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Home My WebLink About06-5346 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5346 Permit Number: 5346 Permit Type: ADDITION/AL TERA TION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: 5,708.00 Date Issued: ./16/2007 Total Fees: 135.00 Amount Paid: 135.00 Date Paid: 8/16/2006 Work Desc: REPLACE WINDOWS-SIZE FOR SIZE Address: 39105 PARK DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: ZEPHYR HEIGHTS Parcel Number: 12-26-21-0030-00000-0080 Name: HEMPHILL, LOIS Address: 39105 PARK DR ZEPHYRHILLS, FL Phone: 813-783-8162 10 WINDOWS -REPERMIT 8-16-06 / ,f\ y\ lote 0\\~ ~ U H PL 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. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection trips 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 posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, 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 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. ~~.. ~. ONTRACTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5346 Permit Number: 5346 Permit Type: ADDITION/ALTERATION Class of Work: 434-ADD/AL T RESIDENTIAL Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 5,708.00 1/23/2006 90.00 90.00 1 f23,'2006 2 - 2 -Dip ~ REPLACE WINDOWS-SIZE FOR SIZE Address: 39105 PARK DR ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: ZEPHYR HEIGHTS Parcel Number: 12-26-21-0030-00000-0080 Name: HEMPHILL, LOIS Address: 39105 PARK DR ZEPHYRHILLS, FL Phone: 813-783-8162 10 WINDOWS , \ T R H B 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. REINSPECTION FEES: Reinspection fees 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 posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, 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 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. ~~~ .. &~ / ONTRAC OR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER OWNER'S NAM'\N~ '~~~ ADDRESS ~~'. \ ~ ~ Z0IL\L~ CITY OF ZEPHYRHILLS PERMIT APPLICATION , BUILDING DEPARTMENT 5335 Sth STREET ZEPHYRHILLS, FL 33540 . ~~ ~cr9 Phone:S13-7S0-0020 Fax:S13-7S0-0021 ~O~ DATE RECEIVED i bo loCo PLANS RBVIBW FRE PHONE CONTAC{J1 ~-e83 - 3/ (p).. ... JOB S 1'I'E PARCEL ID # BLOCK _\ SUBDIVISION tel ~'-'.r t\.'.~U~ (OBTAIN FROM PROPERTY TAX NOTICE) LEGAL DESCRIPTION: LOT(S) WORK PROPSED: []NEW CONSTRUCTION Os IGN o ADDITION [] MOVE o ALTERATION REPAIR '--..0 INSTALL o DEMOLISH PROPOSED O~SGL FAMILY DWELLING o COMMERCIAL OMULTI - FAM1LY 0# OF UNITS o SWIMMING POOL o MOBILE HOME o INDUSTRIAL o OTHER DESCRIPTION OF D WURK ~\os:. 0 RESTAURANT & HEALTH DEPARTMENT APPROVAL W,~,'-)'S - '':::,\ u.Jc? 'S\ 7 , SQUARE FOOTAGE ' ---- HEIGHT K~I~ l.l.. \0 > iN,',,} 0 .,15 BUILDING SIZE 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. NOL .-L ~ BUILDING [] ELECTRICAL PERMITS REQUESTED $ 5loD cD VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o FLORIDA POWER [] W.R.E.C. [] PLUMBING [] MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION [] GAS o ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: 0 BLOCK [] FRAME [] STEEL [] OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAD YES' 0 NO BUILDER SIGNATURE R~ ****************************************************************** ELECTRICIAN COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ****************************************************************** PLUMBBR COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE MECHANICAL ****************************************************************** COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ***************************************************************** OTHER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ~ .... , ":'i1.~ir 1 iI. ,,".' * *,* .. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * '<~i..\I1lll'l".' CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to ~deed restriction~" 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, 613-786-6611. 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 ot~er governmental agencies may apply to the intended work, and that it is my responsibility to identify what actions I Inust 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 pennit 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 perrrit 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 IfiUst be logged during each six Inonth 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, CONSUr:f WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UND~R $2,500 IN VALUE 00 NO'T NEED TO RECORD AND POST A "NOTIC~' SIGNATURE, OWNER OR AGENT SIG~ CONTRAC"O ac)wowledg:::d , 19_ STATE OF FLORI COUNTY OF The foregoing Before me i by '~~ "Jf , ~~l1o STATE OF FLORIDA COUNTY OF The foregoing instrument was D",fore me this _ day of by (name of person acknowledged) Dwho is personally known to me, or ame 0 person acknowledged) o is personally known to me, or of identification) take an oath. Dwho has produced (type of identification) and who Odid [}:lid not take an oath o who has produced (type and whoo.ctid Ddid not Signature of person taking acknowledgement !...'." .......... ....................."... . " ,.ocT L PRESTON : Slgnature~ C!~.~>" son~~~6k..~owledgment ., '~Q'ij .,- ,., B__lIlN(D)432;;4'Z?>4: ~ (',Jr. ,a N ." , Inc : ...................... Name typed, printed or stamped " . F'2. 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Application #: Date Submitted: Code Version: FL5414 09/21/2005 2004 Product Manufacturer: AddressIPhone/emai1: Simonton Windows 1 Cochrane Ave Pennsboro, WV 26415 (800) 746-6687 Technical Representative: Technical Representative AddressIPhone/ email: Chuck Anderson 1 Cochran Ave. Pennsboro, WV 26415 (800) 746-6687 chuck _ anderson@simonton.com Quality Assurance Representative: Quality Assurance Representative AddressIPhone/ email: AAMA 1827 Walden Office Square Suite 550 Schaurnnburg,IL60173 (847) 303-5664 webmaster@aamanet.org Category: Windows Subcategory: Single Hung Evaluation Method: Certification Mark or Listing Referenced Standards from the Florida Building Code: Section Standarq ANSI/AAMA/NWWDA 101 LS 2 Year 1997 Certification Agency: American Architectural Manufacturers Association Quality Assurance Entity: http://www.floridabuilding.org/pr/pr _ det1.asp?IPT=5414&RV=0&fm=ROSrch 10/26/2005 . Florida Building Code Online Validation Entity: Authorized Signature: EvaluationlTest Reports Uploaded: Installation Documents Uploaded: Product Approval Method: Application Status: Date Validated: Date Approved: Date Certified to the 2004 Code: Page: O~b:1 pp/Seq Product Model # or # Name 5414.1 3-06 waivers to 40-06 5414.2 3-17 waivers to 40-17 nd 40-06 Page 2 of2 Chuck Anderson Chuck _ Anderson@simonton.com PTID 5414 I S-125R2.pdf PTID 5414 I S-126R2.pdf PTID 5414 I S-156-1R.pdf PTID 5414 I S-175-2.pdf PTID 5414 I S-176-2.pdf PTID 5414 I S-19l-2R.pdf PTID 5414 I Simonton Waiver 40- 06etc.pdf Method 1 Option A Approved 09/21/2005 10/11/2005 Model Descri tion Page 1/1 Limits of Use 43-06 waivers to 40-06 43-06 waivers to ee attached waiver. Vinyl 0-06, THD @ H 36x62 DP = +/- H-R45 Home Services 4x62 DP = +/- H-R30 060, Profinish 4x62 DP =+/- H-R35 Builder, Luminess 6x84 Oriel DP = +/- H- 500, Vinyl SH R50 Non-Impact, Not for se in HVHZ area. 43-17 waivers to 40-17 nd 40-06 see attached aivers, Vinyl SH, 4.25x60 DP = +/- H-R40 6x76 DP = +/- H-LC50 6x62 DP = +/- H-R45 4x62 DP = +/- H-R30 4x62 DP = +/- H-R35 6x84 oriel DP = +/- H- R50 Non-Impact, Not for use in HVHZ area. 43-17 waivers to 0-17 and 40-06, Protinish Contractor, Protinish Master, Luminess 700, Luminess 800, inyl SH Next Copyright and Disclaimer; @2000 The State of Florida, All rights reserved. ff~- http://www . floridabuilding.org/pr/pr _ det1.asp ?IPT=5414&R V =O&fin=ROSrch 10/26/2005 ~8.'762" MAX . . . . . . .. .... . -. ... .,. . ~. . . . . , . . ~'. .' ...." .... ,..,. .... .' .' . .' '" '" o. ~ I " ~ " ,., !Ii o :I' L U I U6" ~ !Jt '!'- ~ f ! :' ~..a ~ f [a f t: ~ lot g ~ g o.~ C Q. : ~..' '!to ~ s:.., .. CIf" ~ "s: ~ ::J . ..:c" "'~. 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CITY OF ZEP BUILDING OFF '" '" ~ ~ c: ~ ~ !'> :- jj~ l ~ i ~ l~::JO::r.l!~' 0-3 ~ ~ 6" ~ctg: ~[ ""9 B !!!" - ~~ ~ ~ ~ : o go g i ~ w, ~Q. g ~ ~ ~ g 2. 5' ~ ~. III O'5'."'_,;~Ci I< ::J.2"9, Q. ~.~ r; _ f.a- = 0. 0- ~ 0. ~ ! ~ ~ ~. ::J Q. - ~ g ~ f '" o " Q. ~ ~ ~. ~. 3 0- F ~ .g' ~ " 8" :r a- ~ 0' ~ , , ..'" 5. n e; ~ ~ . " IA' ~ ao ~ G ~ ~ ~~. . ~ " Q. 0 ;; - - . o __ l! ;: i ;; ; == ~ ~ 2 ~ , . ~ -- =. , <T. ",ft Q. if ~ ~ . 0 . 5' g. :I ta . 0 3 ii ~~ :g =-< o ;; Q. n ",0 O:~~ ' c ~ ~.. "';;l c ;D- 6 ...,~~ r I; ..." ~ ;;: <l ~- >> . >>, '2", <l . ~ c: ... '" o >> ~ " 0, '" "l l ;, :lEVI' ~ , "iii 0 ?i , -, '-!:I 0 "'~ '!;! t ~ ~~,.~.~ . ....' '.I;C: I: 'PJl~,: >,1Q' \.,: " 'ilov~~(.' 1 i 2002 " y'l "" ....t,~." , !I~t~~ir~~~~~dl Florilfo II? ~ ',6;",lio, 43409 19506 french Lace Drive Lutz, fl 33556 '" 1 J ~ " '" ~ ~-; ~. ~"l '" '" iE ANCHORING CROSS SECTIONS FOR 2X BUCK TO MASONRY SINGLE HUNG VINYL WINDOW Simonton Windows One Cochrone Avenue Pennsboro. WV 26415 PH, 800.426,2249 ~ You can do it. We ca......m It May Concern: This letter will authorize the following person(s) to act as agent(s) on behalf of THD At-Home Services, Inc., ,D/B/A The Home Depot At-Home Services, 3200 Cobb Galleria Parkway, Suite 200, Atlanta, GA 30339 to pull for permits and inspections with respect to the installation, maintenance and repair of windows, siding and fencing under Florida State General Contractor license number CGC1507093. Authorized person(s): Brian Kirby Elizabeth Grote Timothy 0 'Malley Chris Pate Anthony DeCandia Jason Kirby Don Kirby Gregory Kidd ~~~I~~ THD At-Home Services, Inc. The Home Depot At-Home Services STATE OF GEORGIA COUNTY OF COBB The foregoing instrument was acknowledged before me this'..1clay of November, 2005 by Edward Lynn Guillory. ~ n 1 ~ y-~------, Notary Pu~c-State of Georgia Margaret Payne Printed Name: 1/21/06 My Commission Expires: (Seal) MARC3PJiET P.L\Yf\JE NOTAil"V FUBL!C C\fvinnetl State 01 (j80tgia My Cormn. Expires Jan, 21, 2006 ,"; ~'~~.'._'''''~~"'-''-<'''''''''"~''',,,,,,,,,-,,,,,,= Personally Known_X Or Produced Identification THO At-Home Services, Inc. 3200 Cobb Galleria Parkway, Suite 200 · Atlanta, GA 30339 770-779-1300. Fax 770-984-0709. Toll Free 877-469-0114 Parcel Information for: 12-26-21-0030-00100-0080 Card: 001 Page 1 of2 Search~6gaiQ ShowJv1cmGeneralized Buitding Schemati~ Estimate TC!xes SeELIc:P(~oll~Qtor InfQ[mation - CurremtlDelinquent Taxes Frequently Asked Questions ParcellD 12-26-21-0030-00100-0080 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Assessment (totals) Ag Land $0 HEMPHILL LOIS E Land $13,650 39105 PARK DR ZEPHYRHILLS, FL 335424690 Building $64,965 Physical Address Extra Features $621 39105 PARK DR Total Assessment $79,236 ZEPHYRHILLS, FL 33542-4690 Save Our Homes $44,081 Homestead - $25,000 Legal _O_Etscription (First 4 Lines) ZEPHYR HEIGHTS PB 5 PG 50 LOT Taxable Value $19,081 8 BLK 1 Warning: A significant taxable value increase OR 1316 PG 591 may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line ~ Description ning Units Type Price C~ Value 1 SFR OR1 7,000.00 SF 1.95 1.00 $13,650 Additional Land Information Acres II 0.16 II Tax Area I 30ZH Fema Code JUJ Res Code ZHL Building Information - Year Built 1959 USE 01 - Single Family Residential (Card: 001 of 001) Ext Wall 1 Concrete Block Stucco Ext Wall 2 Concrete or Cinder Block Roof Str Gable or Hip Roof Cov Asphalt or Composition Shingle Int Wall 1 Plastered Int Wall 2 None Flooring 1 Carpet Flooring 2 None Fuel Electric Heat Forced Air - Ducted AC Central Baths 1.00 Line Description Sq. Feet Rep!. Cost New 1 BAS 1,080 $75,816 2 FEP 252 $12,355 3 FOA 80 $1,123 4 UST 120 $3,791 I 5 I FCP 200 I $2,808 I I 6 I UOP 32 I $351 I Extra Features (Card: 001 of 001) I Line II Description I~ Units Value I 1 " DWSWC I 222 $225 I 2 " UDU-M I 2003 II 1 I $382 I Sales History I Previous Owner I N/A I Year II Month II Book / Page I Type II Amount I 1984 II 02 II 1316/0591 I WD $40,000 http://www.appraiser.pascogov.com!search!offline_tca.asp?Sec=12&Twn=26&Rng=21&Sbb=0030...1 /412006 RattHlt to: Mitme: 11m At-Home &nicer. Jnc:.. - dNa The Home Depot At-Heme Services Adcfre.a: 3200 CoIlb C.neria Ply. Sto. 200. AdaJna. GA 30339 This JMInmlcntPrepuedBy:The Home Depot NlUIIe: 207 -G Kelsey Ln. ~: Tampa,FL33619 813-630-4111 off 813-630-4112 fax Property AppnIiscn PsnIeJ TdeatificatioD: 11111111111111111 1111111111 11111111111111111111111111111 I11I 2006012528 . . Rcpt: 961736 DS: 0.00 01/20/06 Rec: 10.00 IT: 0.00 --- Dpty Clerk - JED PITTMANA PASCO COUNTY CLERK 01/20/06 110: 38am 1 of 1 OR BK 6804 PG 203 NOTICE OF' COMMENCEMENT Permit No. Folio No. rL-1.6 --2...' - O(),~ 0 - 00/00... tJO'bO . STATF.OFFT.ORIDA ~'\ COUNTY OF ~S( c) 20l2lLG> The uadersiped Ii.. DDIice tIIat impnmDlCIJII will be ....10 ccrtaiD neI property. _ ill ~ with CbepIw 713. FJClrida SIa1ata.. the fhJlowioS iabmatioo is provided in this NOTICE OF COMMENCEMENT. LepI ~ of~ (mclude Ibm add,as, ifndllble: 2 Cd PH y.. ((.J. t 1":0 h fr P A . f)6 -:;0 /P7" 15 131 It I O/<. I 316 P6 ~ "5'9 J '3 It? 'i r-J/Jr 0'2 'r..:: General dacriptiOlloriraplUvcmCllll: of' 'Ow g,;r TDmrmaIion - ft8IDe ead address: P / '3<:3rY2. rmer.t ill Properly. Lv VI NlUIIe andiddreM nfftte simple tidehotdet'-(lf-~____,____ '__ Lo t'S' 1-/ e 1"1 ,/0 A ,., I '3 PI (;) t' ,.o/l..}(,.f A)/I. '2 f'A:JI1A/I A / II;, R Contraclor-lWIIC 811d~ Tho Home DIDot At-Home Senices ' 207 Kelsey Lane. Sa_ 0. T..... FL 33619 Phone Number: 813-630.4111 Santy -IUIIIIO ami address: Fax Number: l J.ender - name and address: J, Phone L Number: 813-630.4112 Fax N_bar: ~h4 Amouatof SolId: s l Pennns within 1he State of Florida dellignated by Owner wham nntice!I of adter dllcumOllb may he urved.. prcmded by Soctinn 713.13(IXa)7.. Florida St:atuer. / Name UId Iddresa: {l,.-- / rJ / PhoM NIIIIlber: Pax Number; In addition ID bimsel( Owaer dosipates or to RlCeM a copy oftbe Litnor"s Notice as Pt01'ided in S~ 713.13(lXbl. Florida Statures. (F'dl fa at OwDer's option) Phone Number. Fax Number: Expiration dam ofNOCice ofComlllCDCOlllCnt (the axpimioa date is 1 year ftom~to ofn.onfia. unlZ;- do""'... da1II. . is specified). I)(~.~ "*- ----"-'~ 'i(2-t~'7 Stpatvnl of ofQwaOi,. L.. I ~ Alrit,YrV\1l.h, LdlS f~/I-<Pj.f-l L. 1pJ;.~~ ofOwnct PriIItrd Name orOwber Sworn to and sa_..ibed before me by _ who is JlOI'SOIIltIIy bowa to,me or JIIOduced --tificaaioa. ad wfrodicL-~,.. dUs~ d4y,~!..-- 20__ , SipatunlofNotary c'/'L;:'h,~ ~ of$ .......--) tl t., __ Printed Name nfNobuy: Commissiou No./Expinllioo: ~*~.:r.~~. Adoiio .SU.H~.t. l!/~' ':'!: Commission # 00293398 ~~~~.: Expires March 15, 2008 # fh I"'" Oonoed Troy ~aH1..lnsurenca. Inc. ~7019 ,