HomeMy WebLinkAbout11-11621 CITY OF ZEPHYRHILLS
� 5335 - 8TH STREET
` (si3)�so-oo20 1 'r621
BUILDING PERMIT
Permit Number: 11621 Address: 5251 19TH ST
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-17710-0060
Improv. Cost: 5,387.00
Date Issued: 3/10/2011 Name: MOORE, JAMES & MARY
Total Fees: 65.00 Address: 5251 19TH ST
Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/10/2011 Phone: (813)362-9181
Work Desc: REROOF SHINGLES 30 LB FELT
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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 inspections called d) work not ready for
inspection when called e) permit not posted on job site fl 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 properly. If you intend to obtain financing, wnsult with your lender or an attorney
before. re�oi�ling your notice o commencement."
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CO RACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 11-26-21-0010-17700-0060 001 Page 1 of 2
Data Current as Of: Weekly Archive - Saturday, March 05, 2011
Parcel iD 11-26-21-0010-17700-0060 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
MOORE H JAMES JR & MARY L Ag Land �p
5251 19TH ST Land $24,073
ZEPHYRHILLS FL 33542-2175 Building $39�872
Physical Address Extra Features $3,849
5251 19TH ST
ZEPHYRHILLS FL 33542 Market Value �67,794
Assessed (Save Our Homes) $67,794
Leaal Descri�tion (First 4 �ines) Homestead 196.031 -$25,000
See Plat for this Subdivision .�'° Non-School Additional Homestead Exemption -$17,794
TOWN OF ZEPHYRHILLS PB 1 PG 54
ALL OF LOTS 6& 7& LOT 8 EXC Non-School Taxable Value ¢25,000
SOUTH 3 Ff THEREOF BLOCK 177 khool District Taxable Value ;42,794
OR 5646 PG 765 Warning: A significant taxable value increase may occur when sold.
Click here for details and info. regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price Condition Value
�� 0100 SFR OOR2 8,400.00 SF $2.72 1.00 $22,848
�� 0100 SFR OOR2 3,500.00 SF $0.35 1.00 $1,225
Additional Land Information
Acres 0.27 Tax Area OZH FEMA Code �� Residential Code ZHLHLP2
Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1959 Stories 1.0
E�cterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
interior Wall i Drywall interior Wall 2 None
Flooring i Terrazzo Monolithic Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 2.0
Line Description Sq. Feet Repl. Cost New
1 FST 144 $3,188
� Z Q 128 $1,417
3 B� 1,170 $51,808
4 FCP 240 $2,657
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 CLFENCE 1988 800 $2g2
2 FIRE PL 1973 � 1 �24�
�3 � UDU-M 2004 1 $2,238
4 UDU-M 1983 1 $522
r 5 DCFENCE 1989 1,500 $560
Sales History
Previous Owner MILLER CHRISTINE
Year Month Book/Page Type Amount
2003 � 11 —� 5646 / 0765 WD $87,900
2001 12 4826/0254 TR �p
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http://appraiser.pascogov.com/search/parcel.aspx?sec=11 &twn=26&rng=21 &sbb=0010&b... 3/10/2011
e�a-�eo-oozo City of Zephyrhills Permit Application Fax-813-780-0021
• Building Department I � _ I / / � �
=, ! r`
Date Received
Phone Contact /or Permittin
Owner's Name j ��� Owner Phone Number ��� - .3�`G� �
Owner's Address s� J�' � T J/_ � Owner Phone Number
Fee Simple Titleholder Name �� Owner Phone Number
Fee Simple Titleholder Address �/
JOB ADDRESS �� "� � � . � 7 �f � j S7Z LOT # (� � S'f
SUBDIVISION -� pARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR B ADD/ALT Q SIGN Q MOVE Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK � FRAME Q STEEL Q OTHER
n � /
DESCRIPTION OF WORK /�'� S. n - in � �ira �v ��/� _Si{, � �; �/,� �
BUILDING SIZE SQ FOOTAGE H E I GHT
Q BUILDING $� �- s� VALUATION OF TOTAL CONSTRUCTION
Q ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY � W.R E C.
Q PLUMBING �$
�
Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
Q GAS Q ROOFING � SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS � � FLOOD ZONE AREA �YES �NO
BUILDER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address License #
ELECTRICIAN COMPANY -�
SIGNATURE REGISTERE� Y J N FEE CURRENT Y/ N
Address
License #
PLUMBER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address � �
License #
MECHANICAL COMPANY -�
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/ N
Address License #
OTHER COMPANY � � � (�' �
SIGNATURE REGISTERED Y! N FEE CURRENT f Y/ N
� y� ' / �, �.,.
Address � � � , � License# �Crl. �
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-0-W Pertnit 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 onsde, Construclion Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster Site Work Permit for all new pro�eds All commeraal raquirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans
""PROPERTY SURVEY reqwred for all NEW construction.
Directions:
Fill out application completely
Owner 8 Contractor sign back of epplication, notarized
If over E2500, a Notice of Commencement is required. (A!C upgredes over 55000)
" Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITfING (Front of Application Only)
Reroofs Sewers Service Upgrades A/C Fences (PIoUSurvey/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 comp�iance 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 tMPACT 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 buiidings, 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'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 certity that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed 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 inGude but are not limited to
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management Distrid-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health 8� Rehabilitative ServiceslEnvironmental 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" uniess 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 fiil the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fili will not adversely affect adjacent
properties. If use of fill is found to adversely affed 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 T1MCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEF E RECORDING YOUR NOTICE OF COMMENCE
FLORIDA JURAT (F S. 117.03) �
OWNER OR AGENT � CONTRACTOR u ��
Subscribed and sworn to �) forej9e this S� cribe� � bY n to (or a vm d efor e'
/`�Ar.:� r � bY �.� �r /a� !', -
Who is/are onall known to me or hasRiave produced Who is/are personally known to me or has/have produced
as �dentification. as identification.
'1 .�
� ' Notary Public � v �. ��.�'�� Notary Public
Commission�. Commission No �
NOTARY PUBLIC�TATE OF FLORIDA
Name of_ �ed, pnn �� 1�� :' ;��r`._� � ; ��uDA
Commission # DD994127 Name of Notary type �,priW�d or stamped ,, j� �eS
'• Expires: MAY 24, 2014 � t'��;r.�r..��i�n #DD99n12?
� �'�V � • .�ires: MAY 2G, �J14
gpTIpED THRti ATI..4.�"17C BO\"DI`IG CO., ID1G •.,, ,
BOYDl:ll THkU ATLAr'TT� 4 J:�D? VG C�., LVC.
S �TATE OF FLORIDA
� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
� CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
• �`�D�t°'� TALLAHASSEE STR FL T 32399-0783
FIELD, ALAN JAMES
ALAN'S ROOFING
14498 PONCE DE LEON BLVD
BROOKSVILLE FL 34601
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Congratulations! With this license you become one of the nearly one million .•: t�, : . ��.;
Floridians licensed by the Department of Business a�d Professional Regulation. ; j .��=�� ' • ,-,' ��-?,• ;
Our professionals and businesses range from architects to yacht brokers, from •<�+;_�;,..,, ��,�� -.--<-,+� . �_�:"'+�'��
boxers to barbeque restaurants, and they keep Florida's economy strong. f.;:�.�; i''�� f�s�� Y�'�y!`.:'f� •1- _ �,�!�`i"` � e
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�.;;.. ; t, , �;:..�,,.:,�,; `,.,�;;��:�:;��, '� .1 ' �;`� - ' , .�J��' _ � ,.-. _ :,' ��1�
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�
� - CONTRACT Hernando: (352) 686-3330
LAN �� Citrus: (352) 341-1400
Commercial 8� Residential Pasco: (727) 816-9278
R O 0 F I N G, I N C. " Home of the FREE Roof Inspection Toll Free: (800) 309-5667
14498 Ponce De Leon Blvd. WN/N/.aIaC1SrOOf Cl inc.com Fax: 352 754-8902
Brooksville, FL 34601 9 �
445 Douglas Ave, Ste 2205E LICENSE NO.CCC046942
Altamonte Springs, FL 32714 �� �
lease Print
AME /�Y1 / � /UfJ�t° PHONE �"��� `l S� DATE � /
DDRESS ��...1 � � t � S - CITY �i V ; /� ZIP �',�'S��
M. HOME SE
_ OTHER COMMERCIAL JOB#, � �G�/�rJ
RAND OF �7 ' � � ' ,� �L
RODUCT l.f L✓ /I p i� ��j� COLOR ,��T �a PITCH `'� 2
] 1 PULL A CITY OR COUNTY PERMIT SQ. RENAIL WOOD Z 7
] 2. TEAR OFF Z SQ. OF OLD SHINGLES SQ. OF FLAT ROOF � SQ. OF OLD TILE
] 3. DRY IN WIT�3 FELT 1 LAYER 2 LAYERS Ff / 'SQ. TILE �
] 4. INSTALL �� FT. GALV VALLEY METAL-�� FT 55# SELF ADHERING UNDERLAYMENT � FT. METAL OVER RIDGE
] 5. INSTALL � FT. ALUM./ FT. STEEL DRIP EDGE "�� FT. PAN/ ""— FT. L. FLASHING W� COLOR
] 6. INSTALUREPLACE � FT. OF R.V "" QTY./ � FT OFF RIDGE VENT�PLUGS � COLOR
��
] 7 REPLACE 1�/z IN. 2 IN. Z 3 IN. LEAD BOOTS 4 IN. 10 IN. GRV'S ELEC RISER
] 8. STARTER STRIPS
] 9 LAY ���SQ. OF NEW FIBERGLASS SHINGLES / CAP Z FT H.R.
] 10 INSTALL ��� SM./ LG. DEAD VALLEY
J 11 INSTALL TORCH OR TPO LAYER OF INSULATION �
] 12• INSTALUREPLACE 2 X 2 2 X 4 4 X 4 SKYLIGHTS DOMES cM LOW E G�ss SHING
] 13. HAUL OFF ALL TRASH AND RUN MAGNET AROUND GROUNDS
] 14 ALL WOOD WORK WILL BE EXTRA PER ATTACHED WOOD BILL� v � �� � �� �� f
] 15. SPECIAL INSTRUCTIONS � •� p�-7 �
J Q /
�I � �' � " � ' I ��` � `
!//i7 � �,CV o/�
] 16. ALAN'S ROOFING, INC HAS MY PERMISSION TO CONTRACT WITH AN ENGINEER OF IT'S CHOICE TO
CONDUCT ANY OR ALL INSPECTIONS THAT MAY BE REQUIRED UNDER LOCAL OR STATE LAW.
TOTAL DUE UPON ��� '}°
COMPLETION
ACCESS: Customer agrees to allow access to the property and realizes that heavy equipment is being used.
Contractor shall not be Iiable for, wl[hout Ilmitatlon, damage to driveways, sidewalks, lawns, sprtnkler systems, gardens, septic systems and any o[her structures thereof, as a result of rooftop orjob deliveries.
DAMAGE, ETC. Should customer become eware of damage to property by Cantractor, his agents, or employees during the course of installation of the root, said damage shall be brought to the attention of the
Contrector prior to the time of payment for the roof In question. If Customer fails to notlty Contractor of seid damage, within 5 working days oi occurrence, then shall waive all rights against Contractor concerning said
damage. Alan's Roofing, Inc. is not responsible tor roofing nails penetrating A/C lines in the attic.
DELAYS, ETC. Hereby acknowledges that Contractor may be subject to delays occasioned by inclement weather, labor disputes, and ma[eriai supply shortages which are bayond the controt of the Contractor and
hereby accepts delays occasioned by one or ell of these circumstances in the installation of his roof. Further agrees to pay Contractor an amount to equal 10°6 oi the total contract price should this contract be
cancelied for eny reason priorto the initiation of work on root, but after midnight of the thtrd business day atter signing.
PAYMENT CONTRACT Customer hereby agrees that if the amounts due and owning hereunder are not paid when due, also shall be Iiabl ay all co of cancellation, " I ut not limited to, reasonable
attorneys fees and costs, which amounts, togetherwlth all sums and owing hereunder, shetl bare Interest at 2 h per month. �' /
ACCEPTANCE PROPOSAL. The above prices, specificetions and conditions ere satisfactory and /
herebyaccepted.Allcontrects resubjeclto n tappro I. SALESMANSIGNATURE
CUSTOMER SIGNATURE DATBe! L� MANAGEMENTAPPROVAL
Construction Industries Aecovery Fund: ayment may be available from the construction industries recovery fund it you lose money on a project performed under contract, where the loss
results from specified violations of Florida Law by a State Licensed Contractor. Forinformation aboutthe Recovery Fund andfiling a claim, contactthe Florida CILB stthe foliowing telepho�e
number and address:850-487-139E�, Florida Construction Industry Licensing Board, 1940 N. Monroe Street, Tailahassee, FL32399
, • Issue Date: 12/21 /2010
FLORIDA ROO�ING, SHEET METAI & AIR CONDITIONING CONTRACTORS ASSOCIATION, INC.
S RSA • - ,
1-800-767-3772 • FAX (407} 671-2520
CERTIFICATE OF INSURAI�CE
ISSUED TO: COPY PROVIDED TO:
Alan's Roofing 8� Alan's Alan's Roofing & Alan's Roofing, Inc. and Adco
Roofing Inc Et AI 14498 Ponce De Leon Blvd.
14498 Ponce De Leon Bivd Brooksville, FL 34601
Brooksville, FL 33601
Attention: To Whom It May Concern
Alan's Roofing & Alan's Roofing, Inc. and Adco et al
This is to Certify that: 14498 Ponce De Leon Blvd.
Brooksville, FL 34601
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation
by insuring their risk with the F�ORIDA ROOFING, SHEET METAL & AIR CONDITIONING CONTRACTORS
ASSOCIATION SELF INSURERS FUND, P.O. Box 4907, Winter Park, FL 32793.
COVERAGE NUMBER: 870-0 33049 LIMITS
Workers' Compensation: Statutory - State of Florida
EFFECTIVE DATE: 1/1/201
Employers' Liability: $1,000,000.00 Each Accident
EXPIRATION DATE: 1/1/2012 $1,000,000.00 Disease, Each Employee
$1,000,000.00 Disease, Policy Limit
REMARKS: 1Von-cancelable, without 30 days prior written notice, except for non-payment of premium which will be
a 10 day written notice.
Complete named insured to read: Alan's Roofing & Alan's Roofing, tnc. and Adco Construction, Inc. and BHD
Construction LLC and Spring Hill Construction, Inc.
Alan Field as Qualifier, License #CCC046942
For Informational Purposes Only
This certificate is issued as a matter of information only, is not a policy and of itself does not afford any insurance.
Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown
above or as affording insurance to any insured not named above. This provides coverage for Florida policyholders
and Florida domiciled employees only.
� �
By� By _
Brett Stiegel, Administrator Debra Guidry, CPCU, Un erwriting Manager
FRSA-SIF FRSA-SIF
�� i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iui
2011037036
Rcpt:1355474 Rec: 10.00
DS: 0.00 IT: 0.00
03/10/il A. Giard, Dpty Clerk
Key No. Permit No.
NOTICE OF COMMENCEMENT PpULR 5 0'NEIL,Ph D PASCO CLERK & COMPTROLLER
' 03/10/11 10:39am 1 of 1
THE UNDER5IGNED hereby gives notice that improvement will be made ; OR BK g523 P � �� "��
to certain real property and in accordance with Chapter 713, Florida State e -
Statutes, the foibwing information is provided in this Notice of
Cornmencement: � this space reserved for recorder
_ ...................................�...._._.�... y _.. .......... �
. _ .................... . ........ ,c
7`awn a�/' Z� � r% S 1 / l�.� r�rf i4�o�,�9 •-
1. Description of Pro e Parcel No. 6�'� �/� f$ �,� ,S'p
v� 3 �i 'y'.1P.�cd�',3� 17;
t1 -Z�'�-�t-ovio-1'7�00-40�� or Pg 765 �,,� / �
{Legal description of the pro erty nd street address if available) SZ�J/ y�9 ,f� �iP/1✓j.��
P P /�GC .Sin /� � 1r+ / "" i • 33_'.�`�z- 7
2. General Descri tion of Im rovement
3. Owner Infortnation• Name � L
Address i � e ip
Interestin rop e : �
IYame of �ee Simple i e o er o e an owner :
Address � te p
Gontractor. Name /� � Q n S ROd �r� v� a.� n c•
Address: I+,{� ° I S d�nc e�e f e.z n tty �,.no V �! �. te � Z�p ���
Phone No. .� �" a-/e 4- 3 3. A — Fax f�o. �- 7 S S/ �f'9 o a
5. Surety. Name /�// 14
Address �tY �ZP
Amount o on : one o. ax o.
6. Lender. Name A( � �
Address ��Y `� e P
Phone No. ax o.
� 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), �ip Statutes:
Name /1/� Address Ciry State
Phone� Fax No.
8. In addition to himseif or herself, Owner designates /U �� , of
to receive a copy of the Lienor's Notice as providedi'n�Ton�7 '3.13('f�(6� on a tatutes.
Phone No. of person or entity designated by owner.
9. Expiration date of Notice of Commencement (tha expiration date is 1 year from the date of recording unless a different date is speafied.}
WARNING TO OWNER: ANY PAYMENFS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CHAPTER 713 PART 1, SEC 713.13, FLORlDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT WtUST BE RECORDED AND POSTED ON THE' JOB SITE BEFORE THE FIRST INSPECTION. 1F YOU INTEND TO OBTAIN FINANCING,
CONSULT W H LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
X'
nature er or ne s u onze cer �rector a er anager ignato s ice
"'"' Signature Requlred by same below by `.1" mark "`
�/
STATE OF / COUNTY OF $SC O
The foregoing instrument was acknowledged before me this � day of �/CiC . 20 �l . by U�I/�"�Cs .�I g0'�
as
(�L✓/�o,/ for ame o erson
(Type utho�ity e.g., offce, tru , attomey in fact) (Name of party on behaif of who fnsVUment was executed)
� NOTARY PLTBLIC-STA'fE OF FLORIDA
5ignature o ry � Print, Type or � ,�'ommissio # DD994127
Personaily Known OR Producad J nti cation �+,,,�,,,.•' Expires: MAY 20 , 2014
Type of Identification irduced: BoxnEn'rt�u n7ta.��tc s�:�nL>G co,, IDiC.
Verificafion pursuant to Sedion 92.525, Florida Statutes: under penaldes of perjury, I dedare that I have read the foregoing and that the facts stated in it are
tru to the b st knowledge and belief.
X
gna a ra erson �grnng ve
NOC-Pt8.WPD (71//0'n
9/24/07 tsg
�TA7E t�F ��.�iRlDA, C�►UNTY OF PASCO
THIS �S TQ Gt�TIFY THAT THE FOREGOING IS A
TRUE AND GaRREGT COPY OF THE DOCUMENT
W TNESS MY HAND AN R �FF�IC A SEAIS �FSICE
fU DAY OF ���1� 2 ���
p���A . 'NEIL, CLERK OMP'1 ER
BY
���CLERK