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Home My WebLink About06-5807 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 PLUMBING PERMIT 5807 Permit Number: 5807 Permit Type: PLUMBING Class of Work: PLUMBING RENOVATIONS Proposed Use: SINGLE FAMILY RESIDENTIAL Square Feet: Est. Value: Improv. Cost: 300.00 Date Issued: 5/17/2006 Total Fees: 35.00 Amount Paid: 35.00 Date Paid: 5/17/2006 Work Desc: WATER HEATER REPLACEMENT Address: 5924 14TH ST ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 11-26-21-0010-04000-0170 Name: LIPPINCOTT, CARL & ARLENE Address: 5924 14TH ST ZEPHYRHILLS, FL. 33542 Phone: ~~ 01.{} [)-' "I ^ ,J If' ,0 ~ \" 6' 1 ST ROUGH PLUMB WATER REINSPEcnON 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 a 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." LL PLUMBING SHALL REMAIN EXPOSED PRIOR TO INSPECTION ~. ONTRACTOR PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department Fax-B13-780-0021 Date Received Owner's Name NEW CONSTR INSTALL ADD/AL T REPAIR COMM I I I I LOU 1'3- JD I PARCELID#II \ . ~lP o~ I .DD I D . D~DO o. DJ7~ (OBTAINED FROM PROPERTY TAX NOTICEI o SIGN 0 MOVE 0 tXJ OTHER 1(2 oQ P lete ~ mef\ t- O STEEL 0 OTHER I f2- ~p l ClCL yY\ C-t1 1- I HEIGHT I Owner Phone Number Owner Phone Number I Owner Phone Number I Fee Simple Titleholder Name I JOB ADDRESS Fee Simple Titleholder Address I 15994 I \L.\~ 3 t-Ree:\- I B D D \t eR t-e..( SUBDIVISION WORK PROPOSED B o o I vJcl.-h~_\ I DEMOLISH PROPOSED USE TYPE OF CONSTRUCTION SFR BLOCK FRAME DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE I 0 BUILDING IS I VALUATION OF TOTAL CONSTRUCTION 0 ELECTRICAL IS I AMP SERVICE D PROGRESS ENERGY 0 W.R.E.C. ~ PLUMBING IS.300.DO I 0 MECHANICAL IS I VALUATION OF MECHANICAL INSTALLATION 0 GAS 0 ROOFING D SPECiAlTY 0 OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNa BUILDER SIGNATURE COMPANY REGISTERED ~ FEE CURRENT ~ Address license # Address ELECTRICIAN SIGNATURE Y/N FEE CURRENT ~ PLUMBER SIGNATURE Address MECHANICAL SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT ~ Address License # OTHER SIGNATURE COMPANY REGISTERED ~ FEE CURRENT Address ~ License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms Minimum ten (to) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster Attach (3) sets of Building Plans; (1) set of Energy Forms. Minimum ten (10) working days after submittal date. Required onsite. Construction Plans, Sanitary Facilities & 1 dumpster All commercial requirements must meet compliance. Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. COMMERCIAL SIGN PERMIT Directions: Fill out application completely. Owner & Contractor sign back of application. notarized If over 52500, a Notice of Commencement Is required. CAlC upgrades over 55000) Agent (for the contractor) or Power of AlIomey (for the owner) would be someone with notarized leller from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Fences (PloUSurvey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. 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 Pasco County Building Inspection Division-Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Uen Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify 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. 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, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other govemment 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 Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, WaterlWastewater 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. US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone 'V unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted bUilding using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. OWNER OR AGENT Subscribed and sworn to (or affirmed) before me this by Who is/are personally known to me or haslhave produced as identification. Notary Public ~~ ~ h~Q ^ ~. Lto"r--- Commission No. "i:)D 3 'l~a '5 ~~J.'~1~ Mi~helle J' Stone NameofN:~/~'''i. o:C6'Mn'on DD347225 ~0.:..A.il E.rpires: AUG. 16, 2008 -;".-}.....~,' Boncled Thru ""If:~,f;;\\" Atla.ntic sanding Co., Inc. Notary Public Commission No. Name of Notary typed, printed or stamped CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5808 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: 34,320.00 Date Issued: 5/23/2006 Total Fees: 311.40 Amount Paid: 311.40 Date Paid: 5/23/2006 Phone: Work Desc: ADDITION OF RESIDENTIAL OFFICE, BATHROOM & STORAGE 30'x13.3 5808 ADDITION/ALTERATION 434-ADD/AL T RESIDENTIAL SINGLE FAMILY RESIDENTIAL Address: 6449 HUN 0 ZEPHYRHILLS, FL. Township: Range: Lot(s): Block: Subdivision: SILVER OAKS Parcel Number: 03-26-21-0120-00000-0840 Book: Section: Name: MONTALBANO, MICHAEL Address: 6449 HUNTINGTON DR ZEPHYRHILLS, FL. 33542 G N ZEPHYRHILLS ELECTRIC SERVICE CHRIS BAHR PLUMBING BAHR'S PROPANE GAS & A/C, INC. ~ o--IS \6\ ~\r \\'0-\8 t' 1 0 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. REINSPEcnON 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. /lliJc,,- ~ ~uz [?;kR- . I CONTRACTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE 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 OWNER'S NAME DA~~ RECEIVED :s- - 17 -' ~ ''\ "PRONE CONTACT FOR PERMITTING "If Ie. Ii ,4C: l.- ,#t/ U r fit.. ~ PRO';" (;; 7..~-q<l<l Z- ~4'-/9/ftJNr/M:; -7dA! ;Z;.elt/E- ~::--......_.......-- SUBDIVISION SolOC OAt5 ) JOB ADDRESS LEGAL DESCRIPTION: LOT(S) BLOCK PARCEL ID # tJ;3-O?'- -t?lI-O/dlC) -tJtJtJtJo -8~~() (OBTAIN FROM PROPERTYTAX NOTICE) WORK PROPSED: 0 NEW CONSTRUCTION ~ADDITION DALTERATION o DEMOLISH o REPAIR o INSTALL DSIGN o MOVE PROPOSED USE: ~GL FAMILY DWELLING o COMMERCIAL DMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER c=J RESTAURANT &.HEALTH DEPARTMENT APPROVAL \ KE'l:i. ~- DESCRIPTION OF WORK fJrf)'f)i TfDf'J ()~ or::hcL. t;ArH~ 'r: .$rorzA6e BUILDING SIZE 301 'f.. /3..31 SQUARE FOOTAGE 3q1 HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. & (1) SET ENERGY FORMS. FORMS. PERMITS REQUESTED /" rJOl/ j f:iZl BUILDING $ 55, C(75.00 VALUATION OF TOTAL CONSTRUCTION 1i?1 ELECTRI CAL AMP SERVICE ~ Progress Energy 0 W.R.E.C. QJ PLUMBING ')- ~ MECHANICAL ~,OOO - $ VALUATION OF MECHANCIAL INSTALLATION o GAS ~ ROOFING o SPECIALTY 0 OTHER TYPE OF CONSTRUCTION: pi BLOCK 0 FRAME FINISHED FLOOR ELEVATIONS hlA--r'CU ~{$f 1t...Xc o STEEL o OTHER IS PROJECT IN FLOOD ZONE AREAD YES pi NO SIGNATURE fr~ COMPANY G.L.'s-relG- p,/ .'., -' STATE CERT OR REGIST t ~. e.02-Z-f39 ***** ************************************************************ _1C6r;",,,,'V' BUILDER ELECTRICIAN COMPANY iJ.UW!lL& ~~~ SIGNATURE ~~~ STATE CERT OR REGIST # ()Qe~t~6'" ()C G ;ttC9\r ~l T'f.:1h /:.. ~ ****************************************************************** I ~ ~ PLUMBER /J ffrl#/f /};(/ / COMPANY Q~S 61}jJf.- Pt.-vm6/,oG SIGNATURE(~ .: 0. ~ . STATE C~RT OR..REGIST *. Q..Fc...I~Y.f1-- . _ ." c..,',V .:t:t"1{.p ~ MECHANICAL ~gpU"'''':::/''''UUU'''UUU~~~;~~:'~;:'''~A~'GM € Ai c.lbY SIGNATURE _~ STATE CERT OR REGIST # (l.At..O~~ - - Q.{lY tF( ***************************************************************** OTHER COMPANY SIGNATURE STATE CERT OR REGIST # 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 cormnencement. 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 cormnenced 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 cormnenced 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 cormnenced. 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". 4(/-,,/..>> )Q'~ f;; 4- ~--k..-- SIGNATURE: OWNER OR AGEN STATE OF FLORXDA COUNTY OF ~To~~J! The foregoing ins~ment was acknowledged, f, Befor$1l!le thi~3 day of '-/JJc{>Ld- , 2~ . bY~~ I f.' U ",""l.J~ (name of per~on acknowledged) Owho is personally,knowm tome, or Otwho has produced I/triuA- ,I1.L:"t...lvl /L~' (type of identification) ~Ddid ,I!lff-d not take an oath. . ~ ~.~ ~l/L.;PU-J Signature of person taking acknowledgement ""'v~ Ruth 0 Forrester ,.,_'~"~" 1'\.6 Mr C8m~i8aieFl Q9']i~12 'CI~' i'I./~" Name type~?'Ji.lIE~$r~A'?gUstb~~ed ,/A'~?~ ~ ~'i;;23~~} '~ur~ SIGNATURE: CONTRACTOR STATE OF FLORIDA 0 ASc..O COUNTY OF --L- The foregoing ins .rument was 1\~A!gowledge<? ( . Before me 'his . f'hday of , 20 ~ by ~ '(name of person acknowledged) C1ho is personally known to me, or ~WhO has produced ~ ~ (type of identification) and who Odid ~~d not talJr an oath .QJ) 0 A. ,0.. 0,. a,.,&"J: Signature of person ta g acknowledgment G~f.Jb,' f\;. Slk~P'1-K1J eU:NDA M. SHEPP MY COMMISSION # DO 2Niifue EXPIRES: May 15,2007 Bonded Thru Notary Public Underwnters typed; printed or stamped G ,L s"n~V)~ ( '-N <:)-r. G., 'i lfCf li\)NlIl'!~~rJ .square Feet 3cp Valuation Building Electrical Plumbing Mechanical ~Do~ ',I"" 1't( ~L~c ' .~ 176~~O ~L5C -- ,~ ~) \ ~ ,.. ~~ ? )\. ....., U' "\ 7. ,\oJ Connection Fees Sewer Water Meter frlA School Impact Fee tJ )f1 , , Dollar Amount Transportation Impact Fee N }fJ Park Impact Fee N Jyt Public Safety Impact Fee N )ff 1tGC Community Association 6000 Silver Oaks Drive Zephyrhills, Florida 33542 (813) 779-2844 April 1 7, 2006 Mr. Michael Montalbano 6449 Huntington Dr. Zephyrhills FL. 33542 RE: DRC Number 2000-323 Dear Mr. Michael Montalbano; The Design Review Committee received your application dated March 29, 2006 to have an addition added on the back lift side of your house as submitted with the plans on your DRC application. The Design Review Committee and Silver Oakes Board has approved the application as specified in your request. The Design Review Committed will retain the original application and any other documents you sent over for your project review. We appreciate you completing the application process for the Design Review Committee. If you have any additional questions, please feel free to contact me at 813-780-9751. Thank you, _(l)~ William Cregg 7 Cc/DRC: 2000-323 1111I1111111111I111I11111111111111I1111111111I11111I11111111 2006101823 State of V!{rL:ctc-~ NOTICE OF COMMENCEMENT County of AxJ (!-L~' THE tmDERSIGNED hereby gives notice that improvement will be made to c~rtain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencemcnt: '" 1. Description of Property: Parcel No. tJ.:5-..<? -.;2/ -0/,70 ~.ot:l OOt1 _Ij 8' 4/0 Cit.VEIG tJ~~5 P.II.-?S - tf,.tle L.GlJ ff -~ #~ /'ItJ..v roh d>e. (Legal descr~pt~on of the property and street ad ress ~f ava~lable) 2 . General Description of Improvement A-b b/ 7f oU C 6Yo~ L C);:::- &t7i-f. c F/::::'/cC Rcpl: 999162 Rec: 10.00 DS: 0.00 IT: 0.00 05/17/06 Dpty Clerk 3. Owner Information: Name .d(/C.J-I,,!CL RtJ.(J,/ ,#L--34..<JtJ l~ddress ~~i.(<J /!OJJT///4 n,d ;7Jz, City "i?6P#YI2.#>Lt..~ State ~L ~~~I Interest in Property: tJ WAlE IC.. ~ Name of Fee Simple Titleholder: (If other th~n owner) JED PITTMAN PASCO COUNTY CLERK 05/17/06 03:2~m 1 of 1 OR BK 699~ PG 1828 Address City State - R. -: Contractor: Name C;. L. -5"T~ &PCS7 Address 37C:>5;/ f-rt..l- /1V City 4y~v;ct.J((_.c../ 5. Surcty: Name State ~ .33.s:-y 2 Address City State Amount of Bond: $ 6. Lender: Name Address City State 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)(7), Florida Statutes: Name Address City 8. In addition to himself, Owner designates State of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. 9. ~xp~rntio~ dfite ot Notic~ of Comrnencern~nt (the expIration date is 1 year rr~m the date of record~ng unless a d~fferent date is specified.) Signature of Owner: ~UkL~~",,_J, ~.~ Sworn to and subscribed before me this ,;(.3::J.' day of 777al.cj~ -M ,{JDC& . NotLlry Publ ic : G:?~~~; - / Sfi-1kC My Cominission Expires: PC9305304~ J'~' ~ Ruth 0 Forrester . \f..; My Commission DD138462 ......0 E)(Dires August 01 2006