HomeMy WebLinkAbout05-4633
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813}780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
4633
Permit Number: 4633 Issued: 7 72005
Permit Type: NEW SINGLE FAMILY DWELLING
Class of Work: 101-NEW CONST/SFR
Proposed Use: SINGLE FAMILY RESIDENTIAL
Sq. Feet: Est. Value:
Cost: 108,000.00 Total Fees: 7,897.48
Amount Paid: 7,897.48 Date Paid: 7/07/2005
Name: LENNA HOMES INC
Addr: 600 N WESTSHORE BLVD. STE 900
TAMPA,FL. 33609
Phone: Lic:
Work Desc: NEW SINGLE FAMILY DWELLING
Address: 7506 MERCHANTVILLE CIR
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: CRESTVIEW HILLS
Parcel Number: 35-25-21-0120-00000-0600
LENNAR HOM S INC
7506 MERCHANTVILLE CIR
ZEPHYRHILLS, FL. 33542
Phone:
M
WATER CONNECTION RESIDENl
SCHOOL IMPACT FEE - 97.5%
WATER METER RES 3/4"
PUBLIC SAFETY 5%
RADON
N
419.00 MECHANICAL FEE
1,651.65 TRAFFIC IMPACT FEE 1%
180.00 FIRE IMPACT FEE
26.35 PARK FEES SF
19.72
LEC
71.15 SCHOOL IMPACT FEE 2.5%
'15.88 TRAFFIC IMPACT FEE 99%
273.00 POLICE IMPACT FEE
769.56 BUILDING FEE
42.35
1,572.12
254.00
774.00
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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 ($35.00) shall be made for each trip for each trade:
(a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when
inspection called (d) Work not ready for inspection when called
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
NO OCCUPANCY BEFORE C.O.
SIGNATURE PERM.
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECEIVED
PHONE CONTACT FOR
PERMITTING ~l ~r 1'l~ ~ 2f3/'J
,,\1tu> L\ 0bL
PHONE g!3 ~ gg:z. - j-f&:?(k_~ jCi3,
iu, lie'( r 1-/J/'i/5, Jl(!;
JOB ADDRESS ,$OCn f'0.er%(\+'\J \ \ \e u i r Q (J
LEGAL DESCRIPTION: LOT(S)lI;D BLOCK-&- SUBDIVISION WJx.f-viuJ
PARCEL 10 # :;).f)- f}S-- 21-0 \2'0- o(lYt)-.6 ri.ocD' (OBTAIN FROM PROPERTY TAX NOTICEl
OWNER'S NAME
WORK PROPSED: I:ll NEW CONSTRUCTION
o ADDITION
OALTERATION
o REPAIR
o INSTALL
OSIGN
o MOVE
o DEMOLISH
PROPOSED USE: OOSGL FAMILY DWELLING
DCOMMERCIAL
OMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
DESCRIPTION OF WORK
BUILDING SIZE ~. Co x:.
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
l5i 0 S&
yo
UI7")((~_ ~~( /1r-
SQUARE FO TAGE _[9, d '
HEIGHT ___
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS,
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
~BUILDING
~ELECTRICAL
~PLUMBING
~MECHANICAL
o GAS ~OOFING
$
l [)<? } YLOD
dC()
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o
Progress Energy ~
W.R.E.C.
$
~\ , QCO, -
,
VALUATION OF MECHANCIAL INSTALLATION
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: ~BLOCK
FINISHED FLOOR ELEVATIONS
o FRAME
fd7.oo
o STEEL
o OTHER
IS PROJECT IN FLOOD ZONE AREAO YES
~O
BUILDER
COMPANY
/
Cl:3e i:JI/ (t:1&9j--
SIGNATURE
STATE CERT OR REGIST #
*****~*************************************************
SIGNATURE
. ~ 01
COMPANY Cc. InOfJ....Y;JYI......--
:).:>1
~ STATE CERT OR REGIST t 00/", lJ 'f
ELECTRICIAN
******************************************************************
PLUMBER
k ~ COMPANY Iiu;VkL+ . .
~ STATE CERT OR REGIST # CF~l!J Sf(/ &,/
SIGNATURE
SIGNATURE
******************************************~***~it;;********.****
r. COMPANY. ~ ') - /1)J:{) JO hu
U IX A Cb~ STATE CERT OR RF.GIST B CI1CtJ5t'/ A/ 10
MECHANICAL
SIGNATURE
*****************************************************************
I
~ - COMPANY C. 01-r/i {U1:t- ~t-
. : J..-l~ ,.1
! STATE CERT OR REGIST # .l1e/1 s /() /__
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OTHER
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 Buildiny Department, 813-780-0020.
Furthermore, if the owner has hired a contractor or contractors, he 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 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 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 IMPRO MENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER ~ A TTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALur nJ.1 A--'T'n RH'mm AND POST A "NOTICE OF COMMF.
SIGNATURE:
SIGNATURE: ~..-
STATE OF FLORIDA \J _~; li./- . /Jc~ hlVl /
COUNTY OF ~~2!~~t~
The foregoing inst.rumento;~acknOWledged~r--
~~fore me this .!!ind;f ~ ' 20_
.~ (name of person acknowl dged)
~ho is personally known to me, or
STATE OF FLORIDa'
COUNTY OF
The foregoing instrument was ack owl edged r
~~fore me thiofnnday k~ - , 2~
/ (name of person acknowledged)
~who is personally known to me, or
Dwho has produced
(type
did not
of identification)
take a oath.
Dwho has produced
(type of identification)
and who ~~id not tak;[11 oath
hj~q ~
Signature of person taking acknowledgment
Name
Name typed, printed or stamped
iP."'~ Kimberly Kay Daugelte
;.~ ; My Commission 00026617
'\-;,.....J' Expires Sepleil1ber 10. 2001>
in e 0 s amped
. My C0r.1rnIS~IOn DD026612
~;:- . ~
";"" or ",)'~ !:'(l.Jlf€S SeptetdOel lO '2-00b
--
PLOT, PLAN'
LOT 60
CRESTVIEW HILLS
PASCO COUNTY, FLORIDA.
, ,
PRELIMINARY DRAWING:
THIS PLAN IS FOR PERMITTING PURPOSES
ONL Y, NOT FOR CONSTRUCTION. VERIFY
ALL DIMENSIONS BEFORE ANY CONSTRUCTION.
SKETCH ONLY
NOT A BOUNDARY SURVEY
SEC. 35
,TWP. 25 S, RNG.
21 E.
BEARING BASIS:
NORTHERLY LOT LINE OF LOT 60 BEING N 89"16'10" E
N
THIS SURVEY IS SUBJECT TO ANY FACTS THAT
MAY BE DISCLOSED BY A FULL AND ACCURATE
TITLE SEARCH. ALSO SUBJECT TO SETBACKS,
EASEMENTS AND RESTRICTIONS OF RECORD.
LEGEND:
------ = PROPOSED DRAINAGE FLOW
(00.00) = PROPOSED GRADE
E-OO.OO = EXISTING GRADE
b
I')
UNDERGROUND FOOTER, STEM WALL, AND
UNDERGROUND UTILITIES ARE NOT LOCATED OR
SHOWN.
W
...J
<(
U
VI.
DO NOT SCALE THIS PRINT. DIMENSIONS AND
NOTES TAKE PREFERENCE.
DESCRIPTION NOT CONTAINING PLAT BOOK AND
PAGE INDICATES THAT PLAT IS IN
PRELIMINARY STAGE AND IS SUBJECT TO
CHANGE AND/OR REVISION.
CERTAIN DATA SHOWN HEREON BASED ON
ENGINEERING PLANS PROVIDED BY CLIENT.
· = 10' DRAINAGE & UTILITY EASEMENT
.. = 5' DRAINAGE EASEMENT
LOT 85
1/-2
oS
',9 89'16'10" 60.00'
v.) N E
**
,-- --I
1 b b 1
0 0
) 1 ci ci ,
I') I')
, 1
I ,
"0 I PATIO I
0 10.00' A/CO 10.00'
0 .ur Uj'u
40'-0"
I 1
LOT 61 ~ *' 1*
*1 PROPOSED PLAN ,*
0 1446 - ELEV "A"
LO ....
to I <D, GARAGE LEFT 1
I
'<t ~ 1
b I
0 ,
z 1
I I
) 10.00' 10.00'
uuuru "fu
, I
1- I~' .0 '0 I
0",/ :~- .l~--
. :0 ;0
~ * ~N ~N
'oS)
:>.
J
#r 86
'0'
~'V
~
o
o
o
w
LOT 59
o
LO
to
'<t
b
o
VJ
~
.,
~
,.
~'"
48.05'
.. --€>
~C(P)
W 80.00' .
.4
o.
o
---;;- ari :
-N
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. ..o-----::r--
.~-
- r
MERCHANlVlLLE CIRCLE
(50'R/W)
PROPOSED
LOWEST FLOOR ELEVATIONS:
LIVING AREA: 127.00'
GARAGE AREA:
ELEVA TIONS REFERENCED TO
NATIONAL GEODETIC VERTICAL
DATUM OF 1929. MEAN SEA
LEVEL= 00.00 FT.
DESCRIPTION:
LOT 60 MAP OR PLAT ENTITLED "CRES1VIEW HILLS", AS
RECORDED IN PLAT BOOK 53, PAGES 124 THROUGH 129,
THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA.
NOTES:
LOT GRADING TYPE = A
PROPOSED PAD ELEVATION = 126.50'
FRONT SET BACK = 20'
SIDE SET BACK = 7.5'
REAR SETBACK = 15'
OF
LOT =_6600.~SQ. FT.
LIVING AREA =-1~'1:2-_SQ. FT.
ENTRY =_-AL-SQ. FT.
GARAGE =-i1~L-SQ. FT.
COVERED LANAI =_J:!LL-SQ. FT.
PATIO =_120 SQ. FT.
POOL AREA = __k:!za=SQ. FT.
CONC. DRIVE 395 SQ. FT.
A/C & CONC PAD =_~SQ. FT.
SIDEWALK 35 SQ. FT.
SIDE YARD SWALE = 1100 SQ. FT.
CONSERVATION AREA =_!:!L~_SQ. FT.
LOT OCCUPIED =_~%
AREA TO IRRAGA TE =_~_%
APPARENT FLOOD HAZARD ZONE: Y' COMMUNiTY PANEL NO. 120230 0295 D EFFECTIVE DATE: 9/30/92
LEGEND:
(C)= CALCULATED DATA. (D}= DEED DATA, (M)= MEASURED DATA, {Pl= PLAT DATA, ~ = CENTERLINE, A/C= AIR CONDITIONER, B/C= BACK OF CURB, C/S=
CONCRETE SLAB, CH= CHORD, CHB= CHORD BEARING, CLF= CHAIN LINK FENCE, CONC= CONCRETE, COV.= COVERED. E/P= EDGE OF PAVEMENT, ESM'T= EASEMENT.
F/C= FENCE CORNER, FCM= FOUND CONCRETE MONUMENT, FIP= FOUND IRON PIPE. FIR= FOUND IRON ROD, FNaD= FOUND NAIL 6 DISK, FPP' FOUND PINCHED
PIPE, LFE= LOWEST FLOOR ELEVATION, MAS. = MASONRY, OR= OFFICIAL RECORD BOOK. PB= PLAT BOOK, PCP= PE~NENT CONTROL POINT, PRM= PERMANENT
REFERENCE MONUMENT. R(W= RIGHT OF WAY, R= RADIUS, SIR=SET 1/2" IRON ROD 6 CAP NQ. 4493, SN6D= SET NAIL 6 DISK, TBM= TEMPORARY BENCHMARK,
U/P= UTILITY POLE, W/F= WOOD FENCE. (Rl = RADIAL
O!~
WAY I "(
JOHN R. BEACH Be ASSOCIATES, INC.
SURVEYORS AND MAPPERS
911 WEST ST. PETERSBURG DRIVE
OLDSMAR, FLORIDA 34677
(813) 854-1276 FAX (813) 855-8370
Drawn By:
SMS
Square Feet:
6600.00 :I: LENNAR
Checked By:
JRB
Scale:
1"=30'
>~~
NOT VALID WITHOUT THE SIGNATURE AND Date: PLOT PLAN 6 5 05 BB
THE ORIGINAL RAISED SEAL OF A FLORIDA
LICENSED SURVEYOR AND MAPPER
Revisions:
2984
, .
Lennar Homes
7506 Merchantville Cir
SQ. FEET PRICE
MAIN OR LIVING: 1,972 $ 50.00
OTHER AREA UNDER ROOF: $ 50.00
OTHER: $ -
VALUATION $ 98,600.00
FEE SHEET $ 476.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 774.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 774.00
ELECTRICAL: $ 113.20
PLUMBING: $ 99.50 V-
MECHANICAL: $ 71.15
SUB-TOTAL $ 1,057.85:
Jf{ADON: ..s:: 19.1'_ f?
"TVI~L $ 1,O77.57~
SEWER: $
WATER: $
IRRIGATION: $
TOTAL: $
1,616.00
419.00
(/t(h ~ ~
2,035.00
180:0r
WATER METER:I $
IRRIGATION METER $
SUB-TOTAL $ 3,292.571
PARK IMPACT FEES I $ 769.56 V
PUBLIC SAFETY IMPACT FEES
POLICE $
FIRE $
5% $
SIF'S: $
97.5% $
2.5% $
TI F'S: $ 1,588.00
99% $ 1,572.12
1% $ 15.88
TOTAL: $ 7,S97.4SV
1IIIIIIIIIIIIIIIIIIIIIIIIIlllllllllllllllllllllllllllmllll
2005148539
Permit No.
Rcpt: 905576
DS: 0. 00
07/21/05
Rec: 10.00
IT : 0 . 00
Dpt.y Clerk
NOTICE OF COMMENCEMENT
For the County of Pasco in the State of Florida
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following infoTI11ation
is provided in this Notice of Commencement:
1. Description of Property: Parcel No.35/25/21- clze- oaOOO"O~OO
SEC:35 ,TWP:25 ,RGE:21 /Block', Lot: bO Crestview Hills as recorded in Plat
Book 53 ,Page 124 of the Public Records of Pasco County.
(Legal Description of property and street address if available)
2. General Description of Improvement: Single Family Residence Dwelling Unit
JED PITTMA~ ,JASCO COUNTY CLERK
~~~~062f87rn :G 1065
3. Owner Information: Lennar Homes, Inc.
Address: 600 N. Westshore Blvd, Suite #900 City: Tampa State: FL Zip: 33609
Interest in Property: Fee Simple
Name of Fee Simple Titleholder: Same
R4.
Contractor: Name Lennar Homes, Inc.
Address: 600 N . Westshore Blvd Suite #900 City: Tampa State: FL Zip: 33609
5. Surety: Name N/A
Address: N/ A
Amount of Bond: N/ A
6. Lender: Name N/A
Address: N/A
7. Persons within the state of Florida designated by Owner upon notices of other
documents may be served as provided by Section 713.13(1) (a) (7), Florida
Statues:
Name: Michael F. Southward
Address: 600 N. Westshore Blvd. Suite #900 City: Tampa State: FL Zip: 33609
8. In addition to himself, Owner designates
of
to receive a copy of the Lienor's Notice as provided
in Section 713.13 (1) (b), Florida Statues.
9. Expiration date of Notice of Comme e ent: (the expiration date is 1 year
from the date ofrecording.,un~s a . fere t date is specified.)
Signature of Owner:
Sworn to and. SUbScrib~::. rnef\is .Cl1 day of ~~
Notary PublIc: ~~ My Commission Expires:
,2005
.
~
105763
..-
.
PERFORMANCE BUSINESS PRODUCTS, INC. 813-719-8008 FAX 813-7111-79111
f!l
.
.
.
.
.
(;-~1')D
CITY OF ZEPHYRHILLS ':'
ZEPHYRHILLS, FLORIDA "
WATER ACCT. NO.
7/7/D~
I
DATE
OWNER/
RENTER
~rtar ~
v/d-eL ~r
750(.. ~4u/{{~Ct'r. I-orr;o
~R
o SEWER
MAILING
SERVICE ADDRESS
SHUT OFF SERVICE
o
TURN ON SERVICE
~
~
o GARBAGE
INSTALL METER
READ METER
o
~ITY
CHECK METER
o
o OUT CITY
--+- No. OF UNITS
OTHER
o
_ DEPOSIT AMOUNT
, (
_ AMOUNT LAST BILL
_ DATE
3~ II
-
0f);y ~
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form & return to office.
111111111111 I1IIIIIIIIIII1! 11111 1111I 111111111111111 1111 /III
2005148540
Rcpt: 905576
OS: 0.00
07/21/05
Rec: 10.00
IT : 0 . 00
Dpty Clerk
Permit No.
NOTICE OF COMMENCEMENT
For the County of Pasco in the State of Florida
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following infom1ation
is provided in this Notice of Commencement:
1. Description of Property: Parcel No.35/25/21 ~OI20- CXXXXJ-OfoJO
SEC:35 ,TWP:25 ,RGE:21 /Block:'\, Lot:vl Crestview Hills as recorded in Plat
Book 53 ,Page 124 of the Public Records of Pasco County.
(Legal Description of property and street address if available)
2. General Description of Improvement: Single Family Residence Dwelling Unit
JEO PITTMAN-i "ASCO COUNTY CLERK
~~~~064~tf7m ~G i066
3. Owner Information: Lennar Homes, Inc.
Address: 600 N. Westshore Blvd, Suite #900 City: Tampa State: FL Zip: 33609
Interest in Property: Fee Simple
Name of Fee Simple Titleholder: Same
R4
Contractor: Name Lennar Homes, Inc.
Address: 600 N . Westshore Blvd Suite #900 City: Tampa State: FL Zip: 33609
5.
Surety: Name N/A
Address: N/ A
Amount of Bond: N/A
6. Lender: Name N/A
Address: N/A
7. Persons within the state of Florida designated by Owner upon notices of other
documents maybe served as provided by Section 713.13(1) (a) (7), Florida
Statues:
Name: Michael F. Southward
Address: 600 N. Westshore Blvd. Suite #900 City: Tampa State: FL Zip: 33609
8. In addition to himself, Owner designates
of
to receive a copy of the Lienor's Notice as provided
in Section 713.13 (1) (b), Florida Statues.
9. Expiration date of Notice of Commen e t: (the expiration date is 1 year
from the date ofrecordlU~le . feren oate is specified.)
Signature of Owner: .L \.
Swam to and subscribed before me thisJ,q day of CjJ../K-R.- ,2005
Notary Publie: \Lwtl~ ~~y Commission Expires:____
.
.
~
.
105763
. .
.
WATER ACCT. NO.
OWNER/
RENTER
MAILING
SERVICE ADDRESS
SHUT OFF SERVICE
TURN ON SERVICE
INSTALL METER
READ METER
CHECK METER
OTHER
3~ II
.
.
.
.
.
PERFORMANCE BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813.719.7910
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
5-_ '1 cr '1;3
DATE
7h/IJS
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o SEWER
o GARBAGE
~ITY
o
o
o OUT CITY
o
+ No. OF UNITS
_ DEPOSIT AMOUNT
~~
- AMOUNT lAST Bill
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form & return to 0
JNTRACTOR "= 013375
(i ME:: L1::: j\!'f..j(:l F;: :: 8", C!::: ** (.") <) 1 ::.; :: :I. :::.~ :; 11 :: :I. 0 :: 09
ODR= 4902 EISENHOWER BLVD
/ST=" TAMPA FL 33634
G~NIKAL ~~KM11 11Nb
PASCO COUNTY. FLORIDA
UAI~: 1~/1~/05 TIME: 14=54
P (:d.:H:: :: :i. 0 F :i.
IS~:H.JE OFFICE:: N
RECEIPT NUMBR: 00888327
OFFICE: NEW PORT RICHEY
.J/-..::: BOL I D W[.":I~:;'rE FDF< :ZEPF<H I LI..S
CHECI::: *t 681 :.:.:;
CCNT
:1.:1.4
:1.:1.4
ONTRACTOR= 0:1.3375
TOT(.~t1oo. (.'~/>iClUNT::
COMPNY ACCOUNT CENTER
B450 - 363000 - 2
B450 - 363000 - 2
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