HomeMy WebLinkAbout05-3812
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
3812
ermit Number: 3812 Issued: 2/02/2005
Permit Type: GENERAL BUILDING PERMIT
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: NOT APPLICABLE
Sq. Feet: Est. Value:
Cost: 12,600.00 Total Fees:
Amount Paid: 183.94 Date Paid:
Address: 5904 FO EST LN
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: FOREST VILLAS
Parcel Number:
Name: W D CONSTRUCTI N
Addr: 39134 KENDELL DR
ZEPHYRHILLS, FL 33542
Phone: Lie: RR0017052
Work Desc: ROOM ADDITION 12 X 12
HENRY OTIS
5904 FOREST LN
ZEPHYRHILLS, FL. 33542
Phone:
F
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.
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.
tx'~ AI( .~-~
CONTRACT~S~SIGNATURE PERM~
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021 ) ;:2 <7~"'\ -
DATE RECE IVED - C> --d6
PHONE CONTACT
FOR iP.AOOD'PeflMIT SI;RVICF
'1 -866-824-7894
Toll Free
PHONE
OWNER'S NAME
Ilu.rJ Polls
t1 S- 901f
,c~/'~J"f U/Je-
LEGAL DESCRIPTION: LOT(S) IS BLOCK
PARCEL ID # f() -tJ..{, -cU- 0//0- 000<>>- O/SO
JOB ADDRESS
SUBDIVISION. Fdr-NI- j/i/llb/
(OBTAIN FROM PROPERTY TAX NO\ICEl
o SIGN
y{ADDITION
o MOVE
oALTERATION
o REPAIR
o INSTALL
WORK PROPSED: oNEW CONSTRUCTION
o DEMOLISH
PROPOSED USE: []SGL FAMILY DWELLING
[]COMMERCIAL
[]MULTI-FAMILY
[] INDUSTRIAL
0# OF UNITS
[] SWIMMING POOL
[] MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK
I~ ]( /.).
room tLrL/J I-JO~
SQUARE FOOTAGE /'II./p
HEIGHT
BUILDING SIZE
ItL y:/~
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
& (1) SET ENERGY FORMS.
FORMS.
PERMITS REQUESTED
/'-12, )"c
~\ ~~
, l Co,
I, ~l/
f'7LvG,
~c.
IlrtJ% o.f
f'/J. BUILDING
~ ELECTRICAL
[] PLUMBING
[] MECHANICAL
$
/J.IJOO.oO
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
[] Progress Energy []
W.R.
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: [] BLOCK
[] FRAME
o STEEL
[] OTHER
1f 3<6f?-
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAo YES 0 NO
BUILDER
COMPANY
tL1{)JtI
UlMk ~ .j i()/J
SIGNATURE
vlu.t!u, ~C
STATE CERT OR REGIST #
******************************************************************
STATE CERT OR REGIST #
~ees ~;;] ech,~c:.-r...t ~((.
It{ 401
ELECTRICIAN
SIGNATURE ~\}~\~ ~
COMPANY
******************************************************************
PLUMBER
COMPANY
SIGNATURE
"v/4
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
N/A-
STATE CERT OR REGIST #
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
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 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 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".
, A~ <&A
SIGNA1rURE: OWNER OR AGENT
/
STATE OF FLORI~
COUNTY OF ~~~~
The foregoing in~t ument was
Before m this 0
by
__ ~m of person acknowledged)
~ho is personally known to me, or
. J:~~ ~
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this :2..L~ '
by -
(na of person acknowledged)
~_i-e-...personallY known to me, or
-------j
7---- a.....i/:. ?
knowledged _
'-- , 2005
and WI10"1:ljid
Y
-..-,. '- ,~-
Signature of
of identification)
take an o~h
owho has produced
(type of identification)
an~_ ...nOOdI'?J'x;rdidtL~ an .oath../
", ._."__~d~ - ~/J?t'M(d/
Signature of person taking acknowledgement
person taking acknowledgment
""II", . Ia
oi>>> Bobble Swat nd
Nar4' Q~d'1:C~~~~ DA2r687~t~~d
~" . "'<J uary 22;2008
...r,iiF.j~'Cf-oo BONDfD THRU TROY FAIN INSURANCE. INe
Name
typ~,~?~, printed or stamped
/if. - Bobbie Swetland
~. ; J MY COMMISSION # 00268763 EXPIRES
oi;f,'... February 2~ 2008
,.9f"fli. BONOm THRu TROY FAIN INSURANa. INC.
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 600c-Dl Residential Umited Applications Prescriptive Method C CENTRAL 4 5 6
Small AdditIons, RenOVllllona &: Building Syalems
Con1iln:e. Mehld C ~ ChapIer 6 ollie Fkrida EneIgy E\licieIq Code IlIly bede.......dledlrtlhe use 01 Foon ~11cr addtionsollmSQl8l8Iee1 cr less, sire- irsIaIed ~ 0I111lD1acl1Bl11llnes. ani
1llI1OV86ons1o' 11III residen:es. AIIemaIiVlImelhodsan! . kraddtions use~FoonlDJ8.Ol orlm\'()l.
PROJECT NAME: BUILDER: W
AND ADDRESS: PERMRTING 0 0 0
OFFICE: ZONE: 4 5 6
o 5 PERMlTNO.CLIII:IIIJ URISOICnONNO.: [I]]:IJ]
SMAI1ADD1T1ONS TOEllISTING (tDlSqulll8Ieel or less oIcmilkr1ed area):. ~ ~ il Tables liC-l,&:-2 anlliC-3 apply only 10 Ihe~ oIlhe 8IkIion. nallo lhe existiIg bIiIding.
Spa healing. cooIi1g. and water heaIiY,J lllMJmIInIeIlDen:y levelS IlIISI be met only when ecPPnei1lis iISl8IIed spedIi:aIy 10 _lie adlilion or is being i1sIaIedilcor1tn:fioo wiIllhe adlHoo constucIion. Con1JonenIs
separalinglJ1CllldlkJnedspeces from ooncIIonedspeces II1ISlmeel the jJesailed rriniTUn inlUaIcnlewls. REtlJVAlIOOS (~bItivlll1llergoiJg IllIlOViIICIls aJ5li1g 1IDlI1IIII:MII oIl1eassessedvakJeollhe
bIti1Ol. ~ reQiementS iI Tables liC-1 ani &:-2 apply my 10 lheQlll1lOlB'llS ani eQIipalen\ being Il!lIMlIed or 1l!IBed. MANUFACTURED IQIES AND 8UILDlNGS. Only siIe-i1slaIIed ~ anllealUleS
81800vered by Ihis lam. 8UllDING SYSTEMS ConWwhenClOll1lleie newS)'Slemis iIllaIed. PI_sei Print CK
1. Renovation, Addition, New System or Manufactur't!d Home
2. Single family, detached or Multifamily attached
3. If Multifamily-No. of units covered by this submission
4. Conditioned floor area (sq. ft.)
5. Predominant eave overhang (ft;)
6. Glass area and type:
a. Clear glass
b. Tint, film or solar screen
7. Percentage of glass to floor area
8. Floor type and insulation:
a. Slab-on-grade (R-value)
b. Wood, raised (R-value)
c. Wood, common (R-v.alue)
d. Concrete, raised (R-value)
e. Concrete, common (R-value)
1J. Wall type and insulation:
a. Exterior.
1. Masonry (Insulation R-value)
2. Wood frame (Insulation R-value)
b. Adjacent:
1. Masonry (Insulation R-value)
2. Wood frame (Insulation R-value)
c. Marriage Walls of Multiple Units. (YesINo)
10. Ceiling type and insulation:
a. Under attic (Insulation R-value)
b. Single assembly (Insulation R-value)
11. Cooling system.
(Types: central. room unit, package terminal A.C., gas, existing, none)
12. Heating system*: (Types: heal pump, elee. slrip, nalural gas, LP. gas,
gas h.p., room or PTAC, exisling, none)
13. Air Distribution System.:
a. Backflow damper or single package systems. (Yes/No)
b. Ducts on marriage walls adequately sealed. (Yes/No)
14. Hot water system:
(Types: elee., natural gas, other. existing, none)
· Pertains to manufactured homes with site installed components.
1. ~
2. si ~I e.-
3.
4. {c.J.Lf $~
5. I' :.
Single Pane Double Pane
6a. ~O- . sq. ft. sq. ft.
6b. sq. ft. sq. ft.
7. ,d.7 %
Sa. R= tJ/A (;)..11')" Un. ft.
.
8b. R= sq. ft.
Sc. R= sq. ft.
.
8d. R= sq. ft.
8e. R= ,sq. ft.
9a-1 R= sq. ft.
9a-2 R= If ~CZg sq. ft.
9b-1 R= sq. ft.
9b-2 R= II q(p sq. ft.
9c
lOa. R= (~ I t.fLf sq. ft.
10b. R= sq. ft.
11. Type:
SEER/EER: _~
12. Type: /
. . HS~F/rAFUEF
13a. ________
::~'~.. .
E~
FLORIDA BUILDING CODE - BUILDING
13.203
MINIMUM INSULATION
.COMPONENT INSULATION . INSTALLED
CQIlcrete Block R-5
CI) Frame, 2' x 4' R-l1 1<-11
...!
...! Frame, 2' x 6' R-19
c( Common. Frame R-11
~
Common, Masonry R-3
Under AWe R-30
CI) Single Assembly; Enclosed
(!J
z ,. Frame R'19
:J MeIaI Pans R,l;3 R. -( '3
W Single Assembly; Open R'10
0
Common, Frame ,R-l1
CI) SJab-on-grade No Minimum -
a: Raised Wood R-ll
~ Railijld Concrete R-5
u. Common. Frame R-ll
g In unconditioned space R-6 .-
0 In conditioned space No minimum ,/'"
Climate Zones 4 5 6
TABlE6C-1: PRESCRIPTIVEREQUlREIIENTS FORSMAU. ADomoNS (8llO Sq. FL lIId LesI~ RENOVATIONS TO EXIS11NG BUILDINGS AND SlTE-lNSTAI.LED COMPONENTS OF MANUFACrURED HOMES.
MINIMUM INSTALLED
EfFICIENCY EF.FICIENCY
SEER SeER -
SEER
EER
AS -2' P
Maximum
EQUIPMENT
Central AJC - SpIil
-Single Pkg.
unitorPTAC
C)
z
~
:r
w
~
0.;
U)
=
=
=
.;1.
1'-.87 0', .78 ~ 1"- .78 3', .87 2'. .78 4".87 3'-.78
0'-.75 1': :75 . 0", .61 2' , .75 1'- .61 3', .75 2'0.61
l' - .57 0", .44 2'-.57 1'- .44
0".39 1'-.39 0'-.35
Get certified SHGC from the manufacturer or use defaults: Single clear SHGC = .87, double clear SHGC = .78, and single tint SHGC = .75.
SECTION
606.1
606.1
806.1
606.1
606.1
606.1
CHECK
V
v
V
Combustion
HeaUn
Waler Heaters
606.1
612.1
Swimming
Pools. S
Hot Water Pi
Sho_ Heads
HVAC Duct
Construction,
Insula n . Installation
HVAC Controls
612.1
612.1
612.1
610.1
-
607.1
GENERAl DIRECTIOOS:
1. On Table6C-1 iIdcaIe lie R-vaIue oIlhe ilsUalionbeing added 10 each~ ani theelicien:y IlMlls oItle ~tbeing IlSIaIIed. f.J R-valuesand elicienl:ies inslaled IIIISlmeelor exteed lie ninIlIunvakJes Iisled.
~anlecMmRneiherbeingaddednorrenovaled IIIIY belelt.....
2. AIlDITICHl MY. DeIemine lhepen:enlage 01 new glass toall1liloned bl'llreailliell!lllionas klIIows. TolaIlhe llII!llS 01 at glass wiOOows, sting glass dous anlglassmpnls. IlcUlIe lie lIell 01 alrm-verticaI roo!
glass anlUllto lie peviIls IolaI. WIlen glass il~exIeriorwals isbeiJ.lllll1lll'l!dor en:bIedllflieadlilian. i118111Ol1l\ ecpd 10 Ihe klIIII areaolllisglass maybeun:red Inlm Ihe klIaIglass8l8lL DNiIe lheQJSled
glassllellklllllllflieanllclledllolrllellollllladdlln ~Ilf 1OIItogetliepllltlllll. FiIIIlllllllges\glasspeR:lll1lllgell1derwlichyarcaWaledpen;enlllgelalsOll TaIil6C-2. ~lI8jjvenllflielypeolglass
(5i1gIBor DoItiepane) nlie 0VllIblIIJ.I (ail paieiI wWJ a sdar hear galncoellk:ienl (SHGC). Fa ajjven glass Iype and ~ tle mnun_ heal galnmefDBnlalowed isspeciied. AcUI glass wixkMs and dlOIS
lJllViousIYinlheell/llliJrwalsoll1ehouseanlbei1gnilslalledinlhe lKIdiIonOOnclhaveloc:oopywilhl1eovedBnganlsolarhea1l1aiu:oeli:ientIllqlilllmenlsOll Table6C-2. f.Jnewglass inlleacUlonllUilmeellhereqOOlmenl
1or0000ol111 qlIilIIS i1l11g1ass peR:llI1IlIgecaIeiPY you indk:aIBd. 1I1eowed1Bng (Ol) dstIn:8 isll1l!8Slllld ~ NIl IJe liaollheglass lllaplillcirdttRllrlhe~ edgaol tle 0I'llIharv.
3. RENCWATKHiCJU.llBpIlmnenlglassneeds III meetllllldlrJllqftllPlen8llS. Any_lypeanl sdIlrhealgBllcoel&:ienlmaybeused Iorglass areas llhicharellller atleastatWoloolOillll1lq andTotlose lowest edge
00es not extend ....lhiII81eet tern lie 0Wllhang. ~ lIIll8S beilg nmvatild lhat oo....Ineet IIis aIeria IIIlSlbe eiI1er sifVe1lane Ii1led, cbJlIe.pane clear or doOOIe-pane IiIled.
4. IIUIlDlNG SYSTEMS. COI\1llY when new system is insIIlIsd lor system inslaIIed.
5. ~ lheillcmBlion recplSled on Ihe klp hall 01 page 1.
6. Read"MlninullRllqti'emelD lor SrnaI1dililIBand~, TaIil6C-3. and c:heck aI ~ iIIlms.
7. Read, sign and dale the "OwnerfAgenr' Cl!IIiPtion slalemenl on page 1. ' .
13.204 FLORIDA BUILDING CODE - BUILDING
ROOM ADDITION
I I 3" COMPOSITE PANEL ROOF I I
B B
1
12'
~
BACK ELEV III TION
r
7'
1-
L
E3 B -
-
-
-
-
0 -
-
-
-
T
8'
1
-I
12'
SIDE aev A TION
~~
EB~
, ~~
~l
l..G ~ j
",-, ::::: .....
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~ li: ~.~
C'\v:>~l..(
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EXClL
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WOOD FRAME ROOM
ADDITION
Pt., :....- -~g
-."- - ~.;::: ~;;J -. . }1
..,'.". Ii.... ,~.:-:-~;:-:-'
f'U'lC':N . 0 .PT APrr.'....~!J, .' ~
EXISTING HOUSE
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WINDO\N UN~T FOR HEAT &
NC
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3'4 5'4 ----~- 3'4
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ELECTRICAL PLAN S~L CtMf\'f' wrr\4- l}..(/'-'
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1111111111111111111I111111I111111111111111111I11111111111111
2005020592
FlortdlL
NOTICE OF COMMENCEMENT
County of
P(iI[(!O
State of
THE trnoERSIGNED hereby gives notice that improvement will be made to c~rtain
real property, and in accordance with Chapter 713, Florida Statutes, the
following infor~ation is provided in this Notice of Commencement:
1. Oescr iptioll of Property: Parcel No. Id- 6l(p -02/- oj/a - 00000- O/S'O
S 9~tf For~oJl- UI-t
(Legal descrlptlon of the property an street a
General Description of Improvement IlL ~ /,}.... a...clJi-l-/di7
2 .
Rcpl: 852107
OS: 0.00
02/02/05
Rec: 10.00
IT: 0.00
Dpty Clerk
3 .
O\mcr Information: Name J.kA./'{j ;:;0#..[
.J
llddress S-90</ ,cor~f ~ City ~4i'kllr
StateFl. 3.JSYcL
Interest in Property:
Name of Fee Simple Titleholder:
(If other th~n owner)
JEO PITTMAN~ PASCO COUNTY CLERK
02/02/05 0.J : l~m 1 of 1
OR BK 621'10 PG 1865
Address
City
State
4 .
Contractor: N.:lme (;...Jmcl u/JJ.Jru.el-l()~
Address /~/I t/-S .f/tv! dO/ City 1Jd.-6. ~
StateR. J.3S"o1S-
5. Surct y: N.:lrne
Address
City
State
Amount of Bond: $
6. Lender: Name
Address
City
State
7 .
Persons within the State of Florida designated by Owner
notices or o~her documents may be served as provided
713.13(1)(<1)(7), f'lorida Statutes:
upon whcm
by Section
tJc";mc
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of the
Lienor's Notlce as provided 1n Section 713.13(1) (b), Florida Statutes.
'). r-Xpirtl1 J.'Jn d~te of tlut..ice of Commencement (the expiration date is 1 year
fr~m the d.:lte of recording unless a different date is specified.)
~~ c? 'y~
5ig~ature of Owner: . ~ .~ ., / ~ Ld
Sworn to and subscrlbedb~~ore me thls dl4'fh...day of
20 tJS- . ,";~ "'g"\S: '"
::::~:" :l~:~:C ;:~;lr?s}~:;f~-
~
~
,
~'" S
,~~o:..'.':fJ""" ,,' tl~aHl1t Bahl
2*:'~'~~ CommIssion #DDI5713'
=~. () :*- Pvpi . ::.r .
~?'. -.s--'" . r~f. .8'~ 15, 28tle~
"~OF.i.O.>' Bonded Thru
1/!11\\ 4./.
rt anClc Bonding Co., Inc.
PC93053048/ A