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HomeMy WebLinkAbout10-10558 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10558 . MOBILE - HOME SET -UP Permit Number: 10558 Address: 37633 COREY LEWIS AVE LOT 323 Permit Type: MOBILE HOME ZEPHYRHILLS, FL. Class of Work: MOBILE HOME SET -UP Township: Range: Book: Proposed Use:' NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: GRAND HORIZONS Est. Value: Parcel Number: 34- 25 -21- 0180 - 00000 -3230 Improv. Cost: 8,950.00 W; 74 .x; ' .,r: Date Issued: 6/22/2010 Name: GRAND HORIZON HOMES LLC Total Fees: 7,148.08 Address: 4025 MORRIS BRIDGE RD Amount Paid: 7,148.08 ZEPHYRHILLS, FL. 33543 Date Paid: 6/22/2010 Phone: (813)788 -0659 Work Desc: INSTALLATION MOBILE HOME 1,173 SQ FT BMI LL •-ILE H• ELE - I AL 40.00 'W •NNE •N •BIL 1,005.00 JAMES 0 MORTON ELECTRIC CO.,INC. MOBILE HOME SET -UP 60.00 WATER CONNECTION MOBILE HC 320.50 BMI LLC MOBILE HOME MECHANICAL 35.00 MOBILE HOME PLUMBING 40.00 BAHR'S PROPANE GAS & A/C, INC. PUBLIC SAFETY 5% 26.35 WATER METER RES 3/4" 311.25 IRRIGATION METER 311.25 IRRIGATION CONNECTION 266.00 FIRE IMPACT FEE 273.00 POLICE IMPACT FEE 254.00 TRAFFIC IMPACT FEE 99% 3,595.68 TRAFFIC IMPACT FEE 1% 36.32 PARK FEES MH 573.73 I d° V I / V 1 Il , 0 t()Al c• fi r • '. �"-. < :, ti. ;�� s : ', A €� z'' _ ..? . : . :' �� , _ :k'*'ni ,'51af M.ILE H• ET -UP MOBILE HOME ELECTRIC ,1 A �,* Q� MOBILE HOME A/C 1/ ( �� � 1� �y�u . '�,n_ • MOBILE HOME PLUMBING t l ) ' i� i FINAL —< Et" 61 / 2 / d /41, B ` " ! L'` tv P " % REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the following reasons: 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 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances c 0 6612.—, ar 44 41.- ' ■6 00A 1/4 CONTRACTOR SIGNATURE PERMIT OFF! - PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Lisa Booker 8137837891 p.2 41! j7; . CERTIFICATE OF LIABILITY INSURANCE OP ID NA I CATEIMM700/YYYY) 06/09/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS/. AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. •• - - , • • . . e -.7 c an ... r• , r. • -AI a., .. "" must peen.. s... " S ONI WAIVE.. subject to the temn and con Ions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). enceucsR - c....n.n. -. The Vinson Group, LLC -Zeph PHONE FAX Insurance Services 1C, No. Est): f (NC. Ne): 5710 Gall Blvd., Suite C SS: 'PRODUCER FL 33542 - - - -- -- - - - - -- cueralEROS HMI Phone: 813- 788 -5900 Fax :813- 788 -9654 INSURER(S) AFFORCING COVERAGE NAIC L POURED INSURER A: aurl./ngtei. Lwauranc• company LI•C . INSURER 0: asimaartnt ins COMM --+ Larry i Lisa Booker . 39838 Stewart Road INSURER C: Zephyrhills FL 33540 INSURER D: INSURER E : _ ENSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSLRAK'F LISTED BELOW NAPE BEEN ISSUED TO 1HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE-D. NOMARISIMDING . TERBOROOrDIAONOF ANY CONTRACT OR OTHER 000LNENrWTMRESPECTTOWHICHTHIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TEE POUaES DESCRIBED HEREIN IS SLEIJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POL IC IES. LIMITS SHOWN MAY K w EH REDUCED BY PAID CLAMS Ran Tr►EOFINSVRAMCE tHM WW1 POUCY N UMBER IE%VOfl YYYi (M AO � Learn — GENERAL LIAa1uvY EACH OCCURRENCE $ s 3.,000,000 _ 11 X RYJIr.RRCW. IiFHRRAI- I.IAp1.ITY 1038006424 0 1/14/10 01/14/11 Pr SES( E sx ra n ence/ _ 5100,000 1 C AINSMADE © OCCUR MED EXP IAry one person) S 5 , 00 0 PERSONAL a ADY INJRY S 1 , 000 , 000 GEPERAL AGGREGATE 5 2 , 000 , 000 GEM. AGGREGATE LIMB APPLIES PER PRODUCTS - COMP/ AG G S i ncl uded 1 num. 1 AT 4 JE PRgi n Lac -$ — AUTOMOeLE LIABILITY COMBINED SNG(E LIMB _, ANY AUTO (Ea $ — BOOIL V INA17Y (Pet pesos') $ ALL GAPED AUTOS BODILY INJURY (Per acodeH) j 5 SCHEDULED AUTOS — PROPERTY DAMAGE i $ HIRED AUTOS (Per rcadett; — NONOVAVED AUTOS I $ MORELLA LIAR _ __ OCCUI EACH CCCURP.ENCE I $ EXCESS LIAR aAdMS,WOE AGGREGATE } S r— DEOLCTIBLE $ RETENTION $ f X WORKERSCOMPE?ISATION wsnarrnsT nlsvaAKI 05/13/10 05/13/11 XI `'A� RF %TA, oni- AND ERPLOYEiS LIABILITY YIN + l PO UNIT J ER _ ANY PROPRETORPARIHERIEXECU IVE ❑ N r A El. E401 ACCIDENT E 10 0, 0 0 0 CFFICERAAEMBER IXCUAE09 (leendatoty In me • 11. DISEASE - EA EMPLOYEE $ 10 0 , 0 0 0 It gat *Mcrae iodic DESd7IPTTON OF OPERATIONS below F I rJ.' ARP- P01 ICY I MIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES (Attach ACORD 101. Ae111wnsl Remarks eebedu)s. a more spouts required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, NOTICE NTLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Zephyrhills AUTHORIZED REPRESENTATIVE Jackie 5335 8th St. �'m1400� t IZephyrhills FL 33542 �/�({ 9 ACO � All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks el ACORD Lisa Booker 8137837891 p.1 BMI LLC Fax TO: Jackie Fax Number:813- 780 -0021 Date: 06/21/10 39838 Stewart Rd. Zephyrhills, FL 33540 From: Lisa Booker T813 -714 -1476 F813- 783 -7891 Number of pages including cover: 2 BMILLC @verizon.net Regarding: Liability and WC certificate Jackie, Here is the liability and workman's comp certificate for BMI LLC. Also, 1 will be picking up the permit for 37633 Corey Lewis Ave. Grand Horizons Lot 323 today after lunch. Thank you. Sincerely yours, Lisa Booker 813 -780 -0020 City of Zephyrhills Permit Application , i f �-' Building Department /055b Date Received ! , Phone Contact for Permitting f1 ,7/4 -- / `"(1 • Owner's Name a „,, I d 4 y - c t l ' ) 0 1 no r Owner Phone Number i r J 3 - 233 6 )�- I Owner's Address 371,6 6 e o (> ' f ;i.J Li .@� S 3 OtJ>_ , Owner Phone Number 93q- 15V - 3Of 5 Fee Simple Titleholder Name ' � Owner Phone Number Fee Simple Titleholder Address t `, t JOB ADDRESS .3 f (G3 CCC(>i..� L e ki t �� t ' t - "t"v -- . 6 -7 r LOT # 5;X3 SUBDIVISION 1 ( � . - C / "ZenS PARCEL ID# " a 5 -- f - c 2 - 0o Jl .l )' 3 b (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN I I MOVE I I DEMOLISH X INSTALL REPAIR PROPOSED USE xi SFR I I COMM I I OTHER I I TYPE OF CONSTRUCTION I I BLOCK [ I FRAME I I STEEL [} OTHER (? DESCRIPTION OF WORK I do \ . �(Y p_ jj 1 (fly t \cJ- c BUILDING SIZE 1 1--� SQ FOOTAGE! 1) 1 7 2 HEIGHT I I BUILDING $S` ( 50 VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ ± 1 500 AMP SERVICE 9CO I I PROGRESS ENERGY 1>t1 W.R.E.C. I I PLUMBING $ WO ' MECHANICAL $ 1 y 0 CD VALUATION OF MECHANICAL INSTALLATION I I GAS I 1 ROOFING 1 1 SPECIALTY I I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I IYES ENO 1 BUILDER COMPANY Ucni 7l. LL SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT I Y/ N I Address 3` ?O ii _ _ a k , f _t 1 . , it!_ ' o L License # H - (>t`>C4 /` t LI ELECTRICIAN (�° C�� COMPANY J� Jr� V + V SIGNATURE -/a\ - 01` 1,” � -� REGISTERED I Y / N 1 FEE CURRENT I Y / N I Address 3 ( f c lr E 1 \ci -cL L . 2,14 t It 3. 1 I a License # ER. 3 OCR- 5 (05 PLUMBER COMPANY rr) SIGNATURE �`-- )6P \ REGISTERED Y / N I FEE CURRENT I Y / N I Address 3C1C 1 t - f J _ .7- iv, 3.35--10 License # 'I 'O ( j I MECHANICAL COMPANY 1\ V1 SIGNATURE Jr J j :I\ ' ` - REGISTERED / N 1 FEE CURRENT I Y / N Address -\-\ \ , Cet Z i \\S ° S 5 4 I License # C A en La l " 1 x OTHER COMPANY SIGNATURE REGISTERED I Y / N I FEE CURRENT I Y/ N I Address License # RESIDENTIAL Attach (2) Plot Plans; (2) 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 subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (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 SIGN PERMIT Attach (2) sets of Engineered Plans. * ** *PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C 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 A/C Fences (Plot/Survey /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 1, 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. 1 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 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 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. FLORIDA JURAT (F.S. 11 03) i - ` _ = � . CONTRACTOR , / t . � �ilr�.... OWNER OR and ,1 � ( lot �� Subscribed and s �" • for affirmed) • r s •r- e t i subscribed ands !V (or a trme•) • - • re me this s /j uo h_ 3" r of--..10. ' / ; c. MGM, A 4 AI7'/�� h - (b by i s c rH c,,, ✓ Who is /are personally known to me or has/have produced Wh Is /are personally known to me or has /have produced rZ D ` 6 zE, U - - - 6.16 - - as identification. FL O� -4 (3y 6 0 - 5 - 6 4 as Identification. Notary Public Z__ Notary Public Commissl Commission No. _ :o .' SHANE M. STRATTON I = °' I r �� �_ SH ANE M. STRATTON, .__ MY COMMISSION # f70 say, ' �t='r Sta l • r1 ' ,� Name of Notary typed ;F .. „ B ond T IRES, March i, poi i , ` Name of . 7 r , i , prInkft ItiM l Thru Notary P�phc u n t . , of Not Bonded Thru Notary Public Underw , • '∎ Pasco County Parcel: 34- 25 -21- 0180 - 00000 -3230 001 Page 1 of 1 I Data Current as Of: U Weekly Archive - Saturday, June 05, 2010 I Parcel ID 34- 25 -21- 0180 - 00000 -3230 (Card: 001 of 001) Classification I_ 00 - Vacant Residential Mailing Address Final 2009 Value GRAND HORIZON HOMES LLC Ag Land $0 4025 MORRIS BRIDGE RD Land $24,019 ZEPHYRHILLS FL 33543 -5056 Building $p Physical Address Extra Features $0 37633 COREY LEWIS AVE ZEPHYRHILLS FL 33541 -7743 Market Value $24,019 Legal Description (First 4 Lines) Assessed (Non - School Amendment 1) $24,019 See Plat for this Subdivision Taxable Value $24,019 GRAND HORIZONS - PHASE FOUR PB 61 PG 023 LOT 323 OR 7446 PG 1045 Land Detail (Card: 001 of 001) Line II Use IlDescriptionll Zoning II Units II Type II Price II Condition II Value 1 0200 MSUBM 00M1 6,000.00 SF $4.00 1.00 $24,000 2 0200 MBL HM 00M1 34.00 SF SUB $0.55 1.00 $19 I Additional Land Information I Acres Il 0.14 IL Tax Area 11 30ZH 11 FEMA Code II -- I Residential Codell GDHZLP1 I Building Information (Card: 001 of 001) Unimproved Parcel 00 - Unimproved I Extra Features (Card: 001 of 001) 1 Line II Description II Year II Units II Value I No Extra Features I Sales History I Previous Owner II GRAND HORIZONS INC Year II Month lI B ook /Page II Type I Amount I 2007 II 03 I 7446 / 1045 II WD II $ 1995 12 II 3508 / 0207 II W D II $ 1993 II 10 II 3214 / 1147 II WD II $ http: / /appraiser.pascogov. com/ search /parcel. aspx ?sec= 34 &twn =25 &rng=21 &sbb= 0180 &bl... 6/8/2010 ""k<!;; - " .... a , _..,..,_ vi , . ,.. ,__- 1-1, t. \ City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: IS, I 1-- Date Received: 6-3---/O Site: 37633 I:6?ve ket -s d Permit Type: r ' M' h6"`� 3 '�� �x Approved w /no comments: ` Approved w /the below comments: ❑ Denied w /the below comments: ❑ This comme s ' eet s -11 b- kept with the permit and/or plans. id .// a" 7.-td Kalvin wit . -r — in xaminer Date Contractor and/or Homeowner (Required when comments are present) ATE �F 1' d i A', W5 .h s C PASCO IIIIIIIIIIIIVIII VIIIVIIIIIIIIVIIIVIIIIIIIIIIIIIIIIIIIII HIS IS TO CEr C!F ; r-,- r friE,r ,c );NG IS A 2010077266 TRUE AND CORP EC "'C 'D;:- , Of 1 to , _ , 'OUMENT ON FILE OROP'PU a Ei..:�6:),IN II i$S OFFICE Rcpt.:1308046 Rec: 10.00 vVITNF �PY'tHAN AI : - t C..,k ; -'•L THIS DS: 0.00 IT: 0.00 .DAY (.) - 06/01/10 K. Garcia, Dpty Clerk PAULA S s,�,1 -1 C. ' r Z. L,; i,r -r R OLLER PAULA S.O'NEIL,Ph.D.PRSCO CLERK & COMPTROLLER El.',"____ 4' �i ... , " iT "1' C�ERK 06 83 4 P �� 10 NOTICE OF COMMENCEMENT Permit No. Property Identification No. 3LJ - a5 "a or/3Y) - 6000c) .- 3 a3c THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. • 1. Description of property (legal deseri /lion : �,rs ,. ` ,,....li - ,.� ' '2 E = �� MID • F a, 5 a) Street Address: _ 0 !r oli P:�1 s 42, '/ 2. General description of improvements: (T) p�j; ��n� ► nS �0.11� ✓� � '' 1r X . 3. Owner Information 0 a) Name and address. V.-an& c +\ -1- - t cnQ) (roes 9._ b) Name and address of fee simple titleholder (if other than owner) "'' - i o tql c) Interest in property — -. r ` rt /111172111ra rfe, �,.� P> 4. Contractor Information a) Name and address: 1: f f ` _ 'i 2 i -__..._& /• f -. V lb. L535 C. b) Telephone No.: i _�y1lL _ Fax No. (Opt.) 5. Surety Information a) Name and address: b) Amount of Bond: 6 c) Telephone No.: _ Fax No. (Opt.) "i 6. Lender Cf a) Name and address: Phone No. 7. Identity of person withrt the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: 4 b) Telephone No.: Fax No. (Opt.) t j 8. In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes: a) Name and address: b) Telephone No.: Fax No. (Opt.) 9. Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is Specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. n STATE OF FLORIDA COUNTY OF PASCOO■C ,,t!)\NCK/kJ� Signitete of Owner or bwti's uth hor�ize dd�Officer/Director/Partner /Manager L am. 3 (c r- Print Name The foregoing instrument was acknowledged befor me this day of �n�. , 20/1.) , by .&'14...... e/ C as 6 coo_ L � (type of authority, e. f cer, trustee, attorney in fact) for (Y_) 0 f ((( ( (name of party on behalf o hom instrument was exec ted). Known OR Produced Identification V Notary Signature Personal] � Personally rl g �,_ _ _ Type of Identification Produced t bn V Name (print) �"0 1 t 6,6, 0..tl I2 f Y�C„_, e0' cy' 06 d of C9afo CU Verification pursuant to Section 92.525, Florida Statutes. Under penalti - of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. • J NMa,�t• Si_ . ure of Natural Person Sigm g :.ove FORMS /NOC,rvstl2007 ' pHUgb • . n �•, • JACOUALINE BUTLER' ` ` y t r l ' Notary Public - State of Florida ■ 1 %y � a My Comm. Expires May 17, 2014 1 - I �YCa Commission . 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CA � c3 0 ws mo t) C( jfr � I -, , PASCO COUNTY, FLORIDA 14 )R1‘ ) . ee Permit No. /655 8 Date Permitted Builder Name /Owner Name -6 ml Control # County Parcel No. -23- 2-1- 01 op. // .-32 j� SubDiv: `_/ Address /Location L37 6 Cove ,Cn cc7r S / 1.471-* 3Z Classification/Type of Use M& le l TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: 1 / 1 )3 Exempt ❑ Yes No How Determined Impact Fee Amount $ ( 32 Zone No. TAZ: SCHOOL IMPACT FEE Account (056) Single - Family Detached House Amount $ /3/ A- (057) Mobile Home (058) Other Residential Al 23) Collection Fee Exempt L Yes _ No How Determined PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone TOTAL AMOUNT $ 573 '73 Exempt Yes ri No How Determined LIBRARY FEE Land Account Land Credit Land Total Facility Account Facility Credit Facility Total Exempt ❑ Yes _ No How Determined Total Amount /OM RESOURCE FEE ERU TOTAL AMOUNT Prepared By a ' Checked By i NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building permit owner on notice of this assessment and the conditions of payment for same. DATE RECEIVED BY RECEIPT NO. DATE BY :,1.. _ii=i `i � PASCO COUNTY, FLORIDA - Permit No. &6 Date Permitted Builder Name /Owner Name Brru: )--1--c. Control # County Parcel No. 3q -25 21- O / 8O • O C X,X) -32 j SubDiv: Ocq :zjh Address /Location L37 (0 3 a Cov ,C.P cchf S * 32,3 Classification/Type of Use M le TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: 1 / 1 13 Exempt 1 1 Yes 1 1 No How Determined Impact Fee Amount $ , (p 32.00 Zone No. TAZ: SCHOOL IMPACT FEE Account (056) Single - Family Detached House Amount $ /O/ 4- (057) Mobile Home (058) Other Residential (123) Collection Fee Exempt 11 Yes n No How Determined PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone TOTAL AMOUNT $ 573. '7,5 Exempt 1 1 Yes No How Determined LIBRARY FEE Land Account Land Credit Land Total Facility Account Facility Credit Facility Total Exempt Yes 1 1 No How Determined Total Amount /O/7 RESOURCE FEE j 9 0 7 ) . � � —c, t z J ' ` ` ' ' ERA U ,! 7 -1 - cej TOTAL AMOUNT 16 60 A5 -4.e Prepared By 4 / Checked By NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building permit owner on notice of this assessment and the conditions of payment for same. DATE RECEIVED BY RECEIPT NO. DATE BY . . „ ........ . . • , • . • • • • . , • • • , I 414