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HomeMy WebLinkAbout04-3343 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 3343 Permit Number: 3343 Permit Type: ADDITION/ALTERATION Class of Work: ALUMINUM PACKAGE Proposed Use: MOBILE HOME SUBDIVISION Square Feet: Est. Value: Improv. Cost: 16,835,57 Date Issued: 8/31/2004 Total Fees: 207.50 Amount Paid: 207,50 Date Paid: 8/31/2004 Work Desc: SHED, SCREEN ROOM & CARPORT Address: 37438 GILL AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot{s): 191 Block: Section: Subdivision: GRAND HORIZONS Parcel Number: 34-25-21-0010-02800-0191 GRAND I N 37438 GILL AVE ZEPHYRHILLS, FL. 33542 Phone: ACE AIR CONDITIONING & ELEC. E 1 DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED LINTEL PRE-METER WATER SHEATHING FRAME MISC SEWER MISC INSULATION WALL MISC MISC, MISC. INSULATION CEILING MISC. MISC. MISC. DRIVEWAY MISC. MISC. 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 callecl (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 work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~TRACTORSIGNATURE r~M~ CALL FOR SP CTION - 8 HOUR NOTICE REQUIRED PR CT CARD FROM WEATHER 13d)-+ (~~I. L(:;, T Ie; I Cs I LC ~ V. I 1 I 1 1fr LUlU\. . ,(; f1e.W61~ SQ. FE::T PR!C:= MAiN OR LlVING AREA S OT:,ER AREA UNDER ROOF S j 1 OTHER J J VALUA TJON S /b,i.1~. 57 j I BUILJING: S rJ7.- I --5 ..::> -r CREDIT: S ELECTRICAL 5 5S ~ () PLUMBING: $ ;V1ECHANICAL .~ RACON1S " j I T i FS :1 s " LEONARD G. "GEOFF" WOOD. P.E. 4034 THE FENW A Y MULBERRY, FLORIDA 33860 (863) 646-5517 ALL \VOR..:~::'..u ....L\..v""'L..' Y,'lTtlAl.:' Date: 4-20-04 PREY AlLING CODES, FLORIDA BUILDINC, CODE. NATIONAL ELECIRlCCODEMT CITY OFZEPHYRHILLSORDlNANCES B & H Construction Zephyrhills, Florida Re: Address 2004 Jacobsen Gill Ave Zephyrhills, Fl. 33540 Mod # CL3 4609 Lot # 191 Dear Sirs, This letter is to certify that I have reviewed the above referenced structure to determine the structural adequacy of the existing structure to receive the attached structure. The proposed structure is roughly 12x32 carport a 12xlO-shed, and a 12x18 Raised Screen Room. The existing mobile home, has been considered and is adequate as a host structure, with the blocking and anchoring at 5' 4" Based upon review and acceptance of other structure to home per manufacturers requirements. As always, should you have any questions, please feel free to call me at any time. Sincdly, I jj~ ]f;;J;~oOd 4034 The Fenway Mulberry, Florida 33860 )l)rLYf~ /VJ~W j1/,MLL i5~ )2ff~ )Jw ~ [ fftw,rlJr {KJW-M\c..,\\ r- p;q l)/~t3 flAl N [ MIlIf..1 ,t, II 'f?'y Wi./f1.,.. po 1"1 G~ti- ~ uJ"bcrD ~JLuJv%CS Date: 9-12-03 1< I ItJO 6A-5cmcvr C'( I V 1< LoT /9/ (;1 Li /tvE W!ru cf !loR I ZO Jt) J . ,. ( ~CJ Itr- /-7' I OlliVEWAj" ,. Ii lIoJ??f7 /,0 I 1 slltd t ~ Sc.fecp ~ ROOM I~' ..~ ~ ff/iS~d '><. .. .~ tl ( /00 r-- r-- l""l r-- "<t' =ll: W s::... ~ ] ~~ ~ fl ' , t.I.. rL: o C) ~ ]~.B ~"<t'_ l""l :l ~~ I EI1SEmE~T ~ >1 i/((i;~ C(/2z/tJr 1< /J ~( f '.J ~~ ~ ~~ ~~ " ~~ ~~ f ~'~ /0 ~ ~ ~ K .~~ ~~ \(j ~~ ~, ~~ ,~ \U ~\() ~'" ~ I() ;~ ~ -~~ ,\ ~ " ~ do ~~ ( ~~ r-- If "-.l~ r-- M ~ ~ r-- ":t ~~ 'II: W 0 0.. 1.0 ~ ~':J:.. >,00 ]~~ ~~ ~ fi ' ~ ~~ \J~ ' u.. fi: OOj ~ ..... ~~ ~~ \) ':~ ~~ ~":t_ M ;::: ~ ~~ "- ~:2 \J ~ ~~ ~ ~\.l) ~ ~ '0 ~V) '-+- ~ ~ ~ Z I ~ ~ ~ 3J ~~ ~~ ~ fY)~~ o-.i~ ~ ~o..... ;g ~<\(, '-~ ~ ~ ~ ...~ "- "J ~ l\j ~ \.() ~ '\:l ~ '-~ It ~I{) ~ " ......... 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IlO I CD I Co . 0) ~~.... nwrr" I71f ':'& --I--- _~~~ ............... - ....... .. ..... ... .. - ----- j t!'i/fr :;~, ' o~ 'VV',. '... Uf' ~ Y ~ LEDWUI Go 'GEIJF"F" vtJOD O<<iII€:ER ~ lL Veoll. r.r.M7S77 _ ",. r_y 1UMny, "..... ~. . T~""... l\IU) LlS.-SS17 _ m63) 1lI7-1'II73 I ce I . 0) '0 - 6'-0" MAXIMUM TRIBUTARY WIDTHS OF" BEAMS EDGE BEAMS AND CENTER BEAMS BEAM SPAN CURVES - 130 MPH WIND VELOCITY .~ Pi uU Idll i n~J ~ ~~ ~ ~ ;r uU/11 I ftU1 i l~~~~~ I'~" !,~.! 5 .l! :: i ~ '~~Il!! ! '5~"1 l.B. ~ E~ ~ ,:: mfl i~ U ~ ":':Illig ~U ~ ' = ,,~, i ,~mr ~. ~ . '1 .lill ~ ~ 1-- ,.,~ii -- 0: I( fl. ,I ll:l ~.. .1 I.') <t 'I ~ ~ I . .' o.:'~ ~" t:l .~ lu I . '- --- I .... t'l' -- .~ ..... ~ z o I- <: Cl z :::> ~~ f2 ~~=~i ~ ~!~ii ~ !~'li~ 0 Fi~ ~ ~ ~~;.! w ~~3~~ ;: I ~ w !:J <: r tr.w J ,0- 9 , ,0- ,9 S3IC:/I;I/i III i ~ ~ &0;; ~ 5 g ,. ~ ., "" 4TJ.V.~ ....~. oJ'" '" .....lr. V~'J j ')~'JvVV ....,.&.'\.....,"". ......V.l.\..I...........,oJ J..&.V.I...~.,J .., ....... . ,...,.."'."..,...............,.......... .........-..'~.~..l..___ __. ..h . ~E ESTIMATES 4025 MORRISBlUDOB ROAD ZEPHYRHILLS~}~t. 33'543 1-800-224-1206 Lia;ns~ · Bonded · In.ureS. S~lrdn,. sCtpI t, R.oom Add;tiOf\$ · Aj"mil'lUDl · COFlefde lAl J9L Jbd;v(,jjon c;" { { CNlUJd #()~/7(NU2 0.., /-~6'-O Y ;1""'1 ;/11, ~~~ CL3-tf'{)Q , - ,. Ltp 10 W ~ ";r~ ...TQ.GO~~- OLASS ROOM WALLS p~~ Color W~. <to + ... · L/Flt i,,," Color Jl"-~ltred-'::"';- ~Sq Itl ).14 8~ Coror !.apSJdiq I' ~..._. _1..(F' )( 6.36 I All ~ lurn irio~h iJ\~I\lde: PIN, Trim. 0,,_, t)own. Hud ~JInI----'_l.P II 11 n ~~O\.ll~ jxJ Pose" 2x4 s.mJ ud $h""J~ Plashl", SMp R.UU\i- , - .--..&....BA ~ &1,09 7'>/~ ,/ K . - _.!I''l,.? V o...r t>oor _x_lEA It_ a..F''&1IslJ..Fll.-oft~$q J't:J( '.)9. ),11 OcR.. Door HtadCll'-~-_ __E. 1, _ ~Pans_'Ft l..onL-Sq" x '3.".-1.ft o.nccDcloro,en....._._t'l_ _PatlS_1'1 /...ML-Sq PI x 3,39. ),11 ~JJc; ':rY?,ofp I ~PVls_'Fll..on,--S4) l'\~ 3.19 -1,a ~-. , ;2. jl,i.,.(MfNUM TOT A L Vat.nee...... ...nm._...~..Jt:LlIP J ..,.., G\ln~ on HOOle..-.----.....tn I ...~ ., &,4 ~, ~() CONcRiTE AND BRlCI< WORK Gibl~ 8u", Work on Front L..oacl..-.... 144.72 141 (I ~.4.. P.Uo.sIlb--..&2..I~.~ Sq Ft,. 2,n :M. ?, 6, ~ "2 x4 SM ~Qm...._-.-..s...lIF~ 3.~ ," .", ,- hdo '~4 ~ ..1':1...-..:Ii.LScI F1 I{ 2,2) ~/:l~ h~ $M BGII'l.....-.-.- _l.h)l ~.3" "do ........ I '" ,sq F1 I{ 7,23 2%7 'SM fJ4Iam----.-- _UP x "A1 .Put.~"""" I~-1Zl:$q FI x 22) 'u -,r./<f hg $M 8e&m.-----------~LIF x 1.~ N~ !J.-' q as. W-.Ik-.:!L.Jj!....iQ..Sq FI :r 2,2) I? r;: I!L'" 2:0:9 SM 9am-..~._--_LIFJl '.1' .~~JLJt .~SqFIJ, 2.2J II/. :I.l l& 2.10 SM Ball'l...n..~_--.-_L.IP'x 11.96 OM"')' Plair~I.lL"...f2...$q Fr x !If 41~. ,., SCREEN ROOM W~LS ~~~_II~"-l:.-""l 31.'" ~ " Lap )(.)' .a.. .. J.i.. · _ + _ ., ~ t.IF ~ :n,~ SI.J:. fi,J.() R.1M,d'I,tJ. f e- /L1l..J.b.-lJI,..Sq Ft lL &. iil ~,,~ ~~y Sc:TtJr:n ()Qor Il'cllld.,,: RIlMid helo,6 C. _"_ · _$q Fl X a,I4 I Closer Il'ld Thr.bold...,........1-VF ,. '4:31 'v'.; K Owr 6, per It ,.. B.J..L. -Z/lVf 1 2.2~ ""L ~.Jo Gable Fill on( Sidc-...~...--_1A I ".10 Footer &)(12 RtbIfotoed -;JLUf X H} /. I-"/~O Insu/..ed Kick PI.t..--........_V1ll }.63 ;oOWl2Z1ibJAtor-s .~lIF IC 57<1 J ~- 'T fift SQ/Tl (1101 wircd}---- -L..-!A I 62.9'2 L~,9~ .,.~.~ , ~IA x 217 '/~I~ , UTILITY ROOM WALLS I J,~, ~.2 I Trad' s-p.------ _EA II 73.90 ~JII~J.J.....lE.. ... I~~ .. _ - ~VF II 33." % T,.., $Np-;- -.!- EA x 147.80 ,,4 Sn.d) 16'. OC /,- .cl 3 ,.,.~.. - ......=%. E!\ .-; 121,71 L{-V~;'i:2 511~ Door In" r WindoVlln---L- 1.11 xl51.01 4x".~P. ---" _fA It 229.71 ~inBle W;nOo,,", ('E.x~.>-_.'- ~EA s St.43 ~.o! ..t;,.., ~'~~'HJ", S,'I S,..itld--.....u-,.._....._~VJF X ,.~ .~. ,,- Owl',,. ft,., ~_LIF )l 2,QO_. t"'r;~t .spUr irick ~tr SUek-_/.IF x 10,00 - SpllrBrfck Sol~ "'~VF ~ 11.15 /L3:? '::9'" .. oWr5'plrftpcr~~L/F x ~,23 /~ 7/10 VfNYL ROOM WALLS FIII,Db1.~-.---- L.oacb" 100,00 ~co'~~ \/I"yl W_Il_+__i_+_._LnxSO.3-4 ,,-- ~ . -------,.-100,00 /(!>o .00 ;""d: KiCk PI.'cn--..........-._LlPI '.12 ~ae:':'-' Lap Top tn, ide &lid CM...._... _LIP':II 1$,10 .r~fT ) CONCRETE 1Ipo;.z: >-7 ~Io' idol GI&.H.....u.--_.-..m-_Lh X 10.01 31 ~ . ") ALtJM1NVM k.~~(. (nSulale Twp &NJ BonOlll---_ lAx S,J9 OAt! }.q-1~ r:n-1I PERMIT :[. ')0 to () r'loors .ncl",d~ (1) 2 Tr.c:lI: Uniu Tlvcskold and Clasr--_!A 1I. 1~,1'2 PAX .TO' j1 S.6S8S TAX MH ",ill not butSpOn$ible ror 11\ I*' I F'Q'RENOIm!lU'NO TOTAL /b >- 3~5'~ ,n vr?-lYt ROOMS X l IV' -'c~, ~ lIlIlWtel, m""""" 1If..)'lIIt. A PIN>>ICI CHAlO. " I J" 1IIt.oMll wi" ._-.ad Ol\ ,U ..~....,........ ~AL lac&rr .40' U"'" II"'".......,'. _It MIIIIMIY lIl.nd, ~ 'd ~O?j..:::i ~.JdL~; ~ ~-8 r-1'" CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPAR~NT 5335 S~ Street, Zephyrhill., ~ 33542 S13-7SP-0020 FAX:S13-7S0-0021 DATE RJ:CIl IWD PLANS REVIEW FEE JOB ADDRESS C!ZJ4f\/o ~31 Ll.3 ff /Jy; fl ( 70,J 0/LL /nt/P t1VE , PHONE <f=' J 3- '1<? Z ---- / Dr; t( OWNER'S NAME LEGAL DESCRIPTION: 1..-0 T / 1 i LOT (S) BLOCK SUBDIVISION.GRA;V~ 1-/6121 ceyv /JfJ-);/ "J,L( -2'5"-2/- (')01 0 - 0 Z~O;o- o/1iBTAIN FROM PROPERTY TAX NOTICF,\ PARCEL ID # WORK PROPSED: ~W CONSTRUCTION OSIGN PROPOSED USE: ~L FAMILY DWELLING OCOMMERCIAL ur:(DDITION o MOVE OALTERATION o DEMOLISH o REPAIR lJl.-11ilsTALL OMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME CEOTH E R /i tJM I (/(/#L DESCRIPTION OF WORK & HEALT PARTMENT APPROVAL t r ~O;fEi"; /ZiY~ SQUARE FOOTAGE 7 20 BUILDING SIZE HEIGHT AMP SERVICE o FLORIDA POWER /j, // 01" ~~. RESIDENTIAL: COMMERCIAL: ATTACH (2) PLOT PLANS &, (2 ) SETS OF BUILDING PLANS & (1) SET ENERGY ATTACH (3) SETS OF BUILDING PLANS' (1) SET ENERGY FORMS, PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION, ~ILDING lkYELECTRICAL $ 1 t,ffS-, -5'7 / /' PERMITS REQUESTED / I' f VALUATION OF TOTAL CONSTRUCTIO o o PLUMBING o MECHANICAL $ o GAS o ROOFING o SPECIALTY VALUATION OF MECHANCIAL INSTALLATION o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES 0 NO ,/, , -.. . . . . -,... . . . -.-.. ., . , .. ., . , .". .. .. :.,; ~L :..:~.;.; t.;J ..'.".'-. . " ( ,..'::: H~,: 1'0 ..".. ".,'::::' ::::.:::::::' \.C~~~A~~' f?j /1 C~frrzUU--IDlv I/~C&VI!lAL STATE CERT OR REGIST * r:'f?( D 5" 7 I/.r- z. CITY PROCESSING * 210 BUILDER SIGNATURE ~ II- au. I Ft. ' *******************************************.********************** ELECTRICIAN ~ j/~ (jd~ COMPANY 11C1~ pLE c T72{ L STATE CERT OR REGIST # CITY PROCESSING # 1~7 SIGNATURE ****************************************************************** '. PLUMBER COMPANY STATE CERT OR REGIST i CITY PROCESSING # SIGNATURE MECHANICAL **********************************************~******************* COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************'.************ OTHER SIGNATURE COMPANY STATE CERT OR REGIST # CITY PROCESSING # ***************************************************************** __""'............................"....., .....".... ..........l.\.l,..l...l.oJr. ...~.l.;....J,.,I,('")."J..J. A, NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to ~deedrestrictions" wh~ch, may be more restrictive than City regulations. The undersigned assumes responsi9ility for compliance with any.applicable deed restrictions. B. UNLICENSED CONT~CTORS 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 intende~ work, they are advised to contact the City of Zephyrhills Building Department, 613-766-6611. Furthermore, if the owner has hired a contractor or contractors, h. is advised to have the contractor(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 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 Conswner Affairs. If the applicant is someone othe.r that the ~owner", I cerify that I have obtained a copy of the above described aocument 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 agenci~s iz:1c~ude but are.n~t'~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 aqate~ent I also certify that, if fill material i$ 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 unle,.tne.. W,PJ:,k, .~thc)l:1'.Q by such permit is commenced within six months of issuance, or if wOJ:k .~,~hodr;"d,'bt,.::tn.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. I!'.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 ~NOTIC-E OF COMMENCEMENT". ~ 1 /1/ d;j 1~) ~ ~ /.l iPr&-.t 1ff{ - /~ SIGNATURE: 0 R OR AGENT . SlGN TURE: . TRACTOR STATE OF, FLORIDA TIASC . COUNTY OF r.. 0 The foregoing instrument was acknowledged Before me this 2iLL day of APRJL , 20.t:!:f by r:;OrtO TJ/~ ' (name of person acknowledged) UJ..-t;mo is personally known to me;~or STATE OF FLORID~ !.~ 0( COUNTY OF j 0 The foregoing instrument wa~cknowle~e~u Before Ce this ~ay of /-11-'/21 L , LU <2I by /ZE;; T3"" - ~. (name of person acknowledged) ~ho is personally known to me, or and whoO did ~ o who has produced (type of identification) Odid not take an oath. 4. ~ Owho has produced (type of identification) and who Odid OUd not take an oath T3wa 4. fMdJ Signature of person taking acknowledgment Signature of person taking acknowledgement l3ILJGE If. A(;IJ~L Name typed, printed or stamped R"j' Bruce A Asbel ,~ ,; My Commission 00116710 0Ifl.'of Expires June 22, 2006 B[l(/~ E /-1. A50r;l- Name typed, printed or stamped R~1 ii\. Bruce A Asbel ;.~ .; My Commission 00116710 ~O'fl.'of Expires June 22, 2006 This space Jor userby Clerk of the Circuit Court only, 1111111 11111 1111111111 111111111111111 llill 11111 11111 II 111111 2004165233 Rcpl:812597 os: 0. 00 09/01/04 Rec: 10.00 IT: 0, 00 Dpty Clerk I JEO PITTMAN, PASCO COUNTY CLERK 09/01/04 01: 40pm 1 of 1 OR BK 6009 PG 849 NOTICE OF COMMENCEMENT Slate of Florida The undersigned hereby gives notice that Improvements will be made to certain real property, and in accordance wilh Section 713,13 of the Florida Statules, the following Information Is provided In the NOTICE OF COMMEN~EMENT. 1. Legal Description of property (street address required): '3 '7 L/ 35" 6' L L ,q V E J-() T !? I "sL{'- :25"-2/- 00(0- 02rtlO- 0/<(( 2. General description of Improvements: A l VrVl1 ;J U /J"l. p/.fC /-:: AG E:. Ja, Owner Name: CJ!2A jJiJ l-fo/u cO/V /}1 /~j/ Owner Address: ~71n 'I- ~ GI2/::eIJ ':;L~.f'? Pt?' Oil. 2fflf!V/2If/L L.)> F(. '']:3 J::;L{ f _ r!t'00 Jb, Owner's interest In site: Jc. Fee Simple Title holder (of other than owner) Address: R Contractor Name: f3 {I-I {" {)fV5r /LUe... T( ON OF cf/v (!2A-c... Address: '/tJzS- f/1(CJ/bU5 /],e.t/JGF la-J, ?//,wV/ZtI/US j::C. 3 ~54"3 Fe, Phone: .:PI ft -- 7 r 2 - /CJ6 c.( 7. Person wilhln the Slale of Florida deslQnated by owner upon whom notices or oth'er documents may be served as provided by Section 7,13,13(1)(a)7, Florida Stalules, Name: Address: Phone Number: 8. In addil/on to himself, Owner designates the fQ!lowlng person \0 receive 8 copy of lhe Lienor's Notice as provided In Section 7,13, 13( 1 )(b), Florida Statules, Name: Address: Phone Number: 9, Expiration dale or Nollce of Commencement (expiration date Is one (1) year from dale of recording unless a different dale Is specified). 0?d~ /Ztc (l/hU) t. f2b-f 8tiZ0 STATE OF FLORIDA / . / The foreQoing instrumenl was acknowledge before me lhls ;2i,o' 1-1 A-/z,.} i., 12L-7//362& proOduced rfrz 5 o;./tl-l.(... '( ,kIVOi./'//V (Driver's License #) I date of ~<;j;rwVl;J Ell- ,20 c.i{, by who (Is) (are) personally known 10 me or as IdenlirlcaUon, who did/did not take an oath, &.~'U' ;l, CW;:.eQ :1~' ~f> Bruce A ASbel ;,~ ..; My Commission D0116710 ~o....df Expires June 22, 2006 Signature. Notary Public (A copy of any bond must be allached atlhe lime of recordation of this Notice of Commencemenl)