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Home My WebLink About05-5006 I I CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 RESIDENTIAL SWIMMING POOL 5006 Permit Number: 5006 Permit Type: SWIMMING POOL Class of Work: POOUNEW Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: 40,000.00 Date Issued: 10/11/2005 Total Fees: 437.50 Amount Paid: 437.50 Date Paid: 6/29/2006 Work Desc: SWIMMING POOL Address: 6309 IL VER OAKS DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: SILVER OAKS Parcel Number: MCCULLOU H,BRENDA 6309 SILVER OAKS DR ZEPHYRHILLS, FL. 33542 Phone: J B POOL ONTRACTING HAWKINS ELEC. SERVICE JTB POOL CONTRACTING MR.CONSTRUCTION BUILDING F E PLUMBING FEE ELECTRICAL FEE B~ILDING FEE ~-- b:n;Zt tfJ- 352.50 35.00 , 35.00 ( "1,15~/ <;)~-'iY-C /, /..J 'i o /- / c.. ./ . ~'7' / POOL ST EL POOL PLUMBING/PRESSURE_ REINSPEcnON FEES: Reinspection fi s will comply with Florida Statute 553.80 (2)(c) when extra inspection bips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not ~Osted on job site f) plans not at job site g) work not accessible. NOTICE: In additio.n to the requirements pf this permit, there may be additional restrictions applicable to this property that may be found in the public records of this ~ounty, and there may be additional permits required from other governmental entities such as water management, state !agencies or federal agencies. The payment of inspection fees shall be mbde before any further permits will be issued to the person owning same "Warning to owner: Your failure to $Ord a notice of commencement may result in your paying twice for improvements to your property. If y u intend to obtain financing, consult with your lender or an attorney before recording your notice of com ncement." CL CON &-. PERMIT OFFI SPECTION - 8 HOUR NOTICE REQUIRED OTECT CARD FROM WEATHER I I CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 RESIDENTIAL SWIMMING POOL 5006 Permit Number: 5006 Permit Type: SWIMMING POOL Class of Work: POOUNEW Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: 40,000.00 Date Issued: 10/11/2005 Total Fees: 422.50 Amount Paid: 422.50 Date Paid: 10/11/2005 Work Desc: SWIMMING POOL Address: 6309 SILVER OAKS DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: SILVER OAKS Parcel Number: Name: BRENDA MCCULLOUTH Address: 6309 SILVER OAKS DR ZEPHYRHILLS, FL. 33542 Phone: JTB P OL CONTRACTING HAWKINS ELEC. SERVICE JTB POOL CON1:RACTING ijEMINGIDN Al..UM1NUM INC --- BUILDING FEE PLUMBING FEE ELECTRICAL FEE ~-,. . DOL DECK & FOOTER FINAL REINSPECTlON FEES: When extra in ion 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 i spection when called (e) Permit not posted on job site (f) Plan not at job site (g) Work not accessible The payment of inspection fees shall be m de before any further permits will be issued to the person owning same "Warning to owner: Your failure to r cord a notice of commencement may result in your paying twice for improvements to your property. If y u intend to obtain financing, consult with your lender or an attorney before recording your notice of comm ncement." Complete Plans, Specifications and Fee Mu t Accompany Application. All work shall be performed in accordance lth City Codes and Ordinances CONTRACTOR ~M. CALL FOR I $PECTION - 8 HOUR NOTICE REQUIRED P OTECT CARD FROM WEATHER I I :. : "-rlJ.. ~ I , a-- () 0 ~ P.O_ Box 550 I t Zephyrhills, FL 33539-0550 813.782.0357 813-780.7803 FAX 1m PdoL CONmACllNG, INC C L tto E-6 ?ff .. , P l1 ~ bL AA(j-C~ ~ ~/ ~:/:F 550<.0- G30g ~~~ ~~ Wt~~~~ ~-rL~~~ ~ ~~.~_~~~~0. ~~- r1IA' ~. ';(5~ . ~ ~ y . . . . . . . . . . . ., . . . . . . . . AP!/28/2005/FR! 08:20 I I AM ZEPEYRHILLS BUILDING ?AX N0. 8\3-780-GUn CZT% O~ ZZPHYRBILLS PERMiT AP~L~CA~~f. SUILDmr.: bJ:PA:R~ !J33.5 B". at, !ephydli..lla, i'L 33542 . elJ-7fJo.\1020 "AX; 81:3-780'.0021 . . :::lA'l'li: Reel: IV11D r. UUlIUUI r /:ujor 7/tj 5' _ " PRONB ComAO'f lOR naMrTTnfO LEGAL i:>.ESCRIPTIVN! LCT (5) /ir::; ---- ~,J ~r).k -6i-l:-, 0 /~ A -IJ()(J()O- J./cJ.d SLaCK pao~~~ =:~=~CE . . . . ToI Ree SUBOIVISION . S'/Jbtr '11 ~ ~;, -I OWNP' 9 NNiE 8 r.e,....i4.. &S01. /!7, c.CtL//~A.' .. ,Sf !(,ltr (}~kif 1Jtt/~ .;J()Ji Jl.DD2ESS_ .~ . I:"lI>>.CIU.. 1D # _ '09T"~N lc~nM p~Op~~y '1'AX wn!l''r~.\ ~R~ P~OPBED: ~mw CbNST~UCtYON DSIGN !?ROJiloSlSD USE ~ ~SGL. 1!'~IIl.Y DWELLING Ll COMMERCIAL o ADDITION. C ALTERATION' D Al!:PAIR " o INSTALL q MeV ~ o DEHOLISa OMULT:r:-!'~ILY o INDUSTRIAL 0*, o~ UNITS DSWI~ING POOL o MOBILE aOME o oTHER. nln~ntnmTOf nr InftW , CJ ~:;'1'AURANT .& HEJU.'I:'R DJe.pAAT~N'l' .t\PPROVAL . J"q~' Me/ f ~,^-~i~" QESIDSNTIAL! llT'l'ACH (2) PLOT .PLANS 6 {21 .a~TS OF Br.JlL~ING !1'LAIiIS 1:.(1) SIlT 'E~GY FO~. CoMMtRCIAL 1 . ATTACH (:)) SETS or BrJl1DING E'LMS , (1) SJ!:'t ENE,G't I!'OIufs. IF SIGN PERHI':.' Ol~l.Y (2) SJiiTS OF EN(sINnR!)i:.lp!.JU~8 .Ri:Qt1IIt~D~ PROP&R1~ ~ORVEY REQOIRED ,OR ~L ,NEW CCNSTROCTIO . , aMI:' SERVICE D. Pr<)l;p:glUI ~.Qrgy ~ BlJn..D:t)l~ o Et.6C1'P.ICAL [J FLO~eING ,0 M~CMNICAL 00 s-1Q.O()O,. - . PIlRMITS RBQUBSTED V~~OAT!ON OF TOTAL CONSTRUCTION $ -:_ VALtUlTION ot' ~ECBANCIAL :NS'l'ALLA'l'rON o 01'BER . WG";..S 0 ROOfING 0 S,!'EC!A1..TY TYPE OF CONSTRUC'IION!. b ~LOCI: .. a fRAME o S'l'I:1ilL . 0 OTIiBa rZNIS~ED rLOO~ EtF.VA~IONS '--,.A rSPROJECT lliI FLOOD zon ~tJ ya;s C NO . I ;~ ~-<'.:".f.._~,;'-,~I'~~~~';~'~ "~"'I~'~Z1'pt"1 ~:~~";'1;j~I~:~_ 't. .::rt.:...~... ~.~-=--. tJ.' .. ---:f ..""~.:~~~_,"'~_______ '~--=---- - -" ',' BUXLOER , .~ COMPi"'.N'l-.- /!f1J/ &A/rrJcI-(I!/ SIGHA'IfJRE " (II r, ~. II. ~r- ~t..~ . 1>-lui ,(2_ ;~ .STATE CEkT OR REGIST '. **.**W~~*~*W...~.~~...~W***~*.~+.4"*..****..*.~***.~*~..~~.*..*w** 1,S.>) ~ COMI'~'i 7;rt1J ~d..u.J ~J SIoIlCu.rCIAN SIGNATURE ~b..c.~~ :f-tL~' " - STATE CERT OR Rl!:13IS~ . I ,~...~********k*~~*~~.._.*..*~~*w****._.~.***~*****~**~*..*..**~*.* I . J'LtQdBaJl . ?5'~~M?ANY' j-fB p~ &r1A~ ~ SIGNATURE , t '~4~ " STATZ CEllT OR l:l.ECIST . *.****~*.....~.~.*~.***~********~*~*.*****..****...**~****~**.~... .....~v.ll'rr... T. COHPlillY Td W~e~:60 900e Be '~d~ : 'ON X~.:l WO~.:l I I ~IGNA'l'ORE STATE CU~ O~ QEGIS1' t .. 1}O" .... ~OtHJ:B. ~~**._w.w....*~*....**..*~*~~*****.~.*.*....~ COMPA~~ 4/ t/IYJ/J. r. STATE CERT OR ~I;GIS'l'. R)(.. i,c=::, -JC\ L\-7 ~ ('f1 ( . U~+iG.., .-' cd W~C~:60 900c Be '~d~ 'ON X~.:I WO~.:I I I CITY OF ZEPHYRHILLS PERMIT APPLICAT~~f . BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED II:MIV~ tI~~ PHONE CONTACT FOR PERMITTING OWNER'S NAME I3redtt (p :3 07 , I ;ire Cu//ocu,A u/(wr O/kJ" Pt/Ji Ir). oS cUc-oL - Old A -tJOOdJ PARCEL 10 # PASCO PERMIT SERViCE PHON~ ' 1 866 824-7894 Toll Free SUBDIVISION ,Sj/tll/", t1a/'.J' fJIJ-/ JOB ADDRESS LEGAL DESCRIPTION: LOT(S) BLOCK PROPERTY TAX NOTICEl WORK PROPSED: ~EW CONSTRUCT~ON DSIGN PROPOSED USE: ~SGL FAMILY o COMMERCIAL o ADDITION o ALTERATION o REPAIR o INSTALL o MOVE o DEMOLISH i DwiLLING DMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER c=J ~E~TAURANT & DESCRIPTION OF WORK / flqlroclI._cI BUILDING SIZE .30 f3~~e~ I i HEALTH DEPARTMENT APPROVAL Me) / f Y ft.-~ h..Jtt~~ , r; (PO f HEIGHT SQUARE FOOTAGE RESIDENTIAL: ATTACH (2) PLOTiPLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETSiOF BUILDING PLANS & (1) SET ENERGY IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS PROPERTY SURVEylREQUIRED FOR ALL NEW ~ BUILDING o ELECTRICAL $ tfOJ 000.100 VALUATION OF ENERGY FORMS. PERMITS REQUESTED i AMP SERVICE 0 Progress Energy o o PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALT~ I o OTHER TYPE OF CONSTRUCTION: 0 BLOCK I I FINISHED FLOOR ELEVATIONS I ! o FRAME o STEEL o OTHER IS PROJECT IN FLOOD ZONE AREAD YES o NO BUILDER COMPANY 7TIJ /()()/ 6YAlrocllllf J SIGNATURE ~ ./ a..- Ct\.-- STATE CERT OR REGIST # * * * * * * * * * * * * * * * * *1* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ELECTRICIAN I ~ ".) COMPANY ThJ!} J./fiuJ k-;I1J SIGNATURE ~tlJ....ca- ~/L~ '''2}5. 0) STATE CERT OR REGIST # ****************************************************************** SIGNATURE ~-4~' ?)"~~MPANY j"lB p~ I~~~ STATE CERT OR REGIST # PLm1BER ***************** ************************************************ MECHANICAL COMPANY )j;J~ rpf OTHER STATE CERT OR REGIST # SIGNATURE 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 corrunencement. 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 corrunenced 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 corrunenced 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 corrunenced. 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". t;:S.u ~ ~ L SIGNATURE: OWNER OR NT d( ~--- M SIGNATURE: CONTRAqy6R STATE OF FLORIDA COUNTY OF The foregoing instr~ment wa~ac~owledged __ Before me this ~day of '0' ' 20 05 by (name of person acknowledged) ~o is personally known to me, or ~-sco STATE OF FLORIDA ~ COUNTY OF ra SUJ The foregoing instrument was acknowledged Before me this~day of ,SfT. , 20OS- by (name of person acknowledged) ~o is personally known to me, or Owho has produced (type of identification) O:id not~ke an oath. person taking acknowledgement ,:"?,,r'r'.~; BahI ~. ".r.'f ,', iJ_ \(')'/ t 11';1 ,>~.:i:lr'~}r)15}~~:; Name tYP~!d, \~~ifi:qed;_dr.\slt5~~d <~'~'cc,~;.~_,,;<~- \ ~l:ci'::.l '1"' o who has produced (type of [}:lid not Sig ature ~.,persoB.,~~.~i~~ ~~nowledgment _,",,_/.,' 'UL1IlnC Janl ~~~5-"~\~:.'<'-~~~-" : c<>cJL~,;i(il i,:DD1571j Name t ypedl~I;;iTited',~i;('i3t~mP~~ I I 09/19/2005 15:07 FAX 813 715 0824 ZEPHYRHILLS OPS eTR ~ Progress Enehw September 19, 2005 JTB Pool Contracting Fax: 866-824-7894 SUBJECT: PRO~S .. SPAlSWIMMlNG POOL CONSTRUCTION AT: . MCCULL UGH RESIDENCE 6309 SIL R OAKS DRIVE ZEP LS, FLORIDA Thank: you for notifying ~ of your proposed swimming pool construction at the above location. The pool proposed for COl. truction at the above address does not conflict with any underground or overhead D dUties of Progress Energy, provided that the pool is inst1Jled in the location shown on attached site plan provided to us by the pool contractor; Please call Sunshine State f'ne Call of Florida (1-800432-4770) a minimum of 48 hours before you dig. I I If you have any questions 4 require any additional infonnation, please call our offiCe at (813) 783--6944. I I ! Sincerely, Progress Energy Florida ! & ~I Darry~ . Service Coordinalor DF/atn Prugress Enlrgy FIQtida, Inc. Zephyrf1i1I~ Operation Center 36453 Eiland Blvd. ZClJhyrhills. FI 33542 ~001 I I SrlL V 6" It 0,4 Jd DP tiE ------ ------~ I ~~ ~ (= ~ ~ B ~ ~ 'C) ~ ........ ~ '7 '" '0 ~ ~~,,1 't "C\~l~<;;:::; ~f::14J~ ~ '-> <:> ~ ~ ~ ~ 1 '-J ~~~;~ ....... ~ I ~~ h ri ~ "'\;;) I ~ ....j ...., "J -8\ <=>\ r6. E'~~ \ ,0Q ./~ - o <::> .,., r-A , 01 I \..U ~~ v')~ ~~ "UQ '-:2. - \tl \:;~ 9.~ \.l) - ~ y..:!.51 , g "'8 \~ scR.-IEC.N M - ~ I /2-()O ~ .5 \~ ~ (po' .5- 'Ir-,o ..,.,":3;:. Q ';\ \ \U <3..1 ~ \ ~l \ Q.. I 30.00 t. \ \ \ I i \ ~I i '7~,oK RESIDENTIAL SWIMMI G POOL SPA AND/OR HOT TUB SAFETY ACT OTICE OF RE UIREMENTS I I (We) ~~rOSwl.~ge that a ne\y wimming pool, spa or hot tub will be constructed or installed at /It-er I and hereby affirm that one of the following (Please Print Street Address) methods will be used to meet the req irements of Chapter 515, Florida Statutes: The pool will be isolat d from access to the home by an enclosure that meets the pool barrier requirements of Florid Statute 515.29; , The pool will be equip~ed with an approved safety pool cover that complies with ASTM F1346-91 (Stan~ard Performance Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs); , All doors and windo~s~prOViding direct access from the home to the pool and. located within the enclosure/fence reqUlr d by the Pasco County Land Development Code, Section 530.4(0), will be equipped with an e .it alarm that has a minimum sound pressure rating of 85 decibels at 10 feet; All doors providing ~'rect access from the home to the pool and located within the enclosure/fence requir d by the Pasco County Land Development Code, Section 530.4(0), will be equipped with self- losing, self-latching devices with release mechanisms placed no lower than 54" above the f100 or deck; ! I UNDERSTAND AND AGREE TH T NOT HAVING AT LEAST ONE OF THE ABOVE INSTALLED AT THE TIME OF FINAL INSPECTI N, OR WHEN THE POOL IS COMPLETED FOR CONTRACT PURPOSES, WILL CONSTITUT A VIOLATION OF CHAPTER 515, F.S. AND WILL BE CONSIDERED AS COMMITTING MISDEMEANOR OF THE SECOND DEGREE, PUNISHABLE BY FINES UP TO $500 AND/OR UP T 60 DAYS IN JAIL AS ESTABLISHED IN CHAPTER 775, F.S. '. I FURTHER UNDERSTAND AND AGREE THAT THE OWNER AND/OR CONTRACTOR WILL COMPLY WITH THE FOLLOWING EGULA TIONS CONCERNING SWIMMING POOL, SPA AND/OR HOT TUB ENCLOSURES, IMMED ATEL Y UPON COMPLETION OF THE SWIMMING POOL, SPA OR HOTTUB, IN COMPLIANCE WI H SECTION 530.4(0), PASCO COUNTY LAND DEVELOPMENT CODE: 1. Construct around the swimmin pool, spa or hot tub a MINIMUM FOUR FOOT HIGH FENCE with self- closing, self-latching gates. Th fence must not have any gaps, openings, indentations, protrusions, or structural components that coul allow a young child to crawl under, squeeze through, or climb over the fence. Gates must open outwa away from pool area. The releasing mechanism of the latching device must be located on the poolsid of the gate and so placed that it cannot be reached by a young child over the top or through any op ning or gap. No opening in the fence may be large enough to admit a four-inch sphere. 2. Construct a screen enclosure a ound the swimming pool, spa or hot tub with self-closing, self-latching screen doors. Latches on exte 'or screen doors must be minimum 54 inches from the exterior access standing surface. All screen en losures require Building Permits. 3. Provide and utilize an approved safety swimming pool, spa or hot tub cover that complies with ASTM F1346-91 (Standard Performan e Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs). Such cover must be cap ble of being securely fastened over the swimming pool, spa or hot tub when not in use. I FURTHER UNDERSTAND AND AGR E THAT one of the enclosures described above will be completed prior to final inspection of the pool, spa or ho tub. ADDITIONALLY, I FURTHER UNDERS AND AND AGREE THAT the owner will require his/her pool contractor and his/her screen enclosure contract r, (if applicable) to request and successfully pass a final inspection immediately following the completion/in allation of the swimming pool, spa or hot tub. IF THE SIGNATURE of the Contractor, cting as agent for owner, appears below, the Contractor promises in good faith to make the Owner aware of the above-described requirements and penalties before commencing construction. SWORN AND SUBSCRIBED BEFORE ME HIS Iq~DAYOF S~+c~er ~~tLck.. ~L/L OWNER OR CO RAeToR SIGNATURE ~/~{';< 21A-//o PLEASE TYPE OR PRINT NAME ABOVE 0:/111J ;?y? 17 tA/ ~Y'-l ~YI/ ;< yl( a rt15 () t )J. ~ I I ~/( O,o7~ Cittr..~ 0/~# ;2';:.>~ / 0- ~ y C 6 '7 ;_I.j j I'.J g--' ~ "l<;. 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DO' \ \~ \'6_ __ . ~ ___ ' _--------1------ g ------.-------- ------~ , '\ \ '~ , \ \ 8\\~ 'h 0 . 1,\ 0 ...J. "Co \ \ \ \ \ " \ G"\ \ _______\ \ ~ c;: \ \\ rh rt\ <r, ~ ~ ~ C\:> ' y... b ~ - I t>J 1'<:> v- 10 ' . b -\ I ~ ." - ~~- IIL---lq c_ n-., \ ~' - <<t- 0 I -r?JO S?f rlO 3;1..1-' . 7J 3/17 .IS' C)" Lv ~ I W j0 a ~ ~, ........ b~~~:S: '"'t ........:"'.;:. ~ r-.... !~rr-:. ": c.., '-"") I:::: ~) ~ ff') N ['- ~ ~ t'\'- ~1"'CJ ~ ! ..........~~ k ~ :::t:.. .f!, <i: ~ t:::, c:>> ~ ~. 8: ~ l.: I C, ,--; :---.-. ~~ a, ['- C)" "i 1 I' d ltk S Dv I OCUhev tleld State fL 3?/5t./d-- 3. Owner Information: Name Address l.; 30Ci Si Ivw Interes t in Property: Name of Fee Simple Titleho der: (If other than owner) 111111111111 11111 11111111I1 11111 1111/1111I11111 1/1/1111I1111 2005218746 R..;\.,.4. " -, i Address ~ Contractor: Name -:-i1::q-VOO I Address . PO 00Y S~._D S. Surety: Name , + . , i City S~~ UV1*,a.~ SV\0 City 2qh\.(~tlllS. State fL 3~3 €1 . Address Amount of Bond: $ City State Rcpt: 933112 os: 0.00 10/14/05 Rec: 10.00 IT: 0.00 Dpty Clerk 6. Lender: Name Address City State 7. Persons within the State of F orida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes: JEO PITTMAN PASCO COUNTY CLERK Name 10/14/05 03: 1!pm 1 of 1 OR BK 664~ PG 604 Address City State 8. In addition to himself, Owne designates of to receive a copy of the Lienor's Notice as provided inSection 713.13 ( ) (b), Florida Statutes. 9. Expiration date of Notice of @mnrencement (the expiration date is 1 year,from the date of recording unless a differen date is specified.) ,20~. Signature of Owner: Sworn to and subScribe Notary Public: My Commission PC93053048/A '.~;i.d.1;nc Barn /iDD157lJ i t:,!".!!C B()oded Thru