HomeMy WebLinkAbout07-6379
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6379
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
6379
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 5221 SHADY REST LN
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 10-26-21-0010-09900-0000
4,641.00
1/18/2007
55.00
55.00
1/18/2007
REROOF
Name: CURRIER, JACQUELINE
Address: 5221 SHADY REST
ZEPHYRHILLS, FL. 33542
Phone:
I. ):n
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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.
~.r~~ ~~
' /?~/// ,f -.4 'j' -
CONTRACTOR SIGNATURE PERMIT OFF I
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-7!lU-UU~1
Date Received
ff(P 311
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Fee Simple Titleholder Address I
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
B
D
D
L- LOT# I
PARCELlD#IJo4"-dC ~d-I ~(9/>/O - cF,9~~ ..-o~
(OBTAINED FROM PROPERTY TAX NOnCE)
ADD/ALT D SIGN 0 MOVE 0 DEMOLISH
REPAIR
COMM 0
FRAME 0
~-J-. J
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E1
PROPOSED USE 0
TYPE OF CONSTRUCTION 0 BLOCK
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DESCRIPTION OF WORK f2.t?-,,~
~~:~~~~,~~~~"..,I",."" ..",..,.. .""!",, ,~~;,~~:~~~!." 7~.~,~., ~~~~~. ,I.,:'~~""""~""",, "'" """ '"
D BUILDING 1$ if; 7"/- I
1$ I
1$ I
1$ I
D GAS ~ ROOFING D SPECIALTY D OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
11111111111111111111111111111111111111111111 ! 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
BUILDER I~ - / / /' ,./ I COMPANY [,1;1 #,.dr M-~t J.~
SIGNATURE / ;/,/"v'/'/'-> /--z:k/ ~ REGISTERED V N I FEECURRENT(~N
AddressY?DS-ffv./~~'~ I?/t..rj ~~ JJ7t~icense# I((//sd/'~~ I
I ;::,= I VI N FEECURRENf V IN I
I
I
I
I
I
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I
SIJBDIVISION
JOB ADDRESS
OTHER I '
STEEL 0
OTHER I
VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL
AMP SERVICE
D
PROGRESS ENERGY
o
W.R.E.C.
D
D
D
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
~\.) c.)
PLUMBING
ELECTRICIAN
SIGNATURE
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
YI N
FEE CURRENT
Y/N
Address
License #
COMPANY
REGISTERED
MECHANICAL
SIGNATURE
Y/N
FEE CURRENT
Y/N
Address
License #
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
111111111111111
RESIDENTIAL
License #
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-Q-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence Installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence Installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
COMMERCIAL
SIGN PERMIT
DI~~~ti~~~': . . . . .. . . . . . . . . .. . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. .. . . . . . . . .. . . . . . . .. .. . .. .. . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . .. .. .
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (Ale upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
Driveways-Not over Counter if on public roadwaysuneeds ROW
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N~TIGE 017 DEED RESTRICTIONS: The undersigned understands that this permit may be subject to lideed~ -
, gien tt1ay,-lj~ more restrictive than County regulations. The undersigned assumes responsibilitY for complia
PHIi~.~ -' '""' ,es,trictions. -
bla 'ONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a con
9.el"take work, they may be required to be licensed in accordanceWith.st~{&~!1dl~c~l/r~!'ul~Ua6~ti:Hf.'
'Ii,qensed as required bylaw, both the owner and contractor m~Yb~dt~~J~r.~.roJ~9~<, ~t
;xlf the owner or intende~ contractor are uncertain as to whl:lt.lib~iising,t~~4i.r~rn~nt~"" ""', ' ,', . ,'.,. .,.ri
"'" l/,":y.are advised to contact the Pasco County Building InspectlonbiViSiortM-Lic~nsiDg,~',~t.?t~7~,~"
",J)~;"2.",,;.-re, if the owner has hired a contractor or contractors, he ,isadvlsed,to".havetl1ei"" .",.",att()r{~)~igtl
p~tti()ns"-ftH~h~.~~ritractor Block" of this application for which they will be responsible; ilyou, asfhe~\}Ji'i~rsig~ ~s. tHe.] "
,-'bmf~c.Jpay be an, indication that he is riot properly licensed and is hot entitled to permitting prrVilegeslnj:)asCo ,', i
.~u~tYc';.,' '" ,,'., " , " "".' ",' ",.". t
RAN~e~c~""ti~,N IMPAGTJUTILlTIESIMPACT AND RESOURCE RECOVERY FE,ES: The undersigned understands')
,.,MtTtf19~P ~tllmpact'F,res and Rec~>urse Recovery Fees may apply to the construction ofhewbuUdings,t::hange()f
'4~~m,~xis, ", 'ings, obexpanslon of existing buildings, as specified in Pasco County Ordinancel1ymber 8~~oj ahd
:~9:~071.aSt:lri1)... ~ The undersigned also understands, that such fees, as may be due, will be Identified at tlie time of
p~tniltting.(lt,l~,.(yl"ther understood that T;ransportation Impact Fees and Resource Recovery Fees mUst be paid prior to
re?eivinga.?~~ifjeate of occupancy" or nnal powerrelease. If the project does not involve a certificate. of occupancy or
fin~1 power re'~~~e, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fe~s are due;J~~Wmust be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 113, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, fhe applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "oWher", 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'SJOWNER'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 government 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, 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.
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 ~hat a s.eparate perm~t may ~e requir~d for elect~ica.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallatlons not speCIfically 1n~luded. In the application. A
permit issued shall be construed to be a license to proce~d With the work a~d not as authorl~y ~o vlol~t~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~".dlng OffiCIal from the~eaft~r
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 th~ work is commenced: An extension
may be requested, in writing, from the Building Official for a period not t~ exceed n1n~ty ~90) da~s and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the Job IS 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 COMMENCEMEN~ d
FLORIDA JURAT (F.S. 117.03) ~~ ' ~ / ~
OWNER OR AGENT CONTRACTOR -7.) ~
Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or armed) beftSre me this
~ ~
Who Is/are personally known to me or haslhave produced Who Is/are personally known to me or has/have produced
asldentiftcaUon. asidentiftcation,
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
f ~J;\'IA; -(""
ALL FLORIDA WEATHERPROOFING "-STEVENS
AND CONSTRUcnON, INC. ~..~........._.
4301 Grand Blvd. . New Port Richey. FL 3t652
(817) 572.-1019 · Fax (727) 572.-5670 GEN-FLEX
. J AN 1-5 2007 Stale Certified LicenseJ CCC1327406 ,
>, .' Cu Mdr.fV' ~/l7 ~,.'O l ~)...
aw"sr(JVPurcha&ef(S): G trio ~. ct'J4c..qvd'r'rphone:{ji) 'Jif' ~ (e) , "
__Address: {;""2.~1 S , r:~ ZLphp.yI/7'f:!ount'i Ilrft:.b SlaleF:Lz:J-:J5t/%.~
\fOrcle:SB-MHPlcommunilyName: ~Jr ' Lot 1#:
Alternate .e.ddren: City:;J <<flHr Zip: _ "'hone:
IfINe, Ihe Owner(s)/purcllaser(s) of the premises described below, hereinafter reltrl1ld \0 as "Purchaser" oller to conlr8Cl wilh ACCURATE ROOF SYSTEMS.INC.,
hereinafter rererred 10 as 'ConlraClOr" to furnish. to deliver ami arranoe, for installation of all malerials necessary 10 Improve the premises located at:
JolJSlte Address: ~~, City: SIIIe: -Zip:
aecording to the following wri n specirlCllions: ,
I
\
... ~,J f.~
saUD WHITE MEMBRANE: BRAND Cl SHINGLE-LOOK MI!MBRANI!: BRAND & COLOR
Cl OTHER:
1. PROVIDE ENERGY-SAVING INSULATED WATERPROOFING SYSTEM FOR THE FOLLOWING AREA(S):
y'~
CUSTOMER
INITIALS FOR
SYSTEM
2. INCLUDE ENERGY-SAVING DOUBLE-FOIL FACED INSULATION AS INDICATED:
. GOLD: DELUXE 1.1/4" INSULATION 0 SILVER: 314. INSULATION 0 BRONZE:.!::lQNE:
3. INCLUDE NEW SPUN ALUMINUM VENTS: ~SMALl.. ....k.LARCE', ,
4. INCLUDE UP TO 100 SQ. FT. Of NECESSARY DECK REPLACEMENT. ADDITIONAL. DECK
REPLACEMENT TO BE INVOICED SEPARATELY AT $2.00 PER SQUARE FOOT.
5, INCLUDE ALL REQUIRED PERMITS.
6. CLEAN UP AND REMOVE ALL JOB-RELATED DEBRIS fROM JOB SITE.
7.. MAIL. OUT UurrED UFETlME, No-LEA~, TRANSFERABLE: WARRANTY'FULLY COVERING ALL LAIIOR AND MATERIAL.
(SSO TRIP FEE MAY APP!-y) .
a. ADDITIONAL INFORMATION:
lIIIt1N MIL JUlIIlIB or.... 1JIUIIf ~ MI
~. NUS "Dr' 1111 aIlIlU to _ CDlIBIlIm.
IlRDB "arm"" a.M1D8 .. 20 _ CIlIlIIIIIID.
9. IT IS UNDERSTOOD THAT THE FOLLOWING AREAS WILL NOT
BE INCLUDE;O IN THE COVERAGE PROVIDED BY TfII~ _'~
AGREEMENT (Also See Drawing at Right): f#JI!.4 .~
ANo A-W/J'tV7 t Clt1l-lmYJ' ..
C~l-- It Sit!'
. OTHEANOTES: I~o. 60 low,) ~trNCr:.... .\
() F ' "3 'f 'J, S 7 RA-tttrllk.. P /Jo.U ",,,,1(
fit.-II ftI"'7IJ "itio IlKi.........F ~~/r.1I1 .
1) .. LOt L., ,). n.. ~(J7 . '
NOTE: RETJUL SALES TAX MUST BE CHARGED UNLESS THE CUIITOIIIiR SIGNS THE FOLLOWING:
I certify that I -. "'. land an which _ e\rualure I 8m impraving Ie .............1Iy .11_. Further........ I he". filed ill chlOIarilltiOn
Mlh tnlI Properly AppfaiHr r&qll8Sling !he structure be.-.eel as realty and It beans an "RP' decal.
I~
INITIALS
SIGNATURE:
O. FfICc. (JJIlI ~NP INtJ01 C( Fl1TL EJ'r<~ '(Jtt-q~,..
The CASH CONTRACT PRICE for all Labor & Materials Qncluding. any applicable diS(X)Unts) is $
lerms: 0 CIsh 0 Credit (subject \0 the approval 01 the Credit Sales Depenment) Sales Till $ '3 '2.'l 8' 1
If this ie a each tr.antAOlion. tho purchtICC p~ ~ ~d O~ followll: ~ 'f f'- "'7 4 91.. Q 1
Cash down Paymenl (Minimum 33%) S , j) BIIl1nce Payable S C>~ . , lowl Price S If,} . ·
If this i$ a credillrlnsaclion, the agreement edA n\lined in I llparate documenl'wtdCIIIs InCOl'\lDllllld he!ltl by reference' and made 8 paifthereOl.
Ime undersilll18d are hereby authoriZlnO ALL FLORIDA WEATHERPROOFING ANO CONSTRUCTION. INC. 10 VlIriIy ,1llCI review my/our cred1t reCOIlI with an Inde-
pendenl crlldit f1lllOrtin9 a9llncy and ,._ l/wm frum .. lilIbilily incuning from il18lMltelll cmiUiOllS tit errors.
Verbel undarstandil\lls and agreemenla with repreeenlltives shall nol be binding. All underllandings IIlCl ~Imenls must be set fot1h in writing In this
Contract. ADDITIONAl.. PROVISIONS ARE STAlED ON REVERSE SIDE AND ARE PART OF lHIS CONTRACT.
UNLESS OTHERWISE SPECIFIED. IT IS UNOERSTOOD THAT THE OWNER(S) IS/ARE READY FOR THIS WORK TO BEGIN. THE PURCHASE PRICE
QUOTED ABOVE wa..L BE HONORED ONLY UN11L . Purdlaser(s) unclIrIllIlKIs.nd ._1hat If this agreement Is cancelled after \he
rescisIion period, the Purclluer is IIIble for twenty rMl percent (25%) of \he toIIIules prlCll es dImIges \0 tie Contr1IctOt. In \he to8IIt this oIfer III eonlrlCl is
nollCQllPled by COnlrIcIor, any payment madB hereunder shall be refunded III \he Purehaler(1) and this pIO}IClIIlIl shall be null and 'oI'<<*I.nd of ng ehcl.
ConlrKb' IS not lWIponIible lor eJiIIing Ilructurll defecls. dry rot or othlr faclols ~ our eonlnll. No ~inng, plallll\nll. painIng, carpentry, or cIecIIr8l-
inO is incIudad unless specifically dWged forlnd spedfil!d in wrting herein. PurchaSer avees \0 IllIY the 1011I Prlce iA full upon InsIiIUIlIcJn unless otherwise
8liraed to in writing. lfintllll8liOn is stilled but not compItled the $11II1 day and tilt partieslglte thal~" ..lion ill not completed. Purchaser may withhold
fO'll. of the TolaI f'riGe until instaIllllio" b c:ompIeled.' ' (J 7
INWITNI!SS WH!W!OF P~) IIavehlNutltD aignlld lheirll8llll(s)1IliI tD day of ' I'r /J 1/ ~ 20
~!!~C!!!'.!!PJ!)_ J!.- co of~~nt..!!C.!:-_______________________,
I _ ~- 7 ~L-, III ~I-IO-~
I SUB I Date A Y: PurehUerlOwner DaI8
I ' I
~~E~~8Y~~~S~~~~~___~____~C~~D~:P~~~_____~I~__J
"/"1//. tJl)
Parcel Information for: 10-26-21-0010-09900-0000 Card: 001
Page 1 of2
$~<::lIQh8g9jD Show Map Generalized Building Schematic Estimate Taxes
Other Parcel Cards: 1 I .2 I .3.
See Tax Collector Information - Current/Delinquent Taxes Frequentlv Asked Questions
PatcellEE::f 10-26-21-0010-09900-0000 (Card: 001 of 003)
Classificati 28 - Rental MH/RV Park
Mailing Address Assessment (totals)
GROH MARIA GABRIELA Ag Land $0
PO BOX 1931 Land $217,980
ZEPHYRHILLS, FL 335391931 Building $60,245
Physical Address Extra Features $3,539
37828 LAGOON CT
ZEPHYRHILLS, FL 33542-1400 Total Assessment $281,764
legal Description (First 4 Lines) Save Our Homes $0
ZEPHYRHILLS COLONY COMPANY Taxable Value $281,764
LANDS PB 1 PG 55 TRACT 99 LESS
RD & PORTION TRACT 98 DESC AS
COM SW COR TRACT 98 FOR POB
Land Detail (Card: 001 of 003)
line Use Description II Zoning U Type Price Cond I
1 0210 TRLR PARK 00M2 1.00 UT 15,127.00 0.98 $14,82
2 0219 TRLR PARK 00M2 13.00 UT 15,127.00 0.98 [$192,71
3 0219 TRLR PARK 00M2 3.00 UT 15,127.00 0.23 $10,43
Additional land Information
Ac . ...." .. ~OZH I ~~~: 181 Res Code IIRMHPCL211comm cOdel RMHPr.I?
Building Information - Year Built 1953 USE 77 - Clubs, Lodges, Halls (Card: 001 of 003)
Ext Wall 1 Average Ext Wall 2 None
Roof Str Gable or Hip Roof Cov Min Roof(Corr. or Sh M)
Int Wall 1 Plywood Panel Int Wall 2 Drywall
Flooring 1 Cork or Vinyl Tile Flooring 2 None
Fuel Gas Heat Convection
AC Window Unit Baths 1.00
Line Description Sq. Feet Repl. Cost New
1 CAN 120 $1,318
2 BAS 768 $28,116
3 FCA 264 $1,940
4 APT 756 $22,149
Extra Features (Card: 001 of 003)
Line Description I Year I Units I Value I
1 t::HUFFLE 8iEj 960 I $720 I
2 UDU-M 1971 I 3 II $135 I
Sales History
Previous Owner GOODMAN AUGUSTE A
Year II Month Book I Page II Type I Amount I
" , II U ,
http://appraiser.pascogov.com/searchloffline _ tca.asp?Sec= 1 0&Twn=26&Rng=21 &Sbb=O... 1/18/2007
NOTICE OF COMMF.NCF.MENT
Permit Nu.
Stilte> of FJnri~
Count\- of ' $' C6
. ,
11111111111111111111111111111111111111111111111111I11111111I
2007010475
Rcpl: 1066257 Rec: 10.00
DS. 0. 00 IT: 0. 00
01/18/07 Dpty Clerk
JED PITTMAN, PASCO COUNTY CLERK
01/18/07 01: 57pm 1 of 1
OR BK 7354 PG 82
l~pared h~.'~:~ -#L~/
--4.:UU;JJl(b/J&.\k~CIS...1I..-~
THE I.JNf)[RSIGNEO hereby ,;i"e'I "otic,," thClt th~ impm,.ement will
be made to certi'in real proper-ti. in acalrdance ,,;th Chaptl'r n:t Florida
Statute,;, the fnUowin,; informatiun i~ pn.l\'ided in the Notic~ of Cc'm1mPnl"'Pl"l'Umt. .
1. Parcel tdcmtificatjonNumtlE-r /p.- d? -J/ -top/&, -O~,ttfLJ -~OOO
2. Description of property ft'lt6~ #/Jd.
3.GeneraJ description of impnwemenbi ~~
..
&YIJ~ /451-14 q~~-0'
. ;:-/ J JS-LjJ-
c) Name and add~ of simple title hold." (if oth_ than owner)
-----
-----
~Owner_dan ~ ~ ~
a) Name a~ address 'a-W::::: Y' /~
b) In~t m pcvpvrty ~"~c::.
~
5. Contractor (name and add~) All Florida Weathetpmofll18 and Construction. Inc.
.'.L"VJ1 c....nd BI...-d NPR M.. ~'i2
Phone: (8m S?2-10t9 Fax l1271 572-5670
" CCC1321406 .
6.Sun:ty
a) Nallur and acldress
b) AmQunt of bMd
-----
----
7. Le!\der (name and add~~) ___________
'. 8. Person within State of Florida daignalled .".. ~ upon who nolica; or other dacwnenta aut)' be
served il5 provided by Section n3.13~, flOrid, a Stat\te5.
Name and addre;!;: _______
9. In addition tel him or herself, owner designates '~f "--
copy 01 thv Lienors Notic:p l'l~ provided in Seetinn 713.13(1)(b), Florida S14IUlo::'.
to NCeive a
10. Expiration date of Nntic;e of Commencement (~ expiratiun date i5 one year
frctm the date ,'f rt.'Cnrdlng untc" a different date is $pedlied): .
C),..t!r~/lP,e $ ~
. &rgna f Owner
The following jn!=trument W"a.c aCknm~.ledSed before me this/ P day of J~
L/",J d? ~ .p4 ',.ho ill personall:r known to me o~ who produced
as identifint~(ln.
.2~bY
, o-L
.., NlIc - StIlt d florida
CammIIsIon Expits ~~, 2010
Commlssion.'J>D ~69326
Bonded By Nati,C?f\ii Ne:,," ~ssn