HomeMy WebLinkAbout04-3566
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
3566
Permit Number: 3566
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 5,879.00
Date Issued: 11/08/2004
Total Fees: 60.00
Amount Paid: 60.00
Date Paid: 11/08/2004
Work Desc: RE-ROOF
Address: 4923 17TH T
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: MOORES FIRST ADDITION
Parcel Number: 14-26-21-0010-00400-0060
Name: KNOWLES, JOHN
Address: 4923 17TH ST
ZEPHYRHILLS, FL. 33542
Phone:
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade:
(a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when
inspection called (d) Work not ready for inspection when called
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
nWarning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement. n
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
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IGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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15911 U.S.'301'-DadeCily; FlOrida 33523 0-' . . ,
352/561-:6047 "~ ~:-. ,. -' . . ~8X: 352/567-4454
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APPi.:reA.'!IOH 'l'OifpDMIT"
en!! OF.&PJlYlUIILLS
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PA.OPOSED USEMGL. FAMILY DWELLING: O': PMULTI-FAiU,LY' ,
o COMMERCIAL OINDUS'fJUAL '
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DESCRIP1'ION OF WORK S)i~p~-" RfJrT-P , '".', ": .
BUILDING SIZE . ,,~Q~~E 'roOT~~E, '?jOOO. '
RESIDEN.TIAL: ATTACH (2) PLOT PLANS ,& (2) SETS OF BUILDING PLANS '~~ERGY
COMMERCIAL: ATTACH (3) SETS 'or BUILDING PLANS & (1) SET ENERGY ~jr-rs.. ~,
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ' I
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o BUILDING
D ELECTIUCAL
o PLUMBING .
o MECHANICAL
"PERMITS REQUESTED
, .$ '5 ~~ . CJ 4." ' ',' VALUA;~ION OF TOTAL CONSTRUCTION
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VALU~~H'" OF MECJfANCIALI~~~~~t ~ ~ "
o SPECIALTY, OOTHER:~; '.! ,',' ..,' __~ .';'~/I:
o GAS
.ROOFING
TYPE of' CONSTRUCTION: 0 BLOCK.,
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, 0 STEEL, " 0 OTHER I',..
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FIN!SHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES 0 NO';' '.f. ~ .
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SIGNATURE
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STATE"CERT..,OR.REGI~'1' lJ' '".,...,
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COMPANY.
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COMPANy'MILBAR'(mmRucrIal, INC.
STATE CERT OR REGIST# COC 051562
CITY PROCESSING ft 21-8- ,
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. FROM' :MILBAR
FAX NO. :3525674454
,.' . C9tll)l11'lp~;.s Of 1'J!;~ 1', AIi'I:'lUAV:l'l'
A.. NOT.ICE Of' DEED RBS'lJUCTIONS ',~ . '~.q';', ;,.'~ ~~;l'" . ,,',' ".. '.. :'/
The undersigned under-tands ~hat.!thi8..P,~~t,~y :bel!~ject to "deed restdcUons" which' '.
~y be ~~e reatrictiYe .thanCity regulations. The undersigned assumes responsibility for
compliance ~ith any,applicablede.ed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hiJ::ed a c':l~tractor' or' cont.ractora to undertake work, they may be;~r~~\lir,!.d;i"(
to be licensed in acco~dance'with state and local- 'regulations.~":'if.thecontracto.r ia not'
licensed as ~equlredhy law, b~th the owner and contractor.ma.y be cited for a IIli.sd~I!..AOF :jl).
Violation under state law." If the'owner or intendecl contractor' are' uncertain as 'to ",hat
licensing requirements may applYr(fQ~ .the intended work, they are advise:d to~ont~cti~t::~e.l'(\;l'\'
City of Zephyrhills 8uilcUng~Departlllent:,'813-788-6611. '" " ... ,.,' " . ' ' .
Furthentore, if the OWner'has.J)~~ed a contractor or contractors, 'he is adVised to,ha~ethelj\:
contraetor (..) sign portions' o('!;~e ; "Contractor 'Sections" of this 'application for whiCh "th~y
will be .tesJJonaible.. If y'oul!:a~()t,he. ,9,,.,n~r, sign,s, as the I C?f;mt.l"a9~o~,. yo,uareindica~iJlg",th~~;:,
you, .rather than the contractor, 'are responsible for the wotk. If the cont.l"actor wishes
you to sign as l::ont:ractorthat Dl~y, ~e(;,~r;t indlcationt~at ,he is not properly "licensed and is
not entitled to permitting ,privileges 'In the City of Zephyrhills..
C. TIU\NSPORTA.TION IMPACT fEES AND UTILITYCONNECTI0N- FEES .."
D. CONSTRUC1lUION LIEN, lAW (C~~Tt:h '713, FLORIDA' STATUTES, AS AMENDED):. ":;"')"7("~
I ce.r:tify that I, th~ applicant.;~'l1a"e been provi.~~d. ~ith a copy of ,~Fl.o,~ida' s Construction
lien La'" - Home~wner s Protecti~~Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the afip.~icaD:~,is ,S~~on,e.o~.er :~hatth~: '!'o"fnerN, I eerify that I
have obtained a copy of the abov~!described document and promise 1n'good faith to deliver
it to the "ownerN prior to commencement.
E. CONTRACTOR' S/OWNER' S AFFIDAVIT .,..
I ce.r:tify that all the infonMtion in this applica~iqn is accu.t"ate and that all work :w11l,\ ~ ,,';
be done in compliance with all applicable laws z:egulating constructlon~ zoning, and land
:;;~~:::::. is hmby made t" obtain ~"~~_ t to ci~ work';;ci' ':"'~'11.t1... .. 1nd1..~";; :;, ~i ~ ';'
cez:tify that no ~ork or ins~al~atio~ ~as cOmlllenced prior; ~o, issu~nce;of a'pe~t and that
all work will he performed to me~t 'standards of all laws regulating'cons~ruction, City
codes, ~oning regulat1ons,.' and land development regulations in the ju~isdiction~I also
certify that I understand that the ~e.gu;Lations ,of. other,go,vernmental agencies may apply to
the intended work, and thak,t.tJ"smy responsibility to ideritify,what actions I must take to
be in c01tlpliance. such-,~genci~'iinclude but are n~t limited to: . *Department of ;- ;.,.;!.,,~
En~ironmental Regulation'3:,cYPli"es~'Bayheads,Wetland Areas and Env~romnentally SensitiVe '
Lands, Watec/Waetewater Trea~~eq~:
*Southwest Floz:ida ,lfaterM;inagemekit District-Wells,. Cypress Bayheads, Wetland Areas;: ',,'1': .':,t
Altering Watercourses '. : '.,', .
*Aimy Corps of Engineers-Se~w.ils~ Docks, Navigable Waterways
*Department of Health , Rehabilitative Servil::es, EnVironmental Health Unit-Wells,
Wastewate~ Treatment, Septic *anks': :~:.I '::',; ',,'.'" ".-' '. :, '1, ':....:1:..,., ;
*U.s. Envirorunental Protectiori'Age=ncy-Asbestos abatement, '.. "."7 .,..,r
I also certify that, if fiii milterial is to be used in, Flood Zone.' "A" or "'A, etc. N, it'is <./.- ,-
understood that: a drainage plan~'~ddressing a "co1tlpensating volume" will be sublllitt~~. wlq.~, ....i
is prepared ey a professional el;i5i1neer registered in the" State of I!'lorida prior to' permit '.
issuance. ,. ~.". . ,,' '., ;',r";'d";
A permit issued shall be cons~ru~~ to be" al1"cense 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 apennit Pfeve.rl~:t.~e..~:~~J.~~g..~~~~~i,~l fJ;~~~,~he~~~~ter .re~r~~~::f~,mf;f'?:'~
correction of error~ in plillJ8, icon.,t~.~~~OI1~;~i,O~>Yi"f)f.~.~J.;~~~;~,?~~~c;o.d.~:.~'{EVe~y, P~~~:.':';;i~ UiC.:[<:3.
issued shllll become invalidun1.ess the'work authorized by sucb~peQDit is cOftmenced within.
six months of issuance, or if work authoriz,ec:t. by the pennit is suspended -ur' 'dbandon.ed f().t,:H'U~;
period of six Months after the.;J~~.e, tJ)". woZ;k),~s cOllmenced. One 90 Slay extension of tiine'-....
Maybe allowed fOJ; the P~.dnitwi~ ":f,e~:'cl1arg~, of $15.00. The exter(8i~ shall be r~ques~~d;.i. ~
in writing to the Building Official':"'An" apPJ;oved.' inspeetion must-be"lo9ged dUring each six
month period, or the projec~wi~i,.b.e ,c:onsidered aba,ndq,ned. .' ,'~q. ,,' . ' , . ',' ,. ' .
WARNING TO OWNER: YOUR"FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR'
PAYING TWICE FOR IMPROvEMENTS.' ~9YOUR;~R9PER~. IF YOU INTEND TO OBTAIN FINANCING,\,~c:~"SU!-1.J~'
WITH YOUR LENDER OR AN ATTORNEY;;BEFORE" RECORDING YOUR NOTICE OF COMMENCBHENT. , JOBS "'UNDER-'" .
$2'50~O IN"V~u NOT NEED'T6 ~ECORD:1WP POST A "'NOT~CEO 'C' , . T~.:":+(Y~;~~~'1(
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SIGti'TURE: OWNER OR A~ENT -DAVIDj~~,:~: SIGNATU:RE:CON'l'M.CTOR DAVIOR. ABLA "~::~:';";~,
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Nov. 08 2004 09:42AM
P3
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STATE OF FLORIDA ',' :, '."_/,~.:,':t"."' ,,} ,;',~~'i, i ,..,
COUNTY OF" PASOO .?':- ;;-'.'.: ,
The fo~egoin9 instrUlllent was 'ack'n'~wledged ,
Before me this_ day of ," lL
by " DAVID R. ART.I\' ,..
(name of person acknowledg~clf' ,.~..~_
)d who is personal! y knO\fl1 to me". or
STATE OF FLORIDA
COUNTY: OF . PASa:>
,The.,to.~egoing ,1n~trume~t .was
Before me th1s ABClay of
by DAVID R.
(name of person acknowledged)
)If,ho is personally knotnl ~o me, 'or'
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acknOWledged "
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D who has produced ,
, (type. of"ideri~ific~ti~n,)
, ..jl!didnot: ,t~,k~ 'A:>C?a~h.~i;i, ,
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and who
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Namet~: "
FROM :MILBAR
FAX NO. :3525674454
Nov. 08 2004 09:43AM P4
U,S; Intec Certified
PlatInum In.""er
15204 ,
,Jrnp.osal
6fI'Mil~.~~!~lnc.
,.', " 15911 US Hwy.301 North. Dade City, Florida 33523 <:::>
3521567i06Q47 - 8001562-2393 - FAX: 3521567-4454
of 2 Pages
Stet. cenlfled '
IIder ICBC023221
state Certln.cl
Roofer 1CCCOS1682
State Aegletered
Roofer .RCD055215
RCI Reg....red
Root Conaull8nt 10149
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Member oft_ FlOrida
Rooflngllnd Sheet Mebll
AuocIatlon
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PROPOSAL SUBMITTED
KNOWLES. JOHN
STREET
4923 17TH STREET
PHaIlE
8131788-4980
JOB NAME
KNOWLES RESIDENCE
JOe lOCATION
4923 17TH STREET
DIQE
10/05/04'
CITY. STAll: and ZIP CODe
ZEPHYRHI~LS, FL 33542
ARCHITECT
[)I{TE OF PUINS
JOe PHONE
ZEPHYRHI~~S, FL
We hereby 8Ubmlt speclllcallona and eelImates for:
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SHINGLE,RE-RODF
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1. Tear off and haul away existing one-layer shingle roofing system.
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.,.__?~.....__,.~~~~~.~.~...Bn~ ~ns~a~~~:::;~o. layers ~:. new 15 lb:....~~te~__~_~;.r~TUZ:Of(.-y-.__
.-...~:...........;~:;~~.~~ii~::~;~::';;~~,~~-~= :i~r~~I:..f;;~y;~1::.=~~{~~B.... s;;tt:.
colors. Shingl.s have A ~5-year 1111lited nrrantY_.fr-oWl TA~~O. .
"'~_._._"'--'-'.~--'~"'''''''.~'.'''''''''''''_...._....n...~...._____.--. ..._____..
4. R.place all da.aged f~a~hin~s (vall.y, vent, or any wall flashing).
.,-,. ".. ..~.'.' ..__......\__... .._-_.P....,...._......._.~---..---.....~.......- ..
5.
Provide' and instaLl ~new,:leAd boots for the .plumbing vents.
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....".._..!'~~~~~...~~.!..~..~~~.'_.~x1st1~!L:f.!~~_,...___ ---~~-c
_!:....._...~..1~e..!"2.!.Btall .!!!!J."e-fini~.d .lu~~u. euvedrip (~ or ~~ ~
8. Replace the existing ridge vent with 50 1.1. of new pre-finished aluminu.ridge
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.. . - .g:_m.....j)ro.y1Cie encf-i'nst.all a-'-crt'cket b.hIiid th~-existing-chIilriey'~"'Cf'lor'rd8 Building Code
require the installation ot a cricket behind chillneys great.er than 30- in width.)
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10. Any rotten or .damaged wood deck, tascia, trim, framing, etc. replecelll.nt or
'--'-"'-"-r:e':;;'ii'aI1irig~"ol', the-~x1st1ng 'roof deck 'will bfi'collpl.teaCiil-a-'cQst.-ja-lus bas"is aboy&
And beyond the contract. pTic~.
.e 'r11pD~ hereby to fU!n!ShjpiBter!al and labor - complete in accordance with above specifications, for the sum of:
;;~ PAGE TW.O.~, ';~ dollars ($ ).
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Inllt KY'uuj'~ : 'I -:.... . :onsldered delln. , Authorized
que ""'~t~ " '. ' >wnet 1Ig1ftS 10 SIgnature
pay 1J.. for collection . Note:ThI& proposaJ ~ 30
ofrl , Jthef ....1I8IY
lllll\ (j,)u..y>\-t.. d.~' !. t)~n.~~ ~18lICe. withdrawn by us if nOt accepted .
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specifications
~c-., Ie aut"or~zed SignatulA
~ve.
J Signature
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'. FROM' : MILBAR
FAX NO. :3525674454
Nov. 08 2004 09:44AM P5
Page No.
2 of 2
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Member of the FlOrida
Roonng and Sheet .....,
Association
U~S.lntac Certified
Plellnum Installer
.s204
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Jrnpnsal'
Pages
'MilSar 'Construction, Inc.
RoOfing · Concrete · Commerdlll · Reelclentllll
15911 US Hwy. 301. North · Dade City, Florida 33523 <:>
352/567-6047'. 800/562';2393 · FAX: 3521567~54
State Certified
Bulldllr tCBC023221
Stele Certified
Roofer tCCC051562
, ' State Registered
Roofer IRCOOSl215
ReI R8gletered
Roof Consubnt 10148
PAOPOSAL SUBMITTED TO
KNOWLE5, JOHN
STREET
4923 17TH STREET,
CITY. STATE and ZIP cooe
ZEPHYRHILLS, FL 33542
ARCHITECT
PHONe
ORE
WfJ heroby submit spoclrlcations and eslimalea'tor.
11. "ilBar ConBtruction~. Inc. to provideS-year warranty on work~nBhip~ e~cluBion8;
.' ,.-... -.. stor.-'dalllaQ'e;-'-fli1r'k-'dO~e-'Or-danrgr1fy'-i)'t!n!flf, tt'ee da.li'!f~; andlor sl:r"ucturar-dillage--'-"
to roof deck.
813/788-4980
JOB NAME
KNOWLES RESIDENCE
JOBLOCATION Il00RES ADDITION
4923 17TH STREET
10/05/04 '
"
JOB PHONE
ZEPHYRHILLS, FL
...--.--......-........."........w......u........__.______.._......._.........
12. Owner to provide access to roof fo~ delivery ~~uck for loading/unloadingfor roo!1ng
',C"-" "'--"-'~'liia''[er'ial's~''''''---'-''---''-'''''''''---
i 3~" '-' "ilBiir"'Constructi'on;--lnc;"'~o"'provicre-GiPnirirLr8liITH.y-aiiOYorlcer ' s 'Co'iipe'nsiitfon
Insurance ($2,000,0001i.it) and re~roofing permit., .
14. OPTIONS
......._.. ..._._._.w_.._....w~....,.~.........w___.___v._.....,......._...._-._._
_..._-........;..-......
-------.....---.
a) Shinale Up-Grade. Provide and ins~811 new TA"KO 'Heritage 30 AR' 30-year
., " .u---'-----.--l'aiiil'ii8{eiI Cfiiiensional alg8@::res1S{anr?:l:berglass-alITiigles in l1eu-o'rT'KIlKO
_.." ._,.__~.Q,...._._ 'E~i tI~;'~'Il.:.~s Seal. ..~~.~e;~~;:t8b fib:rgl~h~,ngles. .~bingl~_~_~ 30-
~ year ;1," ."eCl warran"y ;1;1'011 u.
ADD 8598.11 to the contract price.
,---_ ...................__w_......_... ........... . ''-''_ ..........____,.,.. _._..__.
, ,
. ....,.......... .._..._--_..__....".....~.-"'----........._--.---_........_-----......
....,---..-..-....... ....,....,._--_.~--...............
.... :.
....,..,.. ---.--..--. ............".......--.--..-......
.... ..... '...,'..~."...- .._.. ._-... ..."........."-w....._._-....-,...........,~._____v............
.........._-_...........-....-__......---~-_...-.........__......__._--
~t .JIropaS2 hereby to furnish mater~aJ and labor -complete in accordance with ~ specifications, for the ,sum of:
, _n_';' - -n----UoJ/ar$ ($ --.S, 879~ 94 ).
"
Im/oic;lId IIIllOUIllS not paid In acCoftIance with Ihe payment 181'lNl Ghell be consldefecl delln.
quenl and bear InteleSl al th8 rate 01 one and 0fl8-ha1l percent per mon1tl. Owner agr... 10
pay all coats ir1C\llred. SUCh BSa1Iorney I..s. collector 1888, coun cOsts. 811:.. for c;ollection
of dellnquenl inwk;es Including Inleresl. OWner to carry lire. lDmado and olller necessary
insurance. Our WOlkeI$ are fully ca..ered by WorIcmen's ,~i1eallon Insurance.
Authorized
, Signature
, Note:Tttjs,proposal maybe
withdrawn by us if not accepI8d wllhin
30
days.
'.
/" ~cattbrna nf arnpltSat:~ ~ ab0v8 ~~&. epecificaUons
and c~';Jltk;~s are S8trSarctOry and hereby aceepte.d.Vou are authorized
to do the work as specified, Payment will be made, as outlined above,
~ .Date of Acceptance:
"" '
Sigriatur
r~-: MfU:lH~
-- l-""RX' NO.' : .:5~~~b (44~4
Nov. ~~ ~~~4 ~.:5:~.:5~M ~1
NOTICE OJ? COMMENCEMENT
MCI f/~
1111111111111111111I111111111111111111111111111111111111111I
2004208442 ,
PemJit No.
Parcel to/FOLIO fllL.)-a.le-~}--Cf)JO- (')DLJDO .-DOtbD
, .
State of Florioa
County of Pasc..O
THE UNDERSIGNED hCTCb:r.:'give notice that the''-irnprovcment will
',: . ",:1 H
be made to certain real property in acco~dance with Olapter 713. Florida
Statues, the folJowing iuformation is provided in this notice of
conullenccmCI1t.
Rcpl : 829327 Rec; 10.00
DS: 0.00 IT: 0.00
11/08/04 ____,__ __.. Dpt.y Cle..k
JED PITT"AN, PASCO COUNTY CLERt
11/08/04 09:51am ' 1 Jf ~
OR BK 6099 PG j, 9~ 1
./
~ .,"
I
l.Dcscriplion ~f prope;ty (/#:811I description of property and address if available) 4 q ~ 3 i 1-t,t) S+ .
Section 14 . '1'0\011151110;;) ~ . RanQe ;;;; [ , . Z-e p h Y '-hI:L.l~ . PL-
2.Gcneral description or improvcmcnts ' L~B54-&-
3.0wner infonnation
a)Name and ~,ddress John \<ODlo\f~ '44a3 1'1 -I:b 8+.
b)lnlcrcst ill property Du...)() p~ 2.e-ph\.,rh{"Ll..S. FL- .33540.-
c)Namc and address of fccsimplc titleholder (if other llIen oWllcr)
4.Contractor(1l3Iile and addrcss) , nn.RAR COHSTRUCTIQtI~. INC.
15911 u.s. 301, DADE CITY, FL 33523
5.Surety
a)Name andaddrcss
b)Amowll of bond
6.Lcndcr (name and address)
,,'
7,Person within tlle Slate of Florida desigllale~ by owner.,upon who notices or other documents may be s~rved as
provided by Sectioll713.I3(l)(a)(7), Florida Statues. .
Name ~nd' address
8.In addition to hin'\ or herself, owncr dl?;;ignates
of to receive a copy of tlle Lienor's Notice as provided in Section
713.1 3(1)(b), Florida Statues.
9.EJlpiratiolJ date of notice of coimncncemcnt
rrom lhe datc of recording uulcss a diffcreilt date is specified).
(lhe expiration date is olle year
I
STATE OF FLORIDA
COUNTY P.r:':'1>~~'~'."::< '.
',j. . - .. ,.:.~
CMNER 's SI~A1t1RE
PlUNTED NAME & 'm'LE
..
v.
The ~olIoWin~ jjlstrum~li.l w'~~ :ackJl~wJc~ged before me lhis~day of ,l)d'"
~1O IS ~{S~ ~.JIy know {o:.JJlC or \v'hO"pt~duccd
...' ... ~~'-. - '-- .." ,,:..::....: '. :~,. '.'\.. . .
After rccordfilg,r~hlruto: Norary Si2Jlature
Name Mil ~8 Cul'JST5UCTION.INC. Name(print)
Address 15911.u.S; 301 ~~, Tille or rank
City O~d~.CIt~, FL33~~~__ lR Serial numb
,~,by~
as identification.
tJb~HA1~~
"-' OLIVIA A LOVETT
cr, jf ~ I \l';:::'1l' EXNEs JUly '.- 951
28 2llNl
NOTICE Oli' COMMENCEMENT
MCI #~'6
11"1111111\ nlll 11111 11111 \111\ nlll \1111 11111 11111 \\1\ 111\
2004208442
Pcrmit No. 35(, ~ ~
Parccl I.O/FOLIO # /L} -a&-,;( J -()OJ 0.- ()()L/ 00 .- DO tb 0
State of I"lorida
County of P05o..O
THE UNDERSIGNED herebY1 givt? notice that the':iInprovemcnt will
be made to ccrtain rcal property'in accordahce with Chapter 713, Florida
Stalues, thc following illfofll1ation is providcd in this notice of
conUlJcnccmclIl.
Rc;pt:829327
os: 0. 00
11/08/04 -
Rec: 10.00
IT: 0. 00
__ Dpty Clerk
JEO PIllMAN, PASCO COUNTY CLERK
11/08/04 09:51am 1 if ~
OR BK 6099 PG 9~ 1
./
I
I.Description of propc~ty (legal description of property and address if available) 4 C} ~ 3 i ltb S+ '
section ) Y . Township ~ Co . Ranqe g ( Ze phyrj-1f=Li~ . Pi.-
2.Gcncral dcscriptioll of improvcmcnts ' 3354-;)"
3.0wllcr informa\ioll
a)Name and address John KnDlu\t':C, Lj...Q93 I 'l-tb 8+-.
b)l.ntcrest in property DL00 P ./'i2-e ph\!,...-h ;~ US. F L.- 335'-((7-.
c)Namc and addrcss of fee simple titlcholdcr (if other then oWI)er)
4.Contractor (namc and addrcss) I1IL.HAR CONSTRUCTION.' INC.
15911 U.S. 301, DADE CITY, FL 33523
5.Surety
a)Name and address
b)Amount of bond
6.Lcndcr (namc allll address)
7.Person within the State of Florida designate~ by owner,upon who notices or other documents may be served as
provided by Section 713, I 3( 1 )(a)(7), Florida Statues. '
Namc and address
8.1n addition to hin-J or herself, owner de~ignates
of to receive a copy of the Lienor's Notice as providcd in Section
713.13(1 )(b), Florida Statues.
9.Expiration dale of notice of commencement
rrom the date of recording unless a diffcrent date is specified).
(the expiration datc is onc ycar
I
STATE OF FLORIDA
COUNTY or i>A.~~
CMNER 's SIGNA'lURE
PlUN'l'ED NAME & 'l'I'l'LE
.a.t".
The follo-.ying instrument was acknowledged before me this~day of
~tsnnally know to lIIe or who produced
l)d,
,
, 2O\lL, by~'no'\ kMJJ~, Jc.
as identification.
NQtary Si2Jlaturc
Name(print)
Tille or rank
Scrialnumbcr, if' I
()/J~JI#~
After recordi1lg, return to:
Name MILBAR C0W:i"H'\UGTION,INC.
Address 15911 U.S. 301
Cily Dade City, FL 33523
OLIVIA A LOVETT
7951
EXPIRES JULY 28 2
w INSUCANCe COMI'ANY