOTES A. AllY other work will be bill.cl at our srenc:lal'd Time & Malerials rates of $39,50 with a 1~V. materials markup, W* Hereby Propose to furnish 811 labor and materials complete in accordance with the above Scope of Work, for the sum of: !i ~ Bid. One Hundred Fifteen Thousand SiJl Hundf'8d Forty One & OQ/100 DollaJ'& ($115,641.00) 'J:t' · and Conditions: Th s proposal agreement is subject to the terms, conditions and inSlruetions appearing on the face hereof and the back page. W rraltt} (in paraglilpn 7) ~ included 0 excluded. This Proposal may be withdrawn by us if nor accepted within (15) davs. The above price. specifications end conditions are satisfactory and are hereby accepted. You are authQrlzed to do the work as sp~cifled. Payment wilt be made as outlined herein. - ~~ ~ ~~:~%: ~/~ ,~ 9:~~ Ie. u.Jof~~~~ C~$lOmer'c ~ ~ _~~ Slgn:ature: . " I Pml Name; Cliff UiMer Print Nam.~ .~ Trtle;~ Date: ~~~c',/~ ,..xcny Title: Account Bcecutive i .! " Page 2 or" (Re , 7/03) TERMS AND CONDITIONS ~ . (re-roofing, repairs and service) , 1. TERMS. One-third (113) of the amount of this contract is due and payable at start- Customer from injuries and/or damages which may arise out of or result from up/mobilization. The second one-third of the amount of this contract is due and Company's operations under this work order and for which Company may be legally payable when the project is 50% complete. The final one-third of the amount of this liable, whether such operations be by Company or by anyone directly or indirectly contract is due and payable upon completion, Interest shall start to accrue 30 days employed by Company, or by anyone for whose acts Company may be liable. from the date of final invoice on any unpaid balance at 1 Yo % per month (18% per Customer agrees to look solely to Company's appropriate insurance carrier annum) or at the maximum legal rate permitted by law. If legal proceedings are for any and all damages resulting from personal injury or property damage required to cQllect an unpaid balance, all costs including actual attomey fees shall claims including those caused, in whole or in part, by Company. Customer be added to the unpaid balance. Non-payment in accordance with these terms expressly waives all claims excluded under Company's insurance policies. The shall be colllsidered material and cause for termination of performance by Customer agrees to provide sufficient insurance to protect Company against loss of Company. materials installed or on the premises due to fire, windstorm, hail or floods. 2, ADDITION~L CHARGES. The following shall be an addition to the contract price Customer provided property insurance shall be on an all-risk policy form and shall and charged pn a time and material basis, including 30% for overhead and profit: insure against the perils of fire and extended coverage and physical loss or damage addition or d~viation from the specifications herein described; damage to our work including, theft, vandalism, malicious mischief, collapse, false work, temporary by others; te~porary protection of the building not originally included in this work buildings and debris removal including demolition occasioned by enforcement of order; premabe notice to start work causing unnecessary trips; trips back to the any applicable legal requirements, If the property insurance requires minimum job to repair ~penings created after work is complete; and any labor required to be deductibles the Customer shall be responsible for payment of the additional costs done outside bf normal business hours. not covered because of such increased or voluntary deductibles. The insurance 3. EXCLUSI~S, The following items are not included in this contract unless shall waive rights of subrogation, if any against Company. The Customer shall otherwise spljcifically stated in writing: repairs to the roof deck, installation of wood purchase and maintain such insurance as will insure the Customer against loss of or cant stri~ furnishing or installation of sheet metal or roof drains, repairs or use of the Customer's property due to fire or other hazards, however caused, The alteration to 'the building other than the roof, identification, abatement and/or Customer waives all rights of action against Company for loss of use of the removal of asbestos containing or toxic material, or work preparatory or incidental to Customer's property, including consequential damages. If Customer is not the these items, No interior protection or clean up included. Company shall not be owner of the property then Customer may satisfy its responsibilities hereunder by responsible fqr any damage: (a) due to nails or screws penetrating the roof deck; having the Owner provide the coverage in compliance with this paragraph. (b) incurred tel anything secured or attached to the roof deck; or (c) due to joists or 10. ACTS OF GOD. Canpa1y shall rd be responsible for danaJe or delay due k> strikes, any other roofing structure member which becomes loose, unsecured or falls as a fires, oo::idenIs, ads ri god, ads of terrorism or WiY or other causes beyood its reasonable result of the roofing operations of Company. Company shall not be responsible for rontroI. any claims, oamages or expenses arising from the presence or disturbance of 11, ACCESS. Company shall be permitted to use driveways, and paved areas asbestos conlaining, or toxic materials, or arising out of or in any way related to leading, or adjacent to, the job site for its equipment without liability to Company biological grmj.1h, including, but not limited to, all types of mold, or any other type of occasioned by the negligence of others or by its equipment. contaminationlof the Owner's building, 12. STRUCTURAL SUITABILITY, Company assumes full responsibility for 4. MATERIALS. All materials used shall be as stated in the specifications and/or fumishing roofing materials and for their proper installation in accordance with attached ScoPe of Work, manufacturer's specifications. Company does not, either itself .or through its 5. CUSTOMER'S RESPONSIBILITY. The Customer is solely responsible for representatives, practice architecture or engineering and offers no opinion on, and structural suil$bility of the building in light of specifications of the roofing system to expressly disclaims any responsibility for, structural integrity, compliance with be applied ptfsuant to this work order, including, but not limited to, load bearing building codes or design. Opinions of competent structural engineers should be capacity, dewl point and vapor transmission calculations. Further, the Customer obtained by the Customer as to the structural soundness of the roof deck and its shall be solelj responsible for any damages to any furniture, furnishing, fixtures or ability to properly support normal roof construction equipment and operations and contents of the building during the performance of the work, except such damages the completed roof system, Company accepts no liability for any failure of the roof as may be caused by the sole negligence of Company. Customer is aware that deck, its ability to support the contemplated roof installation, or resultant damages, roofing produCts emit fumes, vapors and odors during the application process. 13. FINAL PAYMENT. The making of final payment shall constitute a waiver of all Customer shllll be responsible for interior air quality, including controlling claims against Company by the Customer except for those arising from (a) mechanical equipment, HVAC units, intake vents, wall vents, windows, doors and unsettled liens stemming from work performed by Company, and (b) terms of any other opening~ to prevent fumes and odors from entering the building and shall hold guarantee or warranty issued pursuant to this work order. No guarantee or Company hartnless from claims relating to fumes and odors emitted during the warranty provided by Company shall be valid until full and final payment is received. normal roofingiprocess. 14. ARBITRATION. Any controversy or claim arising out of or relating to this work 6. PERMITS. 'Customer shall secure and pay for necessary approvals, permits, order, or the breach thereof, shall be settled by arbitration in accordance with the easements, a$sessments and charges required for construction, use or occupancy Construction Industry Arbitration Rules of the American Arbitration Association and of permanent ~tructures or permanent changes in existing facilities. judgment upon the award rendered by the Arbitrator(s) may be entered in any Court 7. GUARANT~E AND WARRANTY. The type of guarantee and extent of coverage having jurisdiction thereof. Notwithstanding the foregoing, in Company's sole shall be as i*,icated in accordance with written guarantees, if any, offered by discretion, collection of unpaid balances may be sought in any Court having manufacturers: of materials incorporated into the project. In addition to the jurisdiction thereof or under this arbitration clause. Any legal claim against manufacturer'$ guarantees, if so noted in the proposal, and upon receipt of final Company must be brought no later than one (1) year after Company has completed payment, Co",pany shall guarantee workmanShip furnished as part of this work work, order against Ilefects in such workmanship for a period of one (1) year from the 15. MISCELLANEOUS. These Terms and Conditions together with the cover completion of \Nork. ('Warranty.) The value of this warranty shall not exceed the page providing the Scope of Work, etc. and any attachments constitute the entire work order priCe, In all cases Company's liability is limited to repairs or roofing and agreement (Agreement) of the parties, Modifications to this Agreement can be waterproofing work and materials installed by Company, EXPRESSLY made only in writing signed by Company. Customer permitting performance of work EXCLUDING i CONSEQUENTIAL DAMAGES. THERE ARE NO OTHER indicates acceptance without exception of this Agreement, even if this Agreement is GUARANTEE~ OR WARRANTIES EXPRESS OR IMPLIED. not executed, This Agreement is solely for the benefit of Customer and Company, 8. PONDING ~A TER. Company is not responsible for location of roof drains, and is not intended for the benefit of any other parties. adequacy of dtainage or ponding on the roof. It is understood by Customer that a Ponding Water condition is not indicative of defective workmanship under this agreement. Pqsitive Drainage is a design goal and is not always achievable. Company Wi~1 ' ot be held responsible for a Ponding Water condition that results from a roof s cture that is not designed to achieve Positive Drainage as defined by the National R fing Contractors Association (NRCA), Ponding Water is defined as a roof surfa~ that is incompletely drained. Positive Drainage is a drainage condition with idditiOnal roof slope provided to ensure drainage of a roof area with 48 hours after rainfall. 9.INSURANC " Company agrees to purchase and maintain, as required by law, workers' compensation and general commercial liability insurance to protect the Page 3 of 3 ~/ ~1 / R~ase Return To: \ \\\\\1 \\l\\ \\\\\ \\1\\ ,,\\\ \m\ \\\\\ \\\\l mIl 111\1 \\\1 II" 2004103997 , Rcpt: 788277 Rec: 10.00 OS: 0. 00 IT: 0 . 00 06/04/04 ___ Dpty Clerk ~ED PITTMAN PASCO fOUNTYfCL1ERK 06/04/04 1~:57am 10542 OR BK 5885 PG The underjsigned hereby gives notice that improvement will be made to c~rtain real property, and in accordanae with Chapter 713.Frorida Statues, the following information IS provided in the Notice of Commencement. GRi of West Florida, Inc, 5423 N. 59th Street, Tampa, Fl. 33610 Tax ID #65-0398246 NOTICE ,OF C;OMMENCEMENT STATE OF FLORiDA COUNTY OF 1. Legal Description of Property (lndude street address if available): ' 4801 Airpart:Road,. ~ephyrhills, FL. 3~542 Parcel TD# ,13 26 2i 0130 00100 1130 ,2. General Description of Improvements: RoofinQ and Sheetrrietal 3. a, Owner's Name: ' Foxwood Condbmium Association . . b. Owner's Address: 4801 Airport Road, Zephryhills, FL 33542 c. Fee SimpleTitle Holder name (If other than owner): N/A d.Address: ,'"'' .. -0:1" t~:' .~~.,Jj..:: 4.Yc~htractor's Name & Address:GRi of West Florida, Inc. 5423 N. 59th Street Tampa, Florida 33610 5. Surety Name (If any): ' 6. Lender's Name~ 7. Lender's Address: B. In addition to himself, Owner designafes the following person to receive a copy of the Lienor's Notice as provided in Section 713.13 (!) (b), Florida Statutes: . ~uthorized Signatur~: ,;;.~ ~.l,Ll.aP;>U'Vi,,'<N Title: " \' li:J , Expiration date of Notice' of Commencement (the exp,iration date IS 1 year from the date or recording unless different date is specified). STATE OF FLORIDA COUNTY OF .....-' , The foregoing instrument was acknowledged before me this-9'-fi'\ date of J4ne-- 200 If , "-1, " /,) I DY ,j',-r1)Y'r e (,vt.i:, rCtve,.y') v\tho is per~?rl.9_~y-':5nQWrLto mE-.9.r w.D.Q..has produced \Iofary Stamp: ,\\llIi'l C' 1 ,.~:~.v.~~<t;-:. ar<?.(\. Haynes ~(~~:~ Com.mls~lon #00242820 '-,..i-;.....;p,::: ExpIres. Aug 19,2007 -"'/,~ft:;~"'. Bonded Thm Atlantic Bonding Co., Inc. as a form of identification and who did/drd not fake an oath. /), ' , .. Print Name: L 'ct /';:)/ /~_ )-10'1 ;Ik'_~.(~ /~'lPt.__ 17 lltlL,j,,-np._d ,/1 , , " 1./ ", Notary Signature: