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HomeMy WebLinkAbout04-3601 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT SINGLE FAMILY RESIDENTIAL 3601 Permit Number: 3601 Permit Type: ALUMINUM Class of Work: ALUMINUM PACKAGE Proposed Use: MOBILE HOME SUBDIVISION Sq. Feet: Est. Value: Cost: 21,872.15 Total Fees: 245.00 Amount Paid: 245.00 Date Paid: 11/17/200 Address: 37506 LILLY BEA AVE ZEPHYRHILLS, FL. Township: Range: Lot(s): 156 Block: Section: Book: Page: Subdivision: GRAND HORIZONS Parcel Number: 34-25-21-0010-02800-0156 Name: B & H NSTRU I N OF CENTRAL FL. Addr: 11494 SEDATE ST. BROOKSVILLE, FL. 34614 Phone: 813782-1064 Lic: Work Desc: SHED & CARPORT GRAND HORIZON 37506 LILLY BEA AVE ZEPHYRHILLS, FL. 33542 Phone: FRAME ELECTRICAL ROUGH 1 ST ROUGH PLUMB FINAL REINSPECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when inspection called (d) Work not ready for inspection when called (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." NO OCCUPANCY BEFORE C.O. ~j]< ~ _ft-~ CONTRACTORS SIGNATURE PERM~ CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DZPARTMENT 5335 8~ Street, Zephyrhil18, FL 33542 813-78P-0020 VAX:813-780-0021 DATE RECZ IWD PLANS REVIEW FEE JOB ADDRESS C;rzt4JVtJ '37 SoCc i-/-{l/l ( ?{l/ll fiJI/I , Lf LL y' 1564 PHONE 6'"/"5- 7,r2~/cr;0L( OWNER'S NAME 1- Or I S&' LEGAL DESCRIPTION: LOT (S) BLOCK SUBDIVISIONG,t2AVC lIt'fZ( 2$ /lJ/f(/ PARCEL ID # 34-'2c; -- 2( -00/0- fJZf'flC:;O/5((,(OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: otNEw CONSTRUCTION o SIGN PROPOSED USE: ~L FAMILY DWELLING o COMMERCIAL @1\DDITION o MOVE oALTERATION o DEMOLISH o REPAIR Irl'1NSTALL OMULTI,-FAMILY o INDUSTRIAL 0, OF UNITS o SWIMMING POOL o MOBILE HOME ~HER 4LLI"t I fv!U ;41.. DESCRIPTION OF WORK ROVAL BUILDING SIZE SQUARE FOOTAGE (Z-Z'-{ HEIGHT RESIDENTIAL: ATTACH (2) PLOT COMMERCIAL: .ATTACH (3) SETS PROPERTY SURVEY ~ILDING ijYELECTRICAL o PLUMBING o MECHANICAL $ PERMITS RBQUESTED :;? I J' 72 ' / .5" VALUATION OF TOTAL CONSTRUCTION PLANS &, (2) SETS OF BUILDING PLANS~. (1) SET ENERGY FORMS. OF BUILDING PLANS & (1) SET ENERGY RMS. 0, . REQUIRED FOR ALL NEW CONSTRUCTION. '2-/~. cO f-xj)(;.. J "- '35'. u'-' Au2L. $ AMP SERVICE o FLORIDA POWER o W. R. E. C. l1vil{2i- SI-Ir:/J /-~--~ VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALTY 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 .1 ..:':::.:,..:,:1.:)"., ' \....-. , .., . , .' " I,: " "C~~~AN~J? {' 1-1 (ON. )7rZJ L r J ~ of CEtvnlJ4'- STATE CERT OR REGIST , ~f/{ 0 ':> 1 '1<fz- ,CITY PROCESSING' ~~ BUILDER ~L. SIGNATURE ~~l~, ~ ****************************************************************** SIGNATURE ~ II, M~ COMPANY f)C-(~ ~LE (, T(Ll c. STATE CERT OR REGIST # CITY PROCESSING * '~'7 ELECTRICIAN ****************************************************************** '-. PLUMBER COMPANY STATE CERT OR REGIST # CITY PROCESSING * SIGNATURE ****************************************************************** MECHANICAL COMPANY STATE CERT OR REGIST # CITY 'PROCESSING * SIGNATURE ***************************************************************** OTHER COMPANY STATE CERT OR REGIST * CITY PROCESSING * SIGNATURE ***************************************************************** - - .. - -- - - '"'...... '-' .... -................. ..... "" .... J,."I~ \I oJ. .. A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to ~deed 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 intende~ work, they are advised to contact the City of Zephyrhills Building Department, 813-788-6611. 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 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 c~mm8ncement. 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 agencitts iz:tclude but aren9t: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 unle...tne, wprk autho.J:i~ed by .uch permit is commenced within six months of issuance, or if wO.J:k autno'r!&ed, by <tbe 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 logg~d during each six month period, or the project will be considered ~bandoned. 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". I J:1df-# 13 --d (/ SIGNATURE: ~? RACTOR STATE OF FLORIDA B'Ll ~ or COUNTY OF _~'~L C The foregoing instrument was acknowledged Before me this '7-- day of ,~v/L- 'r , 20J2!f by ?1212 G if 6'7Jji? . ~name of person acknowledged) IBWho is personally known to me; or o who has produced ~ype of identification) and whoD did ~d not take an oath. ~ ----Rv<R A, rltl--eP Signature of person taking acknowledgement i3rz-uC (= A. As/? r; L- Name typed, printed or stamped ~J' Bruce A Asbel ,~ .; MyCommissionDD116710 o,~'" Expires June 22. 2006 STATE OF FLORIDA f)/) c( c COUNTY OF f r:t ..;" The foregoing instrument wa~ckno~le~e~U BefOre..)Ae this ?ii/ay of ~ ) L-'f, ~ by cOREe;; !?E~_ " (name of person acknowledged) ~ is personally known to me, or o who has produced ~e of identification) and who Ddid [Bftd not take an oath A. ~ person taking acknowledgment rs [2 UCf 1-1. If ~ (},::: t- Name typed, D,l.~nted or stamped ~"., Bruce A Asbel ;..~ .; My Commission DD116710 V; 0,,..'" Expi~s June 22. 2006 ~tKR Signature of City of Zephyrhills Construction Requirements Survey markers shall be exposed for inspection of required minimum building setbacks. Termite treatment is required with final treatment sticker being posted at water heater or electrical panel. Minimum 6" separation from finish grade to wood frame walls/siding required for slab on grade construction. ALL WORK S . PREy HALL O.h\kL Y WlTH ALL AlLlNa CODES FLORID CODE. NA nONAL ELEf""M-.' A BUlLDINC CITY 0 ,-uuCCODEMTT F ZEPHYRHI'-.LS ORDINANC[c-' '....1.\..... '.l..I' ....v~.\. ~ L..'....'...; ..'_''''~'''>J 1:)<<0 \,v 1'1 I) J.1'\.V\'" l.LV J. 'I US: '-"L:4'" &.L'V"U.t A' &./. ~,,-- 402SMORlUS BRIDGE ROAD .... ~E ESTIMATES ZEPHYRHlILS, FL. 33543 LiC*'lse6 · Bon'" · t,,1IWIId · $ld"lnl · St._ ., 1loorft Addition. · lumiftUll'l · Conc:rete WA~ f,i,RI?>>~ Lor J 5'~ Subdi.,idion J 7. SOfa ~ l'r IiRJ LAp Sidil'tl Co\<< uJ ~ ~ ooQ..> :r o.c. e \, S~ Horne Serial M HomeMcdeJM~ C! L. 3- V~}j'/.\VJ . BalD Color All ahriinum r~ iAcoMk ,... Tra.. QuBw, ~ . spouts.Jx.3 Po<<s. 11I4 $h. PIMIUq. 2d.Pan511..f11a1..i'.f~~ Ptx 3.39. l.U' '. _P.m_Ft ~Sq Pt x ).)9. 3.U _PUU_" l..on&..-Scl Pt x 3.39. 3.U _Pans_FtLonL-~Pt)( ,.,,-,." ~ Val~--.--. ..2IL-l/fx"046 ~ Gutter on HOIU.-~.- ~1A x .uo Gable s.JII Work Oft FrClllI Loed- 1....12 2x4 SM 8eam..------- ..17.J" X 3.1.5 2x6 SM e.m--- /II> 1JP:II; $.34 1x1 SM 8tant ~. /l'-.tAx '.If 2xS SM BeIm - JA II 1.54 2x9 SM Bam--- ~IA. ....~1l"~. 71- 2lt I 0 SM B.am------- ~ X 1 I." SCREEN ROOM WALLS L~ KP _. _ + _... _. -.JJPx2l..M 'SaClCft Door lI'I~I~: Claw WId Thtahoki Uf X M.JI G.b~ Fill on~ S~--==lJFx lS.IO lnS\lI.(ed Kick Pt.~ IJP:II; 'M FVl Beun (nol ...;f'fIlf)-- -I!A II G.f2 UTILITY ROOM wALLS l/IIalul1. + ...&...1..i:..- + _ · ~ lln.9I 2x4 Srucb 16" DC ihed Ooclr UlO I WiD~ ~ 1If :llSl.OI >11\,1. Wind09 (Exn~ I SA X U.61 3\13 Shiefd - . 10 IA:II: $.02 ~isc: VINYL ROOM WALLS "'inyl Wall + + . · lAx50.34 R1.de Kick Plat;=-"'::- . - -lIP a '.12 A1' Top Insidund 0u1.~ _vr x 1'.10 :Iorida Olus------ lA ~ 10.01 nsuWe Tup and 8oIlCllD- ---rn x 5.39 :iOors indttdc (2) 2 Treck UDiU rhtcshold ..~ Clc.r !A J( 1....12 ~H ~U _ be ,.,..,ibJe for. n.b n VI1'IYt ROOMS X 7() , U e". .I).::L I~;r. ~.~ ~~ .ql. '077 "4 i.r/~. ()~ ~ f. ,~ ,~ J'l O.le GLASS R.ooM WALLS WaIJI.. + .. + · --JIl x ~"'-~JL~:' jl;LIq rt ;:J.to 0., 0.. 300.00 HlMJIWq JJ x 11.61 sr., JaIIiDt -IEA x 90.97 0..,.0. _x_iAx_ 0.,. Daat.....- _ll_~. A _ 0...,. Doar 0,..- _x_Ea A _ ~IC: ALUMI)ollJM Tor...L CONCRETE AND BNCK WORX PaDo Slo. J!Lx.J1:.....1J:!L $q fl I( 2.33 PIdo ." .!:k-aJ.L - JlZf..St4 Pr .. 2.33 PIIio SIU _~. _Sq Pt II 2.33 hdoSllll x - ;SqPtx .2.33 Side Walk- ~9' x~ ?JfSq Ph; 2.33 DriWft)' xJL.. - ~ R x 2.33 Driw\fty "'...Lx~ - ~Sq 't x 'J- ItaiMUIWty-_lltr ...!.-4"X j).93 ......... C. _a_. _$q f'1 Jl 1.$1 ....... -..do, e. --Jl_ - _Sq Ft " '.5] 0.''''''. -A-. LIf x 2.33 I.. tx12 ~4llIld -n..v' I( ".02 FoaW I2lU ..... ~1Jf J 6.00 ""'SidrdII ~ I: 2.19 J ThM _. _EA lit '17.23 1 ~.S1lIp _EA Jl IS4A6 3 n.d StGp ....u.. . 1.231.69 4~ SeD G' . _BA 1(240.12 Brk* iid.uaa MIiX 5 HIP SpIk...-IJr. IJf L.Counes x x 2.10 Splh 8rtc* $oIidaJJF AiCaun. x 2.33 Pm Dirt -'- LcIdt II .100.00 Pner.r m"'- .100.00 Mile: NO'M: AcalrdIDa to 1M FIa. Build;... Code ~ pNW......,.;II;, CONCREIE SIG ALUMINUM DATE .. -~; PliRMIT PAX TO 71U'U TAX PO~ ENOINDIUNO TOT Ai "t::.;,j v'" ~ 1.80~224-1206 6 -J't'~Of i9f.. .00 /~I , yo/ Yr~ o. f7 '11 " "/O_ J" t/2fS-;J.. 1/ f')'r 5'7 /,J.{~rj~ :J. 1iO, 00 J ~,y~ , :l :otJ ,/:. ~ ?",(JO "'... I /LJ ~t.:r, U'. -190/;2, ~? _'_00,00 . /bO,OO 1/.20'1..:l 9 f)~Ot 87 < ~OrOO dl J17:J. 1/)' AI' .................... ~ . .,_,.,. A ~c~., 'oS,.,..~ will..--.d 011" -....aid_..... ~ ~AOI "'TI "I'~'" ...........If--.y. e./1Cl. \ I ! -d ~,;r)ci::i W~v:Ol ~J~-S~-8 LEONARD G. "GEOFF" WOOD. P.E. 4034 THE FENW A Y MULBERRY, FLORIDA 33860 (863) 646-5517 Date: 6-25-04 B & H Construction Zephyrhills, Florida Re: Address 2005 Jacobsen 37506 Lilly Bea Ave Zephyrhills, Fl. Mod # CL3 46815 W Lot # 156 Dear Sirs, This letter is to certify that I have reviewed the above referenced structure to determine the structural adequacy of the existing structure to receive the attached structure. The proposed structure is roughly a 10xlS shed and a 18,08 Carport. The existing mobile home, has been considered and is adequate as a host structure, with the blocking and anchoring at 5' 4" Based upon review and acceptance of other structure to home per manufucturers requirements. As always, should you have any questions, please feel free to call me at any time. ~@d 4034 The Fenway Mulberry, Florida 33860 Date: 9-12-03 IV1 111& ;9' eMf ~ l""\ r- ~ :u: , ~ ~ "8 f~ ~ 5 . . u.. ti:. OOj "O~ ::a 8~"3 j~~ 75 'f - 110 /14 C= lYJo h / t: /,. I b8' I 5'8 jDO '. 0) - 9 64-$~iM'1f) / 'V LoT /S,t. ~Of;We I 10 Lt iLl' <: 3'750 d /f:;;,e /20;(,/ J C- RI'tI0 ?~Z:zI4? 71; ~y t-E 1,1 >~ r 'f r-- r-- n r-- .". :l:t; - I u..l 10 0- ~ U - 00 "8 >-, 1"'"'1 '-~ r- ~~ r- ;3 fi.{i: .. ~~ \1 '1.:., . r-- o. . """ - ~ej ~. tf\ J \ ~~ ~~ ~~ .-.-: . ~\f\ - ~ \.0 - ~ ,~ 1.0 ~~ " VJ ~ ~ - "'(a ~ i-- "' I- ~~ ? ~~J ...... ~ ~~ ----- ~ ~ ~ ...-- I~ ~ ~~ K ~ ..10-"'" \J ~ ,{;~ r~ ~ '-- ~ ~\~ \>0 I- Scf \J\ \t~ I .... I- ~ ~ .............. 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'/) ~;~ ,.j.)i .JO Ow ~~.. :s~;> Ii) ~ > g oJ 6~ ~ ~ ~ 5" 0 C v, d -( ~ 1 ;J 'J .. 3 \., '- \. $'3 M' ^ .LH 0 l!H '" '" ~i ~ OQ ~ Q ~ ~I ~ \)-... ~ 'b I ,~ ~ v ~ ~ ~ ~~ 'V) ~~ ~~~ ~ c { ~g~ ~ <r "< ~e 0 Leonard O. Wood PE 1147377 4034 Tho Fenway Mulberry, PI. 33860 ,. Z D I--t f- U =:) ~ f- VJ Z DVJ UQ ~ L<[ ::JH ZZ t---l<[ Lf- ::JV) ~ <[ ~ U ~ ~ . 8 ~ . ~ 01 I~ ~ ~ 00 pu I !=:~ ~~ r--:' - .": ~~~jJ~~ , == 1:" - ~ o~alt> 'g~~+ ~ .. . _ ,< 0 - + 8 ; !Iii - ~ I I~ ~ @tl<tl"'~-~- I~ ; ~~~~: ~ : - ~ lit: ,!11l iU;~'~~~ i 0 ~ . rill = ~ I . w . ~ .~~ f ~ ! ~UI ~ i: ~ 1 i~U h I: . "': i~d l!: ~ ..J ~ :. j i! z /; I ~ ~ :. i ~ I I ~ :. i :. ~ ~ o )C ~ ~ ~ <I: o -l w ! L o r-- b ~~ ." ~ Q I . . 0 'I i .._ N - - . . CI '" I I '0 '" - - LJ Z ~ Q::: W W Z I---t LJ Z W ~ . W ~ (/) ~ ~ :::: M -l <t I- W Q Z . ., 0 t; ~ ~ . (,) .., w )( Z I Z .., 0 (,) ~ · i ~ ." 0 i ~..: a.. ,.,. ~J-l i~ . e..... <t :-'" i ~ ! (,) ~i .' )( a.. g . ~~i ~ I~ ~ I~ ~ ~ <c\. ii~ Ii ~!~ ....... 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'......~S ~. ----- ~ " " ~ Jro _ --- " .. ~ - "" ~~ <, Po _ "" " ........ ~ ~ -- ~ t--- ~ " -........... ............... r--- -- .. r--- i-- <" 'A" ............. .- ............ ~ OSO :> " "'J'J. , -.......:::... 'J ~ ~ . ..J " -.......c.... t r--- CD ~ 0'>0' ---- - I r--- .- . N .- .... .- , - - ~ """"'- - r--- -?- fp " --.......... ~O.( r--- ':) '. 'I::- --- FORla"M~.rnn.. ~ ., ~ --- ---- _ IOIIa1 ~~ ~ ~ ~O,. ~ r--- r--- :::..~:::. '= -- - ~Jf7u ~~ " " . . CD CD CD CO t l / I I I I b CD Go Go I ~ ~:$t 7/1 CD CD " " (7) en .- fj UM TRIBUTARY WIDTHS or BEAMS u:r:JNAAD Go 'GaJf:F" ~ I E:r<<;MER I BEAMS AND CENTER BEAMS L--.I a. .".., ~L ... 7777 _ Tho r_,. SPAN CURVES - 130 MPH WIND VELOCITY ...-.". ~ - r....,...,.."'... CIU) ~ 7 _ eM>> er1-7DT3 24'-0 23'-0 22'-0 I-- I S221'-0 w I >< ~ 20'-0 .' . t o .' 19'-0 If) .... w 1--18'-0 o CD o ~ 17'-0 t t") X t t") 16'-0 o z Vl ~ 15'-0 Vl z ~ 314'-0 o u ~ 13'-0 w ~ w CD12'-0 Vl z 4( e, 11 '-0 ~ ~ ~ 10'-0 >< 4( ~ 9" -0' 8'-0' 7'-0" 6'-0" MAXIM EDGE BEAM ----- This space for use by Clerk of the Circuit Court only. \ c,. ~ "'e OF ... '. ", " rLOR/OA ':" C~uNT,( OF PASCO b~~:~ic~~~lr~~Vi!J,J:~~:.I~~ ~Afj,O AND OFFICIAL SEAL .THIS~I1JAY OF ..:t!:J9f jJ -tvt.l ~ J ~ 2 ~ JE9,~'TTMAN, CLERK OU/RC~OI 'AT . BY~AZJ.hL-. o..r~' ' , EPUTY CLERK I IUI\"\\I\\ "\11 UII\ '\'1' 11"1 1\"\ 1'1'1 I\nl 'II" \11\ 1"1 2004218153 . Rcpt.: 833400 os: 0.00 11/23/04 Ty CLERK PASCO COUN f 1 JEO Pl/~1rA~0: 17am 1 300 11/23 6120 PG OR BK Rec: 10.00 IT' 0 .00 . Dpty Oerk NO"(ICf; OF COMME~Cf;Mf;Nf State of Florida The underslQned hereby gives nollce that Improvements will be made to certain real property, and In accordance with Secllon 713.13 of the Florida Statutes, the following lliformallon Is provided In the NOTICE OF COMMENCEMENT. , . Legal Description of property (.treet address required): '7 ~O~ L-/ L- L l' V E ~ r ~- :I - 2-s - . 0 2- 2. General description of Improvements: flL-UWlI NU HL PlJ"c/(1l t;,' E 3a. Owner Name: (j'/f(( ~ I/o!!! Z otJ fr/ ~ . Owner Address: 'lFtI UoJ/E t>1}',' /IYI2II/Uf j:::.-L ( . ? J ~t.f I ~ 7{') ftJ I::) 3b. Owner's inlerestln site: 3c. Fee Simple Tille holder (of olher than owner) Address: 5. Surely Name: Amount ot bond: Address: Phone: 6. Lender Name: Contact: Address: Phone: 7. Person within the State of Florida dnlgnated. by owner upon whom notices or otlier documents may be served as provided.'by Section 7.13.13(1 )(a)7, Florida Statutes. Name: Add"..: Phone Number: B. In addition 10 hlmu/t, Owner designates the fallowing per.on to receIve I copy of the LIenor's NoUce as provided In Seclioh 7.13.13(1 )(b), Florida Statutes. . Name: Addre..: Phon. Number: 9. Expiration date of Nollce of Commencement (expiration date I, one (1) y,ar tr~m date of recording unless a different dale Is specified). STATE OF FLORIDA .,.. ,,/ " {llcHhlIJ L I jZrh/;}J2~Slgnature ofOwn.er date of !VtJV6/Vl.!J.E/C , 20ei.!/ by who (Is) (are) personally known 10 me or II IdentlnclUon, who did/did not take an oath. \ efore me this 2 3 p'Oduced Pft1.~/)h ,A--U Y IOv6t.A/ tv' (Driver'. License #) & ,HI rJJeP Signature. Notary Public ~..,P 3\. Bruce A AsOOf \.~ .: My Commission 00116710 C/f,..df Expires June 22. 2006 (A copy of any bond musl be allached allhe lime of recordation of Ihl. Nollce of Commencement)