HomeMy WebLinkAbout08-6749
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813}780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
6749
Permit :6749
Permit Type: ALUMINUM
Class of Work: ALUMINUM PACKAGE
Proposed Use: MOBILE HOME SUBDIVISION
Sq. Feet: Est. Value:
Cost: 23,345.54 Total Fees: 260.00
Amount Paid: 260.00 Date Paid: 6/04/2007
Address: 7806 KAY MARIE AVE L
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: GRAND HORIZONS
Parcel Number: 34-25-21-0180-00000-3200
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SLAB
RAISED SLAB
DRIVEWAY
FRAME
ELECTRICAL ROUGH
1 ST ROUGH PLUMB
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 noti mencement."
... '12 _ ~
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SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Site:
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Contractor/Homeowner:
Date Received:
Permit Type:
Approved wino comments1
Approved withe below comments: 0 Denied withe below comments: 0
This comment sheet shall be kept with the permit and/or plans.
G ,- I-Oj
Date
Kalvin Switzer - PI s
Contractor and/or Homeowner
(Required when comments are present)
o 1,)-/ ou-vu,u
~lty or Lepnyrnllls r'ermll AppllCallOIl
Building Department
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Date Received
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Owner'sAddress I'~,-\~~~\(\~\~Q\\
Fee Simple Titleholder NamJ
Owner Phone Number
OWner Phone Number I
OWner Phone Numb~r I
OWner's Name
JOB ADDRESS
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Fee Simple Titleholder Address I I
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INSTALL REPAIR
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SUBDIVISION
WORK PROPOSED
PROPOSED USE
TYPE OF CONSTRUCTION
DESCRIPTION OF WORK
BUILDING SIZE
BUILDING
~LECTRICAL
VALUATION OF TOTAL CONSTRUCTION
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~. AMP SERVICE D PROGRESS ENERGY
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VALUATION OF MECHANICAL INSTALLATION
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SPECIALTY D
FLOOD ZONE AREA
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DYES
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FINISHED FLOOR ELEVATIONS
PLUMBER
SIGNATURE
COMPANY
REGISTERED
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License # I \~ 1 I
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FEE CURRENT
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Address
License #
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/ N
FEE CURRENT
Y/N
Address
License #
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RESIDENTIAL
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date. Required onslte, 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 onslte, 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
I I ~ I . . I I I I I I I I ~ I I I I I I ~ I ~ I I ~ ~ I I I I I I I I , I I I . I I I I . . . .. I I I I I I I . I I I . . I I I I I I I I I . I I I I I I I I I I I I I I II I I I , I I I I I I I ~ ~ ~ ~ I I I I I I I I I ~ j I I I I I I I I I I I I I I I ~ I II I I I I I I I , I I I I
Directions:
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 NC Driveways Fences (Plot/Survey/Footage)
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 Lien 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 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 "N, 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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INYOUR
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.
FLORIDA JURAT (F.S. 1 03) ,l1? /
OWNER OR AGENT CONTRACTOR ~ ~ ~ I
Subscribed and 5 m t or Subscrlbed~ sw . t ffI ) befoIflAll,th~S'() \ , ""-=--,
~y c-....~, lby )~ ~\l)
~ Who iSlare pEQQ.nally known t e or h rodu~ed
s Iden Iflcallon.
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i""'ft"~, Nota,ry Public State of Florida
. ftllss88rfHi
'\; ..'oi My Commission 00463268
OFf\: Ex I
ame 0 mped
B & H CONSTRUCTION OF CENTRAL FL, INC. l-MHI
C 5/15/06 4025 MORRIS BRIDGE ROAD A 2/27/Oi
FREE ESTIMATES ZEPHYRHILLS, FL 33543 1-800-224-1206
**LICENSED * BONDED * INSURED * SKIRTING * STEPS * ROOM ADDITIONS * ALUMINUM * CONCRETE**
Lot #: 320 Subdivision: 7806 KAY MARIE AVE GRAND HORIZONS Date: 4/23/07
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Lap Siding Color: GLASS ROOM WAILS
Home Serial #: Walls + + + = 0 L/F x $0.00
- - - - -
Home Model #: R System Insulated x = 0 Sq. Ft. x $3.20 $0.00;
- - -
Beam Color: Glass Door. . . . .. . . . . .. " . . .. .. . . . . . . . EA x $357.00 $0.00
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All aluminum roofs include: Pans, Trim, Gutter, Down Hand Railing. . . . . . . . . . . . . . . . . . . . . . . ... L/F x $22. 13 $0.00
-
spouts, 3x3 Posts, and Flashing. Step Railing........................... 2 EA x $92.85 $185.70
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49 Pans ~ Ft. Long 931 Sq. Ft. x 4.04 - 4.64 $3,761.24 Garage Door. . . . . . . . . .. 6 X 7 I EA X $492.00 $492.00
- - - -
Pans Ft. Long 0 Sq.Ft. x 4.04 - 4.64 SO.OO Garage Door Header 2 x 6 I EA X $100.00 $100.00
- - - - -
Pans Ft. Long 0 Sq. Ft. x 4.04 - 4.64 SO.OO Garage Door Opener x EA x SO.OO
- - - - -
Pans Ft. Long 0 Sq. Ft. x 4.04 - 4.64 $0.00 Misc: $0.00
- -
Valance. .. .. . .. . . . .. . . .. . .. .. .. . . .. 62 L/F x $4.96 $307.52 ALUMINUM TOTAL $9,304.69
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Gutter on Home...... ... ......... 49 L/F x $5.42 $265.58
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Beam Work 1 x $157.96 $157.96 CONCRETE AND BRICK WORK
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2x4 SM Beam..................... 29 L/F x $4.36 $126.44 Patio Slab... . .. .. ...... 12 X 18 = 216 Sq.Ft. X $3.21 $693.36
- - - -
2x6 SM Beam..................... 70 L/F x $6.09 $426.30 Patio Slab... .. .. .. .. ... 23 X 18 = 414 Sq.Ft. X $3.21 S 1 ,328.94
- - - -
2x7 SM Beam..................... L/F x $6.58 SO.OO Patio Slab... .. .. . .. .. .. x = 0 Sq. Ft. x $3.21 SO.OO
- - - -
2x8 SM Beam..................... 36 L/F x $8.96 S322.56 Patio Slab..... .. .. .. ... x = 0 Sq.Ft x $3.21 SO.OO
- - - -
2x9 SM Beam...... .. .. .. ... .. .... L/F x $9.72 $0.00 Side Walk.............. x = 0 Sq. Ft. x $3.21 $0.00
- - - -
2x 10 SM Beam... .... .. .... . ...... L/F x $10.62 $0.00 Driveway... ... ......... 22 X 18 = 396 Sq.Ft. x $3.21 $1,271.16
- - -
Carport Gable Framing.......... x $102.00 SO.OO Driveway Flair. . . . . . . . . 7 X 22 = 154 Sq.Ft. x $4.82 $742.28
- -
SCREEN ROOM WALLS Raised Utility.... .. ..... 1 1/2" I 4" x $34.60 $34.60
- -
LapKP ~+~+~+_ = 36 L/F x $33.63 $ 1 ,210.68 Raised Patio 6 C- 12 X 18 = 216 Sq.Ft. x $9.74 $2,103.84
- - - -
Screen Door Includes: Raised Patio 6 C- x = 0 Sq.Ft. x $9.74 SO.OO
- - -
Closer and Threshold.. . ... ...... 1 EA x $103.59 $103.59 Over 6 per ft per - 42 X 5 = 210 L/F x $3.04 $638.40
- - - -
Gable Fill one Side............... L/F x $16.71 SO.OO Footer 8x 12 Reinforced...... . . .. .. 23 L/F x $5.53 S127.19
- -
Insulated Kick Plate.............. L/F x $3.92 SO.OO Footer 12x 12 Reinforced.... .. .. ... 36 L/F x $7.76 S279.36
- -
Fan Beam (not wired)............ EA x $68.66 SO.OO Skirting Footer. .. . ..... ... ... . . . ..... 101 L/F x $4.28 S432.28
- -
Misc.: SO.OO 1 Tread Step.... .. .... .. .... .. .. .. EA x $110.12 $0.00
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UTILITY ROOM WALLS 2 Tread Step..... .. .. ...... ....... EA x $221.59 SO.OO
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Walls 12 + 12 + 12 + 12 = 48 L/F x $37.19 $1,785.12 3 Tread Step... .. .. .. .. .. . .. .. .. .. 2 EA x $333.22 $666.44
- - - - - -
2x4 Studs 16" OC 4x4 Stoop......................... EA x $284.52 SO.OO
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Shed Door and 1 Window....... EA x $166.20 SO.OO Brick Skirting Max 5 High
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Single Window (Extra)......... o. J EA x $60.00 S6O.00 Split Brick Air - L/F @ Courses x $2.52 SO.OO
- - -
Bug Shield......... ... .... ..... .... L/F x $5.22 $0.00 Split Brick Solid 136 L/F @ 9 Courses x $2.75 $3,366.00
- - -
Double Shed Doors........ .. . ... EA $ SO.OO Fill Dirt... ... . , . , ..... ... . . . ... . .. .... II Loads x $140.00 SI,540.00
- -
Gable Walls + + + = 0 L/F x $43.31 $0.00 Pretreat.. .. . .. .. .. .. .. .. , .. . . .. . . .. . . . .. .. . .. . .. . .. . . .. .. . $100.00 SIOO.OO
- - - - -
VINYL ROOM WALLS Misc: SO.OO
Vinyl Wall.......................... L/F x $51.34 SO.OO Lot Grading... ............ ...... ..... 1 x $357.00 $357.00
- -
Inside Kick Plate................,. L/F x $5.93 SO.OO NOTE: According to the FL Building Code
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Lap Top Inside and Out. . . .. ... .. L/F x $15.40 $0.00 a crack is not a structural problem until it
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Florida Glass. . . . . . . . . . . . . . . . . . . . . . L/F x $10.27 sO.oo reaches 1/4" in width.
-
Insulate Top and Bottom........ L/F x $5.49 $0.00 CONCRETE $13,680.85
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Doors include (2) 2 Track Units SIGN: ALUMINUM $9,304.69
Threshold and Closer. . . . . . . . . . . . EA x $147.61 $0.00 DATE: PERMIT $360.00
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B&H will not be responsible for any leaks FAX TO: 813-715-6585 TAX $0.00
in VINYL ROOMS X FOR ENGINEERING. TOTAL $23,345.54
---'-- All workmanship and materials are guaranteed for one year. A FINANCE CHARGE OF 1.5% per month will be accessed on aU unpaid accounts in arrears.
ANNUAL PERCENTAGE RATE of 18% plus anomey's fees if necessary to collect. ESTIMATES ARE ONLY GOOD FOR 30 OA YS.
LEONARD G. "GEOFF" WOOD, P.E.
4034 THE FENWAY
MULBERRY,FL 33860
(863)646-5517
Date:
05/02/07
B & H Construction
Zephyrhills, FL
Re:
Address:
2007 Jacobsen
7806 Kay Marie Ave
Zephyrhills, FL.
Mod. #: CH3 4403 B
Lot #: 320
Dear Sirs,
This letter is to certify that I have reviewed the above referenced
structure to determine the structural adequacy of the existing structure
to receive the attached structure. The proposed structure is roughly a
12x18 Raised Screen Room, a 12x12 Shed and a 18x23 Carport.
The existing mobile home, has been considered and is adequate
as a host structure, with the blocking and anchoring at 5'4". Based upon
review and acceptance of other structure to home per manufacturers
requirements.
As always, should you have any questions, please feel free to call
me at any time.
SZJ !1w
Leonard G. Wood
4034 The Fenway
Mulberry, FL 33860
I\LL WORK ShAL~ ("l' 'iuD~ ~~ILD~;;J
PREVAILING CODES, FLC~RlC CODE AN':J
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CODE NATIONAL ELECTRIC CODE AN~I
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Grailieot, load intensity and cros.ion characteristics of slope
MBterial .
1805 .4Footings shall be designed an constructed in
Allowable bearing capacity of the soil is not exceeded, and
That differential settlement is minimized. The minimum
Width offootings shall be 12 inches (305 mm)
Footings in areas with expansive soils shall be designed
In accordance with the provisions of Section 18D5. 8.
1805.4 ./1.1 Design loads, Footings shalJ be designed for
the 0l05t unfavorable effects due to the combinations of
loads specified in Section 1605.3. The dead load shall in-
clued the weight offoundations" footings and overlying
fill. Reduced live loads, lIS specitied in Section 1607.9.
Are permitted to be used in designing footings.
1805.4.12 Vibratory loads. Where machinery opera-
tions or other vibrations are transmitted through the
foundation, consideration shall be liven in the footing
design to ~cnt detrimental disturbances of the soil.
I &05.4 -2 Concrete footings, The design, materials and c0n-
struction of concrete footings shall comply with Sections
I 8D5.4 2.1 through 18D5.4 .2. 6 and the provisions of Chap-
ter lSOS.4-2.
Exception: Where a specific design is not provided, coo-
Crete footings supporting walls of light-frame construc-
tion are permitted to be designed in accordance with
Table 18D5.4.2
1805.42.1 Concrete strength. Concrete in footings
Shall have 8 specified compressive strength (f'c) ofoot
Less than 2,500 pounds per square inch (psi)(17 237 kPa)
At 28 days.
1805.422 Reserved.
SOILS AND FOUNDAAnONS
J 805.42.3 PJain concrete footings. The edge thickness
Of plain coocrete footings supporting walls of other than
Light-frame construction shall not be less that 8 inches
(203 mm) where placed on soil.
Exception: For plain concrete footings supporting
Group R-3 occupancies. the edge thiclmess is permit-
ted to be 6 inches (152 mm),provided that the footing
Does not extend beyond a distance greater that the
ThickneM of the footing on either side of the supported
Wall.
1805.4.2.4 Placement of concrete. Concrete footings
ShalJ not be placed through water unJess a !remie or other
method approved by the building official is used, Where
placed under or in the presence of water" the concrete
shall be deposited by approved means to ensure mini-
mum segregation of the mix and negligible turbuJence of
the water.
1805.4.2.5 Protection of concrete. Concrete footings
shall be protected from freezing during depositing and for
a period ofoot less than five days thereafter. Water shall
Not be allowed to flow through the deposited concrete.
1 &05.4.2.6 Forming of concrete. Concrete footings are
permitted to be east against the earth where, in the opin-
ion of the building official, soil conditions do not require
formin~ Where forming is required, it shall be In accor-
dance with Chapter 6 of ACI 318.
1805.4.3 Masonry-WLit footings. The design, materials
and construction of masonry-unit footings shall comply
with Sections 1805.4.3.1 and 1805.4.3.2. and the provisions
Of Chapter 21.
Exception: Wh<<e 8 specific design is oot provided, ma-
sonry-unit footings supporting walls of light-frame con-
Struction are permitted to b designed in IICCOCdance with
Table 180S.4.2.
1805.4.3.] DimeIWons, Masoory-wtit footing shall be
laid in Type M or S mortar complying with Section
TABLE 1805.4.2
FOOTINGS SUPPORTING WALLS OF LIGHT-FRAME CONSTRUCfIONab.c.d
WIDTH OF nnCKNESS OF
NUMBER OF FLOORS FOOTINGS FOOTING
SUPPORTED BY TIlE FOOTINGS'" (inches) (inches)
1 12 6
2 15 6
3 18 8
For 51: I inch = 25.4 mm, 1 foot = 304.8 rom.
a. Depth of footings sbalI be in accordance with Section ] 805 2.
b. The ground UDder the floor is permitted to be excavated to the elevation of the top oftbe footin8-
c. Interior-ctud-bearing walls are permitted to be supported by isolated footings. The footing width and length shall be twice
the width shown in this table, and footings shall be spaced not more than 6 Peet on center.
d. For thiclcness offoundation walls, see Section 1805.5.
e. Footings are permitted to support a roof in addition to the stipula1ed number oftloors, Footings supporting roof only
ShalJ be as required for supporting ODe floor.
( Plain cooaete footings for Group R-3 occupancies are permitted to be 6 inches thiclc.
. ~--.)
State of .. ~~
NOTICE OF COMMENCEMENT
~D
County of " .
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713, Florida Statutes, the following information is provided in
this Notice of Commencement:
L Description of Property: Parcel No. -\'&:)\..so, t5::;:~--'i ~i \ Q ~'-l~~ 3~(j
3-\ ~~~\-<~\C)~ ~~3~\.\
(Legal description of the property and street address if available)
2. General Description of Improvement3.. \. .~.~~ ~ C'~\\~ -\-
111111111111 1111I1111I11111 111111111111111 111111111111111111
2007095085
3. Owner Information: Nam~ ~~(~\ \- \\::i \ -C-N""\ '\\\\\ \)
AddreSS\\~ ~~~\'f Cit~t\i~\~ "Sta~'J)5:J4\
Interest in Property:
Rcpt : 1104243 Rec: 10. 00
DS: 0.00 IT: 0.00
06/04/07 Dpty Clerk
Name of Fee Simple Titleholder:
(If other than owner)
~E90~~~~M":er~scoICO~~Tl CLERK
OR BK 751g PG 1218
~\4
Address City
Contractor: Na~~\-~.(~1 ~~
Addres~)~(Ab '~~Ci~~~~
5. Surety: Name
Sta~.~~~L\3
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
State
8. In addition to himself, Owner designates
of to receive a copy of the Lienor's Notice as
provided in Section 713.13 (1) (b), Florida Statutes.
9. Expiration date of Notice of Commencement (the expiration date is 1 year from the date
of recording unless a different date is specified.)
My Commission Expires:
PC93053048/ A
Signature of Owner:
Sworn to a
,2~.
i~~
...
~ 0' ~J'
Notary Public State of HJrida
Sabrina Rae Cant
My CommisSion
Expires 0811812009