HomeMy WebLinkAbout04-3037
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
3037
Permit Number: 3037 Issued: 5/04/2004 I
Permit Type: NEW SINGLE FAMILY DWELLING!
Class of Work: 103-NEW CONST DUPLEX 2-UNITI
I
Proposed Use: DUPLEX
Sq. Feet: Est. Value:
Cost: 65,000.00 Total Fees: 2,852.75i
Amount Paid: 2,852.75 Date Paid: 5/04/2004!
Address: 4921 5TH ST
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
Name: ALVIN BACHTEL CONSTRUCTION INC
Addr: 22464 WEEKS BLVD
LAND 0 LAKES, FL. 34639
Phone: Lic:
Work Desc: NEW DUPLEX
Name: JAMESON BACHTEUBACMAR PROP.
Address: 4921 5TH ST
ZEPHYRHILLS, FL. 33542
Phone:
WATER CONNECTION RESIDENl
WATER METER RES 3/4"
,~
H 1
I PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED
LINTEL PRE-METER WATER FINAL MECHANICAL
I FRAME MISC SEWER MISC
INSULATION WALL MISC ! MISC. MISC.
INSULATION CEILING MISC. ! MISC. I MISC.
I~~~~_WAY . MISC. m lMISC. ._.~~IRE DEPT. FINAL ..
! REINSPEcnON 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 commencemenf may result in your paYing twice for--
improvements to your property. If you intend to obtain financing, consult with your lender or an attorne~
be!ore recording your no~ce of commencemt!nt. II
NO OCCUPANCY BEFORE C.O.
- ~
ONTRACTORS SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
~
~~~
LLI
PERFORMANCE BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813-719-7919
If' "'I.~_
V "....""'X
.-":J' ~
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO.
DATE
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OWNER/
RENTER
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SERVICE ADDRESS
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SHUT OFF SERVICE
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TURN ON SERVICE
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o SEWER
INSTAll METER
0'
o GARBAGE
READ METER
o
o IN CITY
CHECK METER
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o OUT CITY
--'-- No. OF UNITS
OTHER
o
_ DEPOSIT AMOUNT
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_ AMOUNT LAST BIll
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---
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_ DATE
_ MISC. CHARGE
WCHK COMPLETED BY
3. DATE COMPLETED
ORDER TAKEN BY
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ORDER GIVEN BY
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X.. '. 6!f/'/:!'UJ:;;t?:&1
~etaJn'Nhlte :'arm : n office at all times. ./
Send pink ,i< fellow'orms "0 Water Service DePl.
'Hater SaP/Ice ;)ept. ~o sign yellow form & ret\Jrn/to office,
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IMPORT ANT: In these spaces, copy the corresponding information from Section A For Insurance Company Use:
BUILDING STREET ADDRESS (Including Apt, Unit, Suile, ancVorBkjg. No.) OR P.O. ROUTE AND BOX NO. Polic.y Number
5th STREET
CITY STATE ZIP CODE Company NAIC Number
ZEPHRYHILLS FL 33541
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
o Check here if attachments
SECTION E . BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without SFE), complete nems E1 through E4. ~ the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1. Building Diagrcm Number _(saect the building diagram most similar to the building for which this cellificate is being completed - see pages 6 and 7. ~ no diagram accurately
represents the building, ~ a sketch or ~.)
E2. The top dthe bottom floor Qncludng basement or erdosure) dthebuilding is _ft.(mLin.(an) 0 ctloveor 0 below (ched< one) the highest adjacent grade. (Use
natural grade, Wavailable).
E3. For Building Diagrlms6-8with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(an) above the highest adjocent
grade. CcrnpIete items C3.h and C3.i on front dform.
E4. The top of the platform of mcd1inery arrl'or equiJl11el1! servicing the building is _ ft.(m) _in.(an) 0 above or 0 below (check one) the highest adjacent grade. (Use
natural grade, Wavailable).
E5. For Zone AO only: ~ no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?
o Yes 0 No 0 UnkooNn. The kx:aI dIiciaI must certify this information in Section G.
SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or ONI1eI's authorized representative who oompIetes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community-
issued BFE) or Zone AO must sign here. The statements in Sections A a 4 and E are corred to the best of my knowfedge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
CITY
STATE
ZIP CODE
SIGNATURE
DATE
TELEPHONE
COMMENTS
o Check here if attachments
SECTION G. COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, S, C (or E), and G of this Elevation
Certificale. Complete the applicable ttem(s) and sign beICM'.
G1. 0 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. 0 A community dlicial completed Section E for a building located in Zone A (without a FEMA~ssued or community-issued BFE) or Zone AO.
G3. 0 The fdlowing information (Items G4-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement
Ga. Bevation of $-buin IaNest floor (including basement) of the building is:
G9. SFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAL'S NAME
COMMUNITY NAME
SIGNATURE
COMMENTS
_._ft.(m)
_._ft.(m)
Datum:
Datum:
TITLE
TELEPHONE
DATE
FEMA Form 81-31 , January 2003
o Check here if atlact'lmbnts
Replaces all previous editions
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'11 Surveyor 's Notes.-
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DA VID L. SMITH
SURJ'8Yt/11(] AND AUPPfN(l, me.
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Parcel Information for: 14-26-21-0010-01100-0060 Card: 001
Page 1 of 1
\i'\lelcom~ : Records Search : Parcel Detail
S~~rGh Aqaln $hQ,^,_M~Q Building Schematic Unavailable C_9Iculate3ax~~
$e~TCix CQII~c:tQr JnfQrrTl~tiQn-Currel1t/DEllinq!Jel1t .ICi)(~!)
ParcellD I 14-26-21-0010-01100-0060 (Card: 1 of 1) I
Classification 00 - Vacant Residential
Mailing Address Assessment (totals)
HARTWIG RUBY H EST OF Ag Land -
HARTWIG W WILLIAM JR PER REP Land $11,880
PO BOX 1252 Building $0
ZEPHYRHILLS, FL 335391252 Extra Features $0
Physical Address
4921 5 TH ST Total Assessment $11,880
ZEPHYRHILLS, FL 33541 Save Our Homes $0
legal Description (Firs~ Taxable Value $11,880
MOORES ADD MB 1 PG LOT 6,
BLK 11
OR 1135 PG 1574
land Detail (Card': 1 of 1)
Line Use Description . ~ Type I Price II Cond II Value I
01 0100 SFR ( 00R3 ,600.00 I SF ~ 1.80 II 1.00 II $11,8801
Add. JjO"nal land Information.....-?"
Acres II 0.15 Tax Area 30ZH "Fema Cod711 AE II) Res Code IIZHLGLP71
Building Information '---'"
Unimproved Parcel 00
Extra Features
No Extra Features
Sales History
Previous Owner -
Year II Month Book I Page " Type II Amount
- No Sales History -
Search Aqain Show Mc:lQ Building Schematic Unavailable Calculc:lle Taxe!)
See_ Tax Collector [nformation - CurrenUDelinquElnt Taxes
http://appraiser.pascogov . com! search/parcel.asp?sec= 14&twn=26&mg=21 &sbb=OO 1 O&bl... 4/2912004
. ,
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8ft St, Zephyrhills, FL 33542
813-780-0020 FAX:813-780-0021
DATE RECEIVED
'1-.:r3-fJ'/
PHONE CONTACT FOR PERMITTING ("HY) 9 ;;8- ~ -::J6- /
OWNER'S NAME 7dm~fJf?;? ~chk ~ EaChtCl,r ~/,....,..n;') PHONE [,;./3) 9.;23"-S'.o8-/
JOB ADDRESS for 0 ~ttz.\ ~ ~~-z..:~ ~.l:t S-{ ,
LEGAL DESCRIPTION: LOT (S) (p BLOCK /1 SUBDIVISION JJ1?L)/'~J ;:;/'~r Adckr/~~
PARCEL ID # /q-,;)~ -()/ - {} 01 () - 0/10 () -O{)6~OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~EW CONSTRUCTION
Os IGN
o ADDITION
o MOVE
o ALTERATION
o REPAIR
o INSTALL
o DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING ~LTI-FAMILY
o COMMERCIAL 0 INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
D RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK A/et/ /?lv/h~ m~/ly .t?t==>J"ldc:"""'nc~
BUILDING SIZE d tJ l X ~? l SQUARE FOOTAGE ~ 00 /
IS'
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (I) SET ENERGY
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
o ELECTRICAL
AMP SERVICE
& (1) SET ENERGY FORMS.
FORMS.
~O G,l(l.\Jltm~
CJ~ Tl f=t ~ )2-
V1-J~ 0(~) (>ttt. ~ll
rr~ IS~"0/).d q~
TOTAL CONSTRUCTION 6t= pri'f2W1 IT
FLORIDA POWER 0 W.R.E.C.
o BUILDING
PERMITS REQUESTED
$ t9~I.}(j~~ VALUATION OF
dc!JO
)(
o PLUMBING
o MECHANICAL
$
q i" tJ(). ?-!!-
VALUATION OF MECHANCIAL INSTALLATION
3 vJ1
-t1 ~/
-1..03
# J
o GAS 0 ROOFING 0 SPECIALTY 0 OTHER
TYPE OF CONSTRUCTION: 0 BLOCK tz( FRAME
~ur S- ,
FINISHED FLOOR ELEVATIONS ~7,
o STEEL 0 OTHER
IS PROJECT IN FLOOD ZONE AREA'M:' YES 0 NO
~PNTI:t1l.C:~;R,SECTION
COMPANy4/(h~ B'aehk-/ G~s-/rvchd,? .:Tnf'.
STATE CERT OR REGIST # C/3Ct) 00,;), 9 'I
BUILDER
******************************************************************
COMPANY J?16/?1 Et~crrd:::. Z'P?C
,
STATE CERT OR REGIST # f::cO/,)t:J3ISY
PLUMBER
SIGNATURE
STATE CERT OR REGIST # CPr!)?,'? d-O~-
SIGNATURE
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ~ * * * * * * * * *; * * *,* * * * *
~ COMPANY l ~'S 1b....J'1J!e f-M1'Y
I' W STATE CERT OR REGIST # c.,~ Il?t.'?Il2.
*****************************************************************
MECHANICAL
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" whith
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, 813-780~00QO.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign po~tions 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 indica~ion 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.
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 "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 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 COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
acknowledged)
known to me, or
of identification)
ta~~ath.
Signature of person taking acknowledgeme
Name
CONTRACTOR
fll- Xo
STATE OF FLORIDA
COUNTY OF
The foregoing instru~ent w~aCknOWledged
Before ~s~~Of' :~--P , 2cPsL
by tc'S'~ -u /~
{name of person acknowledged)
~/is personally known to me, or
o who has duced
(type ~entification)
Oiid~r~ an oath
Signature of person taking acknowled ent
Name
111111111111111111111111111 111111111111111111111111111111111
2004073042
State of" F/or/'da
NOTICE OF COMMENCEMENT
County of
Pasco
2 .
TUR IrnOERSIGNED hereby gives notice that improvement will be made to c~rtain
real property, and in accordance with Chapter 713, Florida Statutes, the
follo~ing infor~ation is provided in this Notice of Commencement:
1. Description of Property: Parcel No. /'7'-;)eo-;) 1-()()/O-O/IOO-0060
tJ/T A.
able)
/11t//h '-/b.vnl /l/ )(JC:O/j-Id~/?c ~
/
Rcpl : 776327 Rec: 6. 00
DS: 0. 00 IT: 0. 00
04/23/04. Dpty Clerk
General Description of Improvement
AI~w
3. Owner Information: Name !1ot:/YJa, ;:;rojJe;rf/~r.:z-I'JC,
llddress IdS;).. L /(/''n.,jst't:Jn A'd City L..Vrz State FL,
Interest in Property: /Jj1//;i/-/'OI"J?/ly X?C'sldencp.
Name of Fee Simple Titleholder: ~~92~~~IM~~/:~~~C01CO~~TI CLERK
( I f other thSln owner) OR BK 5821 PG 1243
Address
City
Stilte
R4.
Address /;:)5;), Lil//hJ.~/.on tl<d City
Contractor: Nu.me AII/t'1/J ,(5a~hk/ L~1'?5:frvc:rI{J1/J :rne-.
L vl-z State FL
3'3559
5.
Surety: N.:lme
Address
City
State
Amount of Bond: $
6. Lender: Name
Address
City
State
7 .
Persons within the State of Florida
notices or o:her documents may be
7l3.l3(1)(a)(7), rlorida Statutes:
designated by Owner upon whom
served as provided by Section
tJ,:.me
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of ~- h_C'
Lienor's Notice as provided ~n Section 713.13(1) (b), Florida Statu:e~.
<). f"xpirnt .1.,,[1 di'lte of tlut.ice of COl'Tlm~ncement.' (the explratlGn date is 1 yeo.'::
ir~m the dute uf recording unless a different date is specified.)
( OCe) n-€-Y )
d; .
<-Ib.;L
Sig~atureofOwner: ~~~~ ~~~
Sworn to and SUbs~;stfefore me thisc<<9A-/ <Jay of
20 ~ q . I )
! /~
it
NotLlry Publ ic:
My C:;:iI,Tli s s ion Expires:
PC9305304S/A
THIS INSTRUMENT PREPARED BY:
RECORD AND RETURN TO:
111111111111111111111I11111111111111111111111111111111111111
2004070855
All Real Estate Title Services, Inc.
4032 Land-O-Lakes Blvd.
Land-O-Lakes, Florida 34639
Property Appraisers Parcel Identification
(Folio) Numbers: 1426210010011000080&0060
Grantee SS #:
Rcpt.: 7754A7 > Rec : 6.00
DS: 91.00 ",,/ ,~T: 0.00
04/21/04 ~ _ Dpty Clerk
~~92~~U"ANs: Gt:;O fOUN~Yf C'iERK
OR BK 5817 PG 111
/ 3 6"1;1;
{ /
Space Above This Line For Recording Data
THIS WARRANTY DEED, made the 20th day of April, 2004 by WILLIAM W. HARTWIG, JR., PERSONAL
REPRESENTATIVE FOR THE ESTATE OF RUBY H. HARTWIG, herein called the grantor, to BACMAR ,~
PROPERTIES, INC., A FLORIDA CORPORATION, whose post office address is 3633 GREATWOOD COURT, ;t~
LAND 0 LAKES, FLORIDA 34639, hereinafter called the Grantee: f"''1..
(Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and . if
assigns of individuals, and thp successors and assigns of corporations)
WIT N E SSE T H: That the grantor, for and in consideration of the sum ofTEN AND 00/100'S ($10.00) Dollars and other
valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases,
conveys and confirms unto the grantee all that certain land situate in PASCO County, State of Florida, viz.:
LOT 6, BLOCK 11, MOORE'S FIRST ADDITION, as recorded in Plat Book 1, page 57, Public Records of
Pasco County, Florida.
TOGETHER, wid1 all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining.
TO HAVE AND TO HOLD, the same in fee simple forever.
AND, the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the
gnmtor has s good right and lawful authority to sell and convey said land, and hereby warrants the tide to said land and will
defend the same against the lawti.ll claims of all persons whomsoever; and that said land is free of all encumbrances, except
taxes accming subsequent to December 31, 2004.
IN WITNESS WHEREOF, the said grantor has s signed and sealed these presents the day and year tirst above written.
Sib"ned, sealed and delivered in the presence of:
WILLIAM W. HARTWIG, JR.,
PERSONAL REPRESENTATIVE,
FOR THE ESTATE OF RUBY H. HARTWIG
, ,
:/~t.- 4
Witness sl8NOre
Witnes~#l Printed~NaJI1e,/) "
i j:>"'--- ': /" :;' '\ ,! .Ir,~ / ./ /'
/Y>"-"'i / i '. if " V~t/
".."," I y, ':1\ . ~/
Wit1~ess #2 Si~ELE /);" BqYO
. ,
,
Witness #2 Printed Name
(.t/~ ,~R
BY: WILLI8M W. AR IG, JR. , P.R.
PO BOX 1252 , ZEPHYRHILLS, FLORIDA 33539
STA TE OF FLORIDA
COUNTY OF PASCO
The foregoing instmment was acknowledged before me this 20th day of April, 2004 by WILLIAM W. HARTWIG, JR.,
PERSONAL REPRESENTATIVE, OF THE . ES~~TE: OF RUBY If., HARTW,~G, ,WhO",i~, erSOnallYf"ow,n)to me or has s
prodU(;e~~asldenhbca~lOn. /1, I',,' 1\'"'" 1/ '
UMTVlt:: ' \ '. I " ,'r' .
"0 \ 0 '00 I '
SEAL o'/""T'- ,," /C (, /
~ ~
Notary Public \ I
MICHELE A. BOYD
"~!:..-~-.;.:~:~:!!~:~!!;.?E-EY C?!!:"~;..i~ :.::::---!'
,
.'
Printed Notary Name
File # 04261
STATE OF FLORIDA
COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COpy OF THE DOCUMENT ON FILE
OR OF PUBLIC RECORD IN THIS OFFICE. WITNESS MY
HAND AND FFICIAL SEAL THIS~ DAY OF
2~
JED PITT AN~..2 OF CIRCUIT COURT
BY ~ DEPUTY CLERK
.
C'OUNTY, f:LOI~IDA
'--".._-"---_._----~~_.~-----_.~-,-_..._.~--
"i'"el 1'10... -. .. '-".. . ..... ..... __... .. _,... _-.,... _. __,.. Sub Dlv :...-.. . "..-... .. "_'..
ress/L "c. 11011 , ", Lf 9 .9....1......., :o.-r:. _...$ t . _., ____ ....._....._.._....___ "__.. __.. __..___
t,. s s ifl ca 1I0lln ype of Use "'_ ']J..e} p..l e 2"___ _ . ",,-- _" ".. ,,_-. "... ""_"",,._. __
THANSPOR !ATION IMPACT FEE r~ale: Sq Fl Unit:
Permit Nu. ...--30.3_'J__
I lale PennlllecJ
----._-~---
:::S-;!.1'l:'<: ~..1h~~..... <:011(10111..___-.._,,__
Exelnpl [I Yes r~
-_. -._-.~-,_.__._--- --
I low Deterlllined
- - - -.- -.-__._.n_.____
Impact r=ee Amollnt __!._____~[,.---.--
--.---.....---.-.--....-.. .-.-..-.----- --_.... -_'__'n..
---.. .~--,-- ._. ~- -._~-
ZOlle No. TAl:
----------. -_..-..-- .... ------- .~----
Amount
~
$ ----.----...-7_~d3__.( _ _.. ____..___
~--.._...-._._---.- .------...---
. . _, ~M__ _" __'_.__
----.--....-...----.--------------.... -.-.,..._..~_._.--.
PARRSAHfj".I~ECREA:rI6NFEE--.~--._-.,,-,-_.--.---.~--_~.._~_.._._____,__..__"
Lallu Account Land Credit Land Total
.---.-.---- ......-.-.-.-
------
Recreation ACCOlI/ It r~ecreaUon Total
--... --~ -~-- '-~-. --..~_.~-~---
Zone
----- ---....-.- ~.._.~.. - _._.~_. ~- '--'-"'-
'h__.~_ __._~ _..__.____._
["J I\J (J
TOTAL /\MOUNTn~___,,_____________
, Ilow Ueterrnlne( I
T~fB'RA~ 'j' FE E" .""..".~.. '"'''' n''''''',"~_",., -"...."-"._",,... "_.."._"._""~_."'""._.~~,,,....
Land ACCOll/ll Land Cree' Land Total
._-. -.~ -----_.~ _._-..._----~._----~
----------
Facllity ACCOlJllt ___.______. Facility Credit _______..___________ Facility Total
...~._--_._-~-_._--. ---..-- -_._.~...-._-_._...__..._---~.__.__.. ---- '-._.
--- .._-..__.._-..~... --..~_u_._____
[J No
How Determined Total Amoullt
. ------..-..---.-----.
T~.~e~~~....--..,~-.-rr~:..:~-:~..--.-------------ER[j .-=-::=~~===-~
--...._------._.....~._-_.~ ---......~..- . - ...._--~.-
_.,~"-,, '''''''' ."."" .." ..~...._.,,-..-,.."..".n.___...__..~,.".._._ .."..' '"_'__'-_''_'''''"''_'''_''' .,......._..,_... ._..___~...~'__._.._.....__._~,_._._._
Prepared By "q_______________________________ Cliecl<sd By
-~._-- --------. -------..------.-----...----.
NO VEIUrFICATE OF Or.GlJl'ANGY WILL BE ISSlIED 011 FINAL rNSI'EGTION
PErU:or~Mr:1J UNTIL lHE TOTAL AMOUNTS L1STI::D IIAVl::
RI=I=I\I D ^ 11'\ 1\ .11',
.....t- #.......... _.._