HomeMy WebLinkAbout05-5272
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
./
5272
Permit Number: 5272
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost: 12,278.00
Date Issued: 12/20/2005
Total Fees: 95.00
Amount Paid: 95.00
Date Paid: 12/20/2005
Work Desc: SHINGLE RE-ROOF
Address: 6417 BRENTWOOD DR
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot{s): 1 Block: Section:
Subdivision: SILVER OAKS VILLAGE
Parcel Number: 04-26-21-0030-00COO-0010
Name: LEE, PIETER & YVONNE
Address: 6417 BRENTWOOD DR
ZEPHYRHILLS, FL. 33542
Phone:
. {\I \D~
< \ ,\o":l.e/
REINSPECTION 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.
I' '12.... _
~ C~u::t~ILt1_ ~.
CONTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
APPLICATION roa PERMIT
CIn or ZRPHYRHILLS
BUILDING DIlPAR'l'ImHT
TO: 7800021 P.2
Me! :j'l5:3
/:;-~t' -f)S-
DATE RECEIVED
PLJ\HS IUWImw I'BE
DEC-20-2005 10:36P FROM:
OtfNER'S NN1E_L ~el Pl'~kP.v ~ YVovy,C,. PHONE ~\~t,88-4-sg~
JOB ADDRESstcL-\;\'l ~-f'rt\';oDcd -:bv-'\\Je C~~'(hi.\~ ,Fe 3~
LEGAL DESCRIPTION: LOT IS) 1 BLOCK r\QYle.. SUBDIVISION Bn::nt LO~d
PARCEL 10 11 0'-1-' 02lo- &/, CO~... croc..OO. c:::t'.:)IO tOBTAIN FROM Plt.OPER'l"{ 'rA}( NOTICEI .,.
WORK PROP3ED: ONEW CONS1'HUC'rION
OSIGN
PROPOSED USE: ~GL FAMILY DWELLING
o COMMERCIAL
o ADDITION OAL1'ERI\'l'ION o REPAIR o INSTALL
o MOVE 0 DEMOLISIl CROO~
OMUL'rr-~'AMILY 0" OF UNI'rS o MOBILE I 10M I::
o INDUS'l'RIAL o SWIMMING pOOJ. o 01'1'IER
DESCRIPTION OF WORK
CJ RESTAURANT & IlEAL'!'H DEPAR'l'MEN'r APPROVAL
S~'I~DoP
SQUARE FOO'l'AGE Co4 ~~ I
BUILDING SIZE
HElGH'!,
RESIDENTIAL!
COMMERCIAL:
ATTACII (2) PLO'l' PLANS, (2) SETS OF BUILDING PLANS
ATTACH (3) SE1.'S OF BUILDING PLANS, (1) SE'f ENERGY
PROPERTY SUIWEY REQUIRED FOR ALL NEW CONSTRUCTION.
o BUILDING
o ELECTRICAL
o PLUMBING
o MECHANICAJ.
o GAS ~OOFING
$ \@If;J~.f'6
VALUATION Of' TOTAL CONSTRUCTION
& II) SET ENERGY FORMS.
FORMS.
of l tKld~dlLci-
~'(XWCLl
R., lQ5"'. t
PERMITS REQUESTED
AMP SERVICE
o FLORIDA POWER
o W.R,E.C,
....
o SPECIAL'l'Y
VALUA'!'ION OF MEClll\NCIAL
o OTHER
INSTALLATI?N ..~ :fJ.. ~
l,_~~
$
'rYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o S'fEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJEC'r IN FLOOD ZONE ARE1\D YI~S 0 NO
BUILDD
SIGNATURE
COMPANY
s'rATE CER1' OR REGIS'I' "
CiTY PROCESSING II
..........***.......................................*..**.**......
iCOMPANY
STATE CERT OR REGIST ff
eI'ry pnOCESSING fl
ELEC'l'JUCIAN
SIGNATURE
.*............................**.....*...........................*
PLUMBER
COM I? AN 'f
STJ\'I'E CERT oR REGIS'I' II
CITY PROCESSING II
SIGNATURE
.******.**.~........*.........*...*..**.*.*............~....*.....
MECHANICAL
COMPANY
STA'I'E CERT OR REGIS'f fI
CITY PROCESSING >>
SIGNATURE
....................*.*.............*....................*.....*.
SIGNATURE
lA-~./A--
COMPANY MILBAR ~STRUcrIOO, INC.
STA'!'E CERT OR REGIS'!' II CCC 051562
CITY PROCESSING II 218
OTHER
...........................................................*.....
DEC-20-2005 10:45P FROM:
TO: 7800021
CONIH'!'lONB o Ii' l'El~l'L' M'Ii'lUJ\Vl'1'
.A. NOTICE OF DEED HES'rRIC'!'IONS
The undersigned understands that this permit may be subject to "deed restJ:ictiolls" which
may be m~re restrictive than City regulations. The undersigned asswnes 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 cOJ'ltractor 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 lntended 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 11ave the
contraotor(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 1n the City of Zephychills.
C. TRANSPOR'rA'rION 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" pJ:epared by the Florlda Deparlment of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I eerily 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'9 AFFIDAVIT
I certify that all the Info~matlon 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 instal.lation as indicated. I
ceJ:tify that no work or installation has conunenced prior. to issuance of a permit and that
all work will be performed to lAeet standards of all laws regulating construction, City
codes, .,;oning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental 8gellcies lOay 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 EngineeJ:8-Seawalla, Docka, 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 "AU or "A,ete.", it is
understood that a drainage plan addressing a "compensating volume" wl!.l. be subnd.l:ted which
is prepared b~ a professional engineer registered in the State of Florida prior to permit
issuance.
A permit issued shall be constru~d to be a license to proceed with the work and not a8
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 authori.,;ed by such permit is commenced within
six months of issuance, or if work authqrized by the permit is suspended or abandoned for a
period of six months after the time the work is conunenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in wrlting 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 COMMENCEMEN'r MAY RESUL'!' IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR ~ROPER~Y. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED 'ro RECORD AND POST A "NOTICE OF COMMENCEMEN'!'''.
~~~ ~-~/
SIGN.~~R/OR AGEtlT DAVID R. ABLA SIGNATURE: CC:-''1'n.'\c'rcn DAVID R. ABLA
P.1
.,.
STATE OF FLORIDA
COUNTY OF PASCO
The foregoing instrwnent w~acknoWledgeq
Before me this ~ day of ~ , ~
by DAVID R. ART.J\ -
(name of person acknowledged)
JiI who is personally known to me, Or
Signat
STATE OF E"LORIUJ\
COUNTY OF PASCO
The foregoing instrpment wa~,~~knowledged
Before me this lilt) day of ~ , ~as
by DAVID R:-1\1ID\
(name of person acknowledged)
~ho is personally known to me, or
a who has produced
(type of identification)
and who Ddid id not take an oath
and whoD did
lodgement
Signa'
owledgment
Name t
Name
DEC-20-2005 l0:36P FROM:
TO: 780002l
P.l
3fl~
~
~ MilBar Construction, Inc.
15911 U.S. 301 · Dade City, Florida 33523 C>
352/567-6047. 800/562-2393. FAX: 352/567-4454
FROM:
be.c..-exY\ k(' ;lQ \. ()~
~~~~~YA~
rhelsetL ....
Mi~ar Construction
FAX: ,$O-OOOJI
PH: I~O.~D
DATE:
TO:
FAX: 352/567-4454
PH: 352/567-6047
RE:
~-l.~ Y'(\l-t-~ r\A.,Ctrl~~ ~ '.
l..:e.~ ,"'?L.e.{ti a '1vonne..
Co y \1~~-tLuO o::;i J),N-e.
uK> V' \;l15\ 'Fe 3e54-a
f!€~Q!~~ i~~~,:!S~73~~r' -
Di\ c:J\ I'V.\J ~V\D(Yt:....
If you should have any questions or require any additional information, please call me at
352/567-6047" ~-== -
Thank you!
C~
. . il i
!\~ ~.~l~t V
State CeI1illed
Builder IICBC023221
State CertIDed
Roofer IICCC0515G2
State Registered
Roofer .RC0055215
RCI Registered
Roof Consultanlll0149
DEC-20-2005 10:37P FROM:
TO: 7800021
P.3
NOTICE OF COMMENCEMENT MCI#~
1111111111111111111111111111111111111111111111111111111I1111
2115254983
Permit No,
P8rcellDlFolio..a:fb2<...,-a 1- C'f:?/')-f"r'C'lT'1' to, a
R
Rept:947585 Ree: 1e.ee
DS: e.1/I1l IT: 1/1.11/1
12/02/15 ____._ Dpty Clerk
State of Florida
County of ~~~
JED PITT"AN, PASCO COUNTY CLERK
12/12/15 19: 39am 1 I' 1.
DR BK 6723 PG 141
The UNDERSIGNED hereby give notice that the improvement will
be made to certain real property in accordance with Chapter 113, Florida
Statues. the following information is provided in this notice of
commencement.
1.
2,
General description of improvements
3,
Owner Information
a) Name and address
b) Interest in property C)l-tJ n
c) Name and address offee simple titleholder (if other than owner
Contractor (name and address) MilBef Constroction. Inc. 1 ~I' dR. tl.hV1 ,
15911 US 301 O,de City. FL 33523
5.
Surety
a) Name and address
b) Amount of bond
Lender (name and address)
6.
Person within the State of Florida designated by owner upon who notices or other documents
may served as provided by Section 713.13 (1)(a)(7), Florida Statues.
In addition to him or herself, owner designates
of to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statues.
Expiration date of notice of commencement
date is one year from the date of recording unless a different date is specified).
STATE OF FLORIDA OwNER'S SIGNAnJRE )( ~J.e.e
COUNTY OF 'f>,J~c PRINTED NAME & TITLE rz 17-( L ~ e. . (J Wrl.L Y"
I )
The following instrument was acknowledged before me-this..... 2.2... day of II fJ\/ , lOCh by
who i~ersonallykno.~r:who produced
7,
8.
9.
(the expiration
a,:; iden~i~cation.
.. '
I ~ .,; r" '\0.
Notal')' Signature
Name(Print)
Title or Rank: ~~~~~ COMMI~SION . Dl'~37951
Serial number i ait~~~~IC' EXPIRF.S JIAV 211, 2008
, ;: ~,gr 80N'JfUlntol:t.=.'H
-qW,V IU tol~.lUAt-ll:' ('C"'.IJA~tt
.' .. '1..'1:,,". .......W9;t.....n:,,..<<JXfY.lt~C\t'.m,:...
After recording, return to:
Name; MitBar Construction. Inc.
Address: 1591 IUS 301
"! City: Da~e City.'FL 33523
DEC-20-2005 10:37P FROM:
TO: 7800021
~
1)7
--....--.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
Mcr
~nl'5=<
--- ~
DATE RECEIVED
PLANS REVIEW FEE
LEGAL DESCRIPTION: LOT(S)
OWNER'S NAME-Leel ~l'(? ~fY ~ YV6~r::..
JOB ADDRESS ~Y \ "l ~-f'+wDcd ::by"Ne
I BLOCK I\OYl e..
PARCEL ID #I 0+' 021o- tX /- 003~ ~ ODGO 0 - ~( 0
PHONE cz:, Y(S I --i 28 ~4-EXS~
~~'(~\\~ jFL3~
SUBDIVISION BrrntGO~d
{OBTAIN FROM PROPERTY TAX NOTICEl
'..t.
WORK PROPSED: ONEW CONSTRuc'rrON
o ADDITION
OALTERA'rION
o REPAIR
o INSTALL
Os I GN
PROPOSED USE: ~GL FAMILY DWELLING
o COMMERCIAL
o MOVE
o DEMOLISH
~...-~
C~~FI~
OMUL'rr - FAMILY
o INDUS1'RIAL
0#1 OF UNI'l'S
o SWIMMING POOL
o MOBILE HOME
o OTHER
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
Shel ~le ~e --r\'")oP
SQUARE FOOTAGE UJ4 ~S I
BUILDING SIZE
HE:! GIl'!,
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
o BUILDING
$ t@I&J~.<'D
VALUATION OF TOTAL CONSTRUCTION
of l D\lJ2YDo~llcl
~yxNcU
~\ct5~ .l
PERMITS REQUESTED
o ELECTRICAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANICAL $
o GAS ~OOFING 0 SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
D OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
D NO
BUILDER
COMPANY
STATE CERT OR REGIST #I
CiTY PROCESSING ft
SIGNATURE
******************************************************************
ELECTRICIAN
· COMPANY
STATE CERT OR REGIST #I
CITY PROCESSING #I
SIGNATURE
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #I
CITY PROCESSING 11
SIGNATURE
**********~********************************~***********~**********
MECHANICAL
COMPANY
STATE CERT OR REGIST 11
CITY PROCESSING 11
SIGNATURE
*****************************************************************
SIGNATURE
;:;;u; ~
COMPANY MILBAR OJNSTRUcrION, INC.
STATE CERT OR REGIST #I CCC 051562
CITY PROCESSING 1t 218
OTHER
*****************************************************************
CONDI'l'lONS OI!' PEkMIT AI!'!:'lVAVI'l'
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 responsi.bility 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, 813-788-6611.
Furthermore, i'f 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 eerify 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: *Departnlent 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 hy a professional engineer registered in the State of Florida prior to perIllt
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 co~nenced within
six months of issuance, or if work authqrized 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 PROPERny. 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 'fO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGN~~ ~VID R. ABLA SIG'~~CT~; R. ABLA
STATE OF FLORIDA
COUNTY OF
The foregoing instrument wa~~cknowledged
Before me this ~ day of l.Je~ , ~m
by DAVID R. ABLA -
(name of person acknowledged)
~who is personally known to me, or
PASm
STATE OF ~~LORIlJA
COUNTY OF
The foregoing instrllffient Wa~)lOWledged
Before me this at) day of ' , ~~
by DAVID R~
(name of person acknowledged)
~ho is personally known to me, or
PAsm
Signat
D who has produced
(type of identification)
and who Ddid id not take an oath
and whoD did
ledgement
owledgment
1
Name t
intedIN""~ff€
Name
NOTICE OF COMMENCEMENT MCI#8'lP53
R
1111111111111111I1111111111111111111111111111111111111111111
2005254983
Permit No.
Parcel ID/Folio ct-l-,;z<.:,-a.l- (TPrrtT(' IIr 00\ a
Rcpt : 947565 Rec: 10.00
os: 0.00 IT: 0.00
12/02/05 ________~ Dpty Clerk
State of Florida
County of ~~'>.~~
JEO PITTMAN, PASCO COUNTY CLERK
12/02/05 09:39am 1 if ~
OR BK 6723 PG 41
The UNDERSIGNED hereby give notice that the improvement will
be made to certain real property in accordance with Chapter 713, Florida
Statues, the following information is provided in this notice of
commencement.
1.
Description of property(legal description of property and address if available)
Section bY: , Township exto . Range OL t Gt../ (~ !3rerL+k)OoO' 0,,- .
., . .. 'Z-{ph0r~ L <:, t' {Fe 32;B-Id-
General descrIption of Improvements f'J ~ i0 R oofl
2.
3.
Owner Information
a) Name and address2 ti.. f--e V' i Y V011ne Le e_
b) Interest in property 0 H.) v') ,.
c) Name and address of fee simple titleholder (if other than owner
Contractor (name and address) MilBar Construction. Inc. / I::'x::lv,d R - AbkL
15911 US 301 Dade City. FL 33523
5.
Surety
a) Name and address
b) Amount of bond
Lender (name and address)
6.
7.
Person within the State of Florida designated by owner upon who notices or other documents
may served as provided by Section 713.13 (1)(a)(7), Florida Statues.
In addition to him or herself, owner designates
of to receive a copy of the Lienor's Notice as
provided in Section 713 .13(1 )(b), Florida Statues.
Expiration date of notice of commencement
date is one year from the date of recording unless a different date is specified).
-, ')
OWNER'S SIGNATURE ~ f~/thJ!~
PRINTEDNAME&TITLEl>rzt7i'. l--ee:~ . (JwrU y-
I )
8.
9.
(the expiration
STATE OF FLORIDA
COUNTY OF Pa.sL-Q
20<:5 by
After recording, return to:
Name: MilBar Construction. Inc.
Address: 15911 US 30 I
City: Da~e Citv.'FL 33523