HomeMy WebLinkAbout05-3825
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
3825
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
3825
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 38421 12TH AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
4,166.94
2/08/2005
55.00
55.00
2/08/2005
RE-ROOF
Name: WILLIAM CIMORELLI
Address: 38421 12TH AVE
ZEPHYRHILLS, FL. 33542
Phone:
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 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.
~WiI~ ~-.
CO NT TOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
APPLICATION FOR PERMIT
CITY 01' ZEPHYRHILLS
BUIIDINGDEPAR'l'HENT
MCI 27}q D
DATE RECEIVED
PLANS REVIEH FEE
. ~';
OWNER'S NAME r~i m tJV" p U,i ..; LO~ \1\ (\\11
JOB ADDRESS 3 B4 ~ \ \ &-B:l A"-Jelvu....e...
LEGAL DESCRIPTION: LOT(S) \ \" \~ ~cl \6 BLOCK.3 to
PARCEL ID ## \ \ - ~ to J 02 \ - D()\ Cl - D3 (oti:) - G\ \l-\
PHONE B 13}l1 ~ - Olotn;;).
Il:)u..::. r) ,of . ' , i i
SUBDIVISION U .r'\hu rhA: \ l.s
--r \
(OBTAIN FROM PROPERTY TAX NOTICEI
WORK PROPSED: [JNEW, CONSTRUCTION
[J SIGN
USE:~L FAMILY DWELLING
,~
[J COMMERCIAL
[JADDITION
[JALTERATION
[J DEMOLISH
o REPAIR
o INSTALL
[J MOVE
(:ROOFING) '\
PROPOSED
OMUL'rI-FAMILY
o INDUSTRIAL
0## OF UNITS
. 0 SWIMMING POOL
[J MOBILE HOME
[J OTHER
DESCRIPTION OF WORK
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
,~'-Y\ 1'9\ e..
C4Jd + ILL4-- -Be --' R~M . ~\ l~
,~1c, J \11 -+ I ('I SOl s --.) r\.\ <V:) S
SQUARE FOOTAGE_~ HEIGH'l'
PLANS & (2) SETS OF BUILDING PLANS & (1) SE~ ENERGY FORMS.
OF BUILDING PLANS & (1) SET ENERGY FORMS.
REQUIRED FOR ALL NEW CONSTRUCTION.
BUILDING SIZE
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLO'I'
ATTACH (3) SET~
PROPERTY SURVEY
PERMITS REQUESTED
[J BUILDING
o ELECTRICAL
o PLUMBING
o MECHANICAL $
::J GAS ]a ROOFING 0 SPECIALTY
$ 4., \\.01..0 qy
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o FLORIDA POWER
[J W.R.E.C.
VALUA'l'ION OF MECHANCIAL INSTALLATION
[] OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
[] FRAME i
o STEEL
o OTHER
..
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES 0 NO',
, '
1:-'
BUILDER
COMPANY
STATE CER1' OR REGIST ## I I.
CI'l'Y PROCESSING ft
.(
SIGNATURE
1 ~,I,
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ELECTRICIAN
'COMPANY
STATE CERT OR REGIST ##
CITY PROCESSING ##
SIGNATURE
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PLUMBER
SIGNATURE
COMPANY
STATE CERT OR REGIST II
CITY PROCESSING It
. " . I.
**********~****************~*************~******************~*****
COMPAN~
STATE CERT OR REGIST It
CITY PROCESSING ##
MECHANICAL
SIGNATURE
.
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;
SIGNATURE
~~~
COMPANY MILBAR CONSTRUcrION, INC.
STA'l'E CERT OR REGIST #-CCC 051562
CITY PROCESSING ft 21'8 J ,;,
OTHER
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CONVl.'l'lONS OJ:' P:~Pl11::: A.':'l:'1..'HW ~:::
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that thisp~rmit 11la~' bl! subJ eet 1~0 "deed restrictions" which
may be m~re restrictive ,than City regulations. Th,! ulld':!lrsi.)ned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSDnLn'IES
If the owner has hired a contractor or contractor::! to under'take work, they may be requir~,d
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and cl:>ntractor may be cited for a misderp.eanor
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, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions oftpe "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 ~icensed and is
not entitled to permitting privileges in the City of Zephyrhills.,
C. TRANSPORTA~ION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCT..uION LIEN LA\'{ (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 Protecti~n GuideH prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone, other that the, "ownerH, I cerify that I
have obtained a copy of the above' described document and promise in good faith to deliver
it to the "ownerH 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. ..1
certify that no ~ork 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 regu;Lations 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, Sep~ic 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.H, it is
understood that a drainage plan~ddressing a "compensating volumeH will be submitted which
is prepared by a professional en9ineer registered in the State of Florida prior to permit
issuance. ,. '
A permit issued shall be constru~~ 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 fForn thereafter requiring a.-
correction of errors in plans, constr~9tion, or violations'of~nY'code. Every per~t
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 ~andoned for,,, a:
period of six months after the "time the work is commenced. One 90 slay extension of time-n "
may be allowed for the permit with f~e charge of $15.00. The exte~si~n 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 PROPERny. IF YOU INTEND TO OBTAIN FINANCING,~CONSV~~\
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO OT NEED TO RECORD ~p POST A "NOTICE OF COMMENCEMEN'l"'. ,>
SIGNATQT~ ~ ABLA
,.
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was ack~owledged
Before me this _ day of " 19_
by DAVID R. ~RT J\
(name of person acknowledged)
~who is personally known to me; or
PASCO
STATE OF FLORIDA
COUNTY OF PASCO
The tore going .instrument ,was acknowledged
Before me this.___~ay of , ~9 -:.,... .',
by DAVID R:-ABLA
(name of person acknowledged)
~ho is personally known to me, or
and whoD did
of ideritificati~n)
t ke i!.n Oath.
o who has produced
(type of identificatiq~)
and who Odid ~id not tflke an oath
.
Signat
,ledg~ment
Signat
ledgment
Name t
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i ~PAOM-w. !3U8MITTEDTO
!: ~I'lORELl..:t, WILLIAM
:~.E'"
" 51.31 HALSTEAD LANE
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" ell..., STA1'E ;1fYf Z,P cot'~
:1 Z~HYRHILLS, FL 33541
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Nc.1€: Till,; pr'JpOSi!!! may be .1\C1
witlvawn by us if not Ilc(;e, "",.MhIn. W ""~:,:!
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of dl!li~~..,""llnvoieu irK~udlng Inlllrtll':l. Ow~er D ')i"Y '1'11, lomSllO and ott~,. neC'O!sa',
in$uranC9. Our ""0001"5 .r~ 1~lly o:.vergd b)' Wol1<,nlln'll C-<:rT'.pc~lioc Inaul'8/'lOO,
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8131779~l()662
J O!I NAI\olE
(UMORELLI PROPElTY
JOe LOCATION
38421 12TH AVENUE
I DATE
10/05/04
Inlol:'!lOlld ~II~ ro(Jl paid In acC'O'tiant't:' witl', ,~.~ ::>!ym.nl tt'rn,~ ~~a" b. llCl'Il!id...'~(j dOli'"
qU!nt ar'(J ~ear l1tcrl!Slllf 1~. 1>118 vI 0110 01'<1 ".....""., po'oenllo't' ",on1l\, O,~, O!l'CO' 10
IllIY all Cllsla Incurroo, Su<:I1l1t ,!IQrn.y fUS, &llfeIO' .\!l8, cu.w! (1)$'9, &10" for 'oll!le~t)"l
<1f deinQvel11ln'fUices in<;llXllng inle.eal, OWl>er 10 oarry '''e. IO'''''do .,,<1 011\8' ,_.....ry
In8LQnce, Our WOt1<o/'S are fully CO'fe'ed Oy WO,lme/l'c C="T1pens~'i()n In&U,.nce.
A~norj%8d w~~ ~ t:/A~'
Slgnllturll____ ~
Note: Tnis proposal may be '30
wiltld,awn tv us ;1 t\O ilOCQr.tod wi1hi1'l
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)\tupimn:c of Jl ttlp.o9aI - The st:o>'e prices, $PElClflcatiOll'
(fnd condition~ are sllti5~a~tory and h.,.::by a':cept~LI, You are authorl~et;1
to (:0 'h8 wcr~ as 6pflclfied, Payment wi'l blil m. .1do al ~\llli:'l~d aoou.
'/ .. I ~ - (};.{
Date of Arr;eptance: I I 11' ~
Signature
Signature
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ROOfIng anti ~Ill!'et
Association
ul.r O~3221
Sun. ~J1'flecl
Roofer ICCC051502
State RegIStered
R()Ofter IRCOO"215
RCI R8git..-od
Roof Cons""tant 1\10140
U.S, 'nteo Certified
P~inum Installer
.s204
M II Bar Construction, Inc.
R:>ot.n~ . Conerillo' Con"'e'ci,. ~ RUlder,!.
15911 US Hwy, 301 North. Dad.. City, Florida 33523 <:::>
352/567.6047 · 8001582.2393 . FAX: 352/567-4454
i\,Crpuhutce of 'ropO'sal-- The above priclt5, llptClllcallOn!
and concfu;~n! are sst'sfactory l'Ind har~oy aCCEli'~e<::, Ye,) ..rll luthorized
to Clo tt',e wor\( as specified. ~a;JT'~~' WIII/~.:fade a, \J1l'!"l",j above,
Dm.. ot Acceptance' _ '
,...::c:....- - ,(I /!I,
I ./.' '/'
Sig'lah1rloJ_.k: -~ I.~ '
ZEPHYRHILLS, Fl.
l~HONE
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MilDsr Construct.ion, 11)(:;. to pl'o\'1dQ 5~y.ar warranty on workmanship; @x- Ii
"cluB10rlai'-'-it:or'ii'dnll'age, 'WGrlCor '" dama~lP done 'by Qthe'rs~'-h",...'d.lri.ge~-"!in'i:O'or .,-,...._...~,
structural d8mag~ lo roof deck. )1
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SignallJ'/! -.-------
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lit lho-pClilt hereby to furnls/" materiel and labor - complete in accortk,n;:e with above speCifications. 70r tM sum of: '
SEE PAG~ THREE. 011'
I ~$"IIO De "'lid' ea 10110"<$: Cl U r~ ($ ) : i
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SHINGLE RND FLRT RE-ROOF'
~1ill!.OLE ROPl'.llfJ~
Tear oft .nd haul <l1l'ay the e:<iesting ol'l~-l5lYE?r ~hingll? reefing ;;:}'liJte~; cli;?~n up
work area daily.
2.
Provide- and"j,tlgtlHl t.wo la'ylPt'5. ot: n~lI 15 lb.~1tJiolt:is:tiid;fiPl+;paplir; ,..
PrrJvide-and in~tQll[je-'" TAlU<C1ft€lile GlalUl-Sl:I<al' AR"'2S:';year'3''' tab a1gia.";r!'~istalj't
fib~rglaa9 ~h1ngl~s; Ownwr ~o select $hingl. color from TAMKO'~ standard
colors. Shin91.$hav~ a 25-y~arli"d.t.ed warranty :!:rolll'T.AftKO.
3.
4.
Repl:ilCii dl dilinag~Cl fhlilihings (valley, vent,' or ariywl!lllflaeihingL
5.
PI"ovlde arid'in~tal.r new lead boots for thiiplulTlbiY\g v...nts.
6.
Providf.? and i fIstall new pre': firiiithed a1 umJ. nU1lI ~8ve:drip "( whi.t~' or br own),
7.
Remove the ho (2) Il'lda'lin9turbil'lli!' venta; plyvood"oy'er" openings; pr'ovide and
cut~in ~0 .:I.. f. of r,.lf pU.-tir,H:hed l!lultir:urn .;:L::lQ@ vent.
a.
Td I.JdLT :';0 "00;:: ('1 ','atJ
2'tH~2'OO8L~18
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:)tH-.u l':lnO-'! tfj
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'm 1 Page No. 2 01 3 ."page~
- 1.1;1 r opn sa ----=-~-:'--:=--Stllt~-certl1le~'
BuIlder #CBC0232:11
it. Cartlfled
Flc..ofer ..CCC06166.:l
9tate Regislerfll
Rooter "~C0055215
RCI Registered
Roof Consuft.n' 41014lJ
. .._.
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Member of the FlorIda
Roofing and Shm:t Melal
AssociatIon
MiI~!! .2,,~4Ol~!tr,!l~!l~J!l) new
15911 us Hwy.301 North. Dade C;~i, ~Iorkla 33523 <:::>
352/~67-6047 · 800/562-2393 · FA){: 352/567-4454
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U.S. 'nlel;: C....tifiltli
Il'llItinum Installer
#5204
I .ROPct,",L 'S('~""""Et' TO
OHON i
alJI77~-0E;62
,.lOB NAMf
.L.0/0~/04
:~sr~ORELLJ, WILLIAn
i ' S~~EET
I, 5139 f!AL5"l"!;:AD LANE
, ,-D:.y-ST~T!! MIl Z1,. CODE
I ZEPHY~HILLS, F"L :3:3541
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SIXORELLI ~ROP~RTV
,JOB lOO,"TQ/o<
OAU: OF p~",,,S
3B421 12TH AVENUE
ZEPHYRHrL.ie~, FL
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:: .lit' larnpo-sl! hereby to furnish matensl and labor - complete in acooroance with above sp9Ciflcatlons, for the S'.Jm of:
: ~.EUAG.!L.TIiB.E~ tioIlA'll (S ), :
, : F';1Vm<lnt '0 bit "'Mt U fOttcwe:
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f1.n ROOFj.JRL1.2I1' -2.Jd' -9-) U
Roof ar~e c;l.1rrefltlYhal'lSh1n~1~ roofing one 1:12ro61' p:!,\:i:in.---FTorida lh..il.H'n!f CodfPs'" ..:;
requirfP flat rOQ,fing mete-riels on roof ar~as with l't.~~ t.h;;m 2:12 roo'! pitch. I:
Thei'f?fore, to 1)1;1' ;i.'l'icomplianc~ yj:thcuffe'l'ltFlar:LdaB\l:i.ldioqCodes. we are q\l'ot:in; " ...,
fl~t roo~in9 system. . ~
Teer off and dispose of the old otle--layo'(, l"'ocfing sy~t,elD.
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Prou1d~ ~nd n@chanically fasten II Firestone MB fiherglass base sheet over the
plywooc:l C1eckpriox- to ":.he' il\stallation of th...nlr',..',n::onli!'''i:oonrig' "~Mhrmri~~'
3~
?rovide and install a nenl" f'1ri'lStone 'APP'lS0 white- gran..l.-eur.{ace roo!in9
mi"mbrane which :160 Q torch-app11e-d tul1~r::adher9d llodiiiQd bit.umen 't"oo1. gystem that
is heal vl?lded at. th(,!,,~..I'Il. to forn: one lil}H~et; and ofi.i-s a' Firestone' e 12-y~ar-
"r1od1fipd Bit. UmQtJ !':Ii'n!br ane Limi ted F'rtlduct ~"l'rar.ty..
4.
All Metal lirad concrete s\.ldac.es will be i't"~\'lI~ with IIn aspha~t bOls:rtp!"imer prior
to installation bt trieFireston& roofing rn.~b~ane;
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Prcvid~ afld install n...", :ole. gauge- gaivani:o:...d TIle.t.3.l. eavedr1p a:cQund t.he
p",rilll.tllPl" of lhlo' 1'1;)(11 as needed.
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~IERA~ COKDITIORS
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l'oUp.n or darna~.::i ".c;JCJdd17c~, !illiCh, tr.,~m,. e~c:, ..rll>p.l~.c.lIIent .o,r re..l'l.,~i1illg ,of.
~);i l!tl ng -rool. deck will be cOllplet.d on Q cost - pl \13 bai::ls Olbove and b.yond
I.:or;tract pr.i?I?
(() I
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Ir,,",j""'l ~ry'ml'1!~ n(~ p;l.i1lln /l':'('C"U.1Ge witt. ft"',. PlOY'''''''! I~~'~ ah31 b" oM&;<I'3!'ed <Mllir. .out"lO 'IZed
t.;:'n')'1I1I"f"l.
-
Jrapusal
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M~bt!r /)f th. Florida
Roofing and Sheet Metal
Assoc:llIltion
MilBar Construction, Inc.
Rooting. ConcrcII8 . Commeroal . Reslclentlal
15911 US Hwy. 301 North. Dede City Florida 33623 Oc
352/567-6047 · 800/562-2393 · FAX: 352/567-4454
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State certified
aullder .cBC023221
SlaM COMI11ed
Roofer ICCCO$16Gll
sa.te Rvgi8tored
Flooter fRCOO$6215
RCI Registered
RGaf Consuhant '0149
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U.S.'nltK: Certifitld
P1l1t1num Inslaller
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!L S!nORELLI. WILLIAn
! i ST'lEET
I; 5139 HALSTEAD LANE:
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i I CITY, ST"TE ...., i:JP CODE
i: ZE?HYRHIL.LS, FL 33541
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: 1 AIllCH'"TECT
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PHONE
el;3177~-0e:;ti2
Joe NAAlE
lOATE lQ/cilG/ra",
SI~ORELLr PROpeRTY
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t1ilrllrnptH5t hereby to furnish material and labor - compiete in accordanc9 ~jth above speOifloations. for the cum of: ' i
1'HR~i rHOUSAN? S.EVEN HUNDRED NINETY SIX AND 94/100 - -- - - - _u_ n__ --<<>narlli ($ 3,79(..94 ). 'ii!
~1JMItf'''etJ~ON. :/
~08 LOCATlOIl
38421 12TH AVENUE
ZEfHYRHILLS. FL
L=
I O~T~ ~~ ~~N$
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! ~W~ "ereby sutnllt s.pecK'tcaions and e~trm.t.. for: ....
1'\' 2. Own~~ to provide acctL"1!J1!J f~r de'live'ry tr-ucks to alloy roof loadi.ng/unlDading
, ~or theent1r. roof arpa.
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~"t ...,d beIlr "18TM1 at 'M fl'''' Qr 01'''' ll,'" ()fW).""" '*'C...., per mon1h. Ownor o~~ lO
PJ'/ ~! CQ~t~ j''''..,IIM. ~UO" ~ lIl10rney t..s, colloelor loc~, court COSte. 110" tor cOIl.cllon
d d4lltflClue"t invoieltS i~lu"i"O 1"'~rMt OWner 10 carry 11111 1OI'naao and olt19r nv<;1.~~",ry
''''SU'~r'Ce, Our WOrktt'1l1r8 1UI1y co_ad by Wor~rnan's CQrrQe"-NltlOf'1lnsurance.
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SIgnature
Note; This proposa'l'l'lO\I tx1
IIIfthdrswn by us 11 not aCCEll:ll8d Within
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a?ld conditions are satisfactory and I1er9lly accepted, You are autt>orized Signal'JTe
'0 do the w9rk 8S specilied. Payment w,lI be made 'l$ OUlli~Qd ~bovG:.
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NOTICE Ol? COMMENCEMENT
MeI H 3~L?j 0
Pemlit No.
Parcel I.O/FOLIO H
~
f t - I).. ~ .. J j ~,oo 10 ....63lo()D ..... (> fI 0
1111111111111111I1111I1111111111111111111111111111111111111I
2004224514
State of Florida
County of
Pftsc, i.J
Rcpt: 835597 Rec: 10.00
OS: 0.00 IT: 0.00
12/03/04 ___.____ Dpty Clerk
JEO pi~TMAN PASCO'COUNTY CLERK
12/03/04 10: 17am 1 1of171 6
OR BK 6133 PG
THE UNDERSIGNED J~ereby,lgive' notice that thc':'improvement will
be madc to certain real property "in' a~~ord~hce with Chapter 713, Florida
Statues. the following information is provided in this notice of
conUllcncemcnl. ':
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3.0wner information n I
a)Namc and address /I/O- K e ffl-,O:.c . " S"i3q lIa/stead I-Af'Je
b)lnlerest in property 0 t"-'l1 e..r
c)Name and address of fee simple titleholder (if other then owner)
335"'( /
4.Contractor (name and address) MIl.BAR CONSTRUCTION~' INC.
15911 U.S. 301, DADE CITY, FL 33523
;j<!
5.Surety
a)Name and address
b)Amounl of bond
G.Lender (name and address)
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7.Person within Ule.Slale of Florida designated by owner"upon who nolices or other documents may be served as
)fOvided by Section 713.13( 1 )(a)(7). Florida Statues. .
Name and address ;
Un addition to him or herself. owner dcs:gnates
)f to receive a copy of tlle Licnor's Notice as providcd in Section
, 13.13(1 )(b), Florida Statues.
'.Expiration date of notice of commcncemcnt
'om thc date of recording unless a differcnt date is specified).
(the expiration date is one year
.1
iTATE OF FLORIDA
:OUNTY OFP-AS- c;: 6
'he following instrumcnt was acknowlcdged be~
vito is personally !uIO\V,~)}O IIIC or,wllO.prod
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(~tfY1d r-t//( f"jW ner
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"l c r, ~,by L,J',) 77 /' C,' .!,'J (//. " ;J/
)~ iV~' '~"aS idefltifreatiun;------
_ ame(print)
I;!~ it Ie or rank ,
· crialnumber, if any fj /J I')., lit
~ftcr recording, return. to:' '. , '
~ame ~"'.1\ MILBAR C0I'~STRUCTION.INC.
~cldress ;':ro!'~ 15911 U.S. 301
:ity ~..;. Dade City, FL 33523
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