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Home My WebLink About11-11744 CITY OF ZEPHYRHILLS 5335 - 8TH STREEI' � (si3)�so-oozo 11744 BUILDING PERMIT Permit Number: 11744 Address: 6421 HUNTINGTON DR Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: SILVER OAKS Est. Value: Parcel Number: 03-26-21-0120-00000-0870 Improv. Cost: 4,540.21 Date Issued: 4/28/2011 Name: REINKE, CLARENCE Total Fees: 90.00 Address: 6421 HUNTINGTON DR Amount Paid: 90.00 ZEPHYRHILLS, FL. 33542 Date Paid: 4/28/2011 Phone: (813)780-7593 Work Desc: REPAIR WATER DAMAGE DUE TO LEAK � f � � ��/�/ ll ., ,� G 0� - � � � �� ,�( �� FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. 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 � plans not at job site g) work not accessibie. 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." ��7�-�-�- _ ` c� `� CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ;��.`��: ��> �a2r.� '� `+, � � '-�;>� ��. �c(�) City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: ��.k' �C.� _ � , Sc�� ;� l� � �-C-� Date Received: .� ' 2'�j -- � � Site: � Z � E.r�-�r� � I�Y� .� Permit Type: (,� G�V�--�— �-y��c -� � ` ri Approved w/no comment • Approved w/the below comments: Denied w/the below comments: O �/ , � .,� > ' o. '!��" .�1� 7" f3� � , - j" � This comment sheet hall be kept with the permit and/or plans. �.�1� 4 �-�- Kalv' Swi r lans Examiner Date Contractor andlor Homeowner (Required when comments are present) o��-�o�-�� v��y v� c.vNi�y��n�o ��.� Bullding Department Date Received 3_2 _ Phone Contact fo� Permittin - Owners Name G � e/�/ Owner Phone Number pL3 ' 7�4 ' 7� 3 Qwners Address 2 � T p.) � Owner Phone Number �S� 3 " 3��t ��S'3 G �ee 8lmple Titleholder Name Owner Phone Number � Ti —� T Fee 5lmple Titleholder Address , JOB ADDRESS C�� c�,�Y� �J yTa �� /Z �P�� Tr/ �� S{"� 3 3 s Y Z LOR # � 3UBDIVI310N Sc�U2/�. D( PARCELID#�3° {OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR B ADD/ALT 0 SIGN � MOVE [� DEMOLISH INSTALL REPAIR PROPOSED USE � SFR 0 COMM � OTHER TYPE OFCONSTRUCTION � BLOCK � FRAME 0 STEEL � OTHER � � DE3CRIPTION OF WORK ��1-t12S �t,,..�. �7 ��}-� �, r„IaTe,2 r�..�.�4�►�tft�e • BUILDING SIZE � 8Q FOOTAGE HEIGHT [� BUILDING $ s�Q �/ VALUATION OF TOTAL CONSTRUCTION � � ELECTRICAI. $ � AMP SERVICE 0 PROGRESS ENERGY ;� W.R.E,C Q PLUMBING $ � I I r �� v� � � i- i ' � j � Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION n��YQ�Gt °� �� Q GAS O ROOFINO � SPECIALTY � OTHER '�� FINISHED FLOOR ELEVATIONS FLOOD ZONE ARE,4 [�YES �NO BUILDER y t Ifl � • COMPANY �e -L ' 1''��9 � P COI��nA ,� SIGNATURE / �� L� � L, � I -- REGISTERED FEE CURRENT Y/ N Address ,3�C� Sc.-fj/t1eT `�� rM p�� FL 3`(b T License # y C '� S HLECTF�ICIAN COMPA�JY $k(3NATU.RE REGISTE�EO Y/ N FEE CURRENT Y/ N Addreas � License # �— RLUAABER COMPANY 31GNATURE REGISTERED Y/ N FEE CURRENT Y/ N Address License # � MECHANICAL COMPANY ' SI.aNATURE REGISTERED Y/ N FEE CURRENT Y! N Address Llcense # �— �� OTH�R T SIQNAT.4JRE COMPANY REGISTER�D Y/ N FEE CURR6NT �� / N Address � Llcense # -.-----�_ RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) sef of Energy Forms; R-O-W Permit for new constructlon, Minimum ten (10) working days after submittal date. Requlred onsfte, Constructlon Plans, Stormwater Plans w/ �Ut Fenee �nstalled, Sanitary Facflltles & 1 dumpster; Site Work Permlt for subdivislons/large proJects COMMERCIAL Attach (3) sets of Bu(Iding Plans; (1) set of Energy Forms, R-4-VV Permit`For new construction Minlmum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Sllt Fence Installed, Sanitary Facilidas & 1 dumpster Slte Work Permit for all new pro)ects. All commerclal requirements must meet compllance SIGN PERMIT Attach (2) sets of Engineered Plans. ""PROPERTY SURVEY requlred for all NEW construction. Directions: , Fill out applicatlon completely, Ovmer 8 Contractor stgn back of appllcadon, notarized If over 52500, a Notice of Commencement is required. (A/C upgrades over a5000) " Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarfzed letter from owner authorizing same OVER THE COUNTHR PERMITTING (Front of Applicatlon Only) Reroofs Sewers Servlce Upgrades A/C Fences (PIoUSurvey/Footage) Driveways-Not over Counter if on publlc roadways..needs ROW .. ! NOTI-CE F DEED RESTRICTIONS: The undersigned understands that this permit may be subJect to Ndeed" resfi�fations" w�ri�h ma , be more restrictive than County regulations. The undersfgned assumes �esponsib111ty for oompl(ance wfth any applicabl deed restrlctions. UNLIC� �D CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: if the owner fias hired a contractor or contracto s to undertake work, they may be required to be Iicensed fn accprdance with state and local regulations. If the contracto��fs not licensed as requlred by law, both the owner and contractor may be cited for a misdemeanor violation under sta e law. If the owner or intended contractor are uncertain as to what licensing requlrements may aRply for the �ntended ork, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8U09. F�tfhermore, ff the owner has hired a cvntractor or contractors, he is advised tv have the contractor(s) sign portions �� the "contractor Block" of this appiication for which tlley will be responsible. If you, as the owner si�gn ss the contractor, that may be an indicatfon that he is not properly Iicensed and is not entitled to permitting privileges in Pasco Counry. i TftANSP�IRTATION IMPACT/UTILITIES IMPAC7 AND RESOURCE REC01fERY FEE3: TMe undersigned understands that Tran�portation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in ex �ting buildings, or expansion of exfsting buiidings, as specified in Pasco County Ordinance number 89-07 and 80�07, aslamended. The undersigned also understands, that such fees, as may be due, will be Identified at the t�me of permittin�. It is further understood that Transportat(on Impact Fees and Resource Recovery Fees must be paid privr to receiving �"certiflcate of occupancy" or finai power release. If the proJect does not involve a certiflcate of occupanCy or flnal pow$r release, the fees must be paid prfor to permit issuance. Furthermore, if Pasco County WateN�ewer Impact fees are We, they must be paid p�ior to permlt issuance in accordance with applicable Pasco County ordinances. CONSTR�.VCTION LIEN LAW (Chapter 713, Florida Statutes, as amendedj: if valuat(on of work Is $2,500.00 ar.more, I Eertify th�t i, the applicant, have been provided with a copy of the "Fiorida Construction Lien Law--Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the appiicant is someone ather tha . �the "owner", I certify that I have obtained a copy of the above described document and promise in gvod fialth to deiiver it t1q the "owner" prlor to commencement. CONTRAI�TOR'SIOWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that aH work wiil be do'ne in compliance with ali applicable laws regwlating construction, zoning and land d�velopment. Applfcation is hereby r�ade to obtain a permit to do work and installatlon as (ndicated. I certify that no work or (nst�llat(on has commenGed prior to Issuance of a permlt and that all work will be pertormed to meet standards of ali laws regulating constructipn, County and City codes, zoning regulations, and land development regulations in the jurisd(ction. ( also certify thait I understand that the regulativns of otHer government agencies may apply to the intended work, and that it is my respo�s(bility to Identify what actions I must take to be In compliance. Such agencfes include but are not limited to: - Department of Environmental Protectlon-Cypress Bayheads, Wetland Areas and Environmenta(ly Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, V4/et�and Areas, Altering Watercourses. - Army Corps of Engineers-Se�walls, Dvcks, Navlgable Watervvays. - ' Department of Health & Rehabilltative Services/Environmental Health Unit-Weiis, Wastewater Tre�tment, �' �` I Septic Tanks, N ., -..��.. . � US Environmental Prvte�tion Agency-Asbestos abatement. Federal Aviation Authority-Runways. I underst hd that the foliowing restrictioFlS apply to the use of fill: - Use of fill is not allowed in Flood Zone "V" uniess expressiy permitted. If the� fill materlat is to be used in Flood Zone "A", ft fs understood that a dra(nage plan a.ddress}.ng a "compensating volume" will be submitted at time of permftting which is prepared by a.professfonal englrteer licensed by the State of Flor(da. , - i if the fiil materiai is to be used in Flood Zone °A" in connection with a permitted building using stem wall , construction, I ce�tify that fiil will be used vnly to flll the area within the stem wali. ' If fill material fs to be used in any area, I certify that use of such fill wili not adversely affect arciJacent ' properties. If use of fiil (s found to adversely affect adjacent properties, the owner may be cited itsr Violating � the conditions of the building permit issued under the attached permit application, fqr Iots less than one (1) ' acre which are elevated by fili, an engineered drainage plan is required. If I am th AGENT FOR THE OWNER, I promise in good fafth to inform the owner of the permitting conditions 5et forth in this a�d vit prior to commencing construction. I understand that a separate permit may be requlred for eleetCt+�al. w:qrk, plumbing signs, welis, pools, air conditioning, gas, or other ir�stallations not specifically included In the application. A permit is, ued shall be construed to be a license to proceed with the work and not as authority to vfolate, cancel, aiter, or � s�t aside any provisions of the technical codes, nor shall issuance of a permit prevent the Bufiding Official from thereafter requirin� correction of errors in plans, construction or vfolations of any codes, Every permit issued shall become Invalld unless th work authorized by such permit Is commenced within six months af permit issuance, or if work autharfzed by the perm is suspended or abandoned for a period of six (6) months after the time the work is commeneed, An extension may be r quested, in writing, from the Building Official fot a9 er consecutive days, th Job dered aban neds )ustt�ab� cause for the extension. If work ceases for nine y( ) � WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING ICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO �BTAtN FIN� ��NG, GQ��-T U LENDER AN ATTOR EY BEF E E ORDING YOU t� �' FLORIDA URAT (F.S 117.03) ,, ��,�-- OWNER O AGENT GONTRACTOR Subscrlbed, and swom to (or affirmed) before me this Subscribed and awom to (or afflrmed) bj f�o�r� e thls b , b .�., v�:� r�� Y Who Is` �a�e personally known to me or has/have produced Who Is/are personally known to me or has/have produced as IdenUficatlon. as identlflcaUon. Notary Publlc Notary Public Commissiqn No. Commission No. ' Name of N tary typed, printed or stamped Name of Notary typed, printed or stamped . � BAY AREA 390 Scarlet Bivd. Tel: 813.835 1445 P0. Box 1887 Tel: 877 GO.BADKI , Oldsmar, FL 34677 Fax: 813.832.4634 info@bayareadki.com www.bayareadki.com April 18, 2011 City of Zephryhills 5335 8th Street Zephyrhills, FL 33542 Dear Sir or Madam: I, Michael P. Coleman, hereby authorize the following to sign for and acquire permits and licenses using my State of Florida License Number CGCO38548: Monica Watson Craig Watson Sonia M. Lee Kim Sheldon Kathryn Blackmon If you should have any questions, please feel free to contact me at 813-835-1445. Sincerely, _ � � �..Cc: � i � 's.�._ Michael P. Coleman License # CGCO38548 STATE OF � COUNTY OF The foregoing instrument was ackno led ed befor his / 1�� da of - �,�� , 2011, by y , who presented as identification, or who is personally know to me and w�o did not take an oath. �'(,�� -� �/�"l�v . ,,,,,,, Notary Public Seal ;�2�, e `�; Notary Public - State of Florida :°_ My Commission Expires Jan 25, 2012 ';;r �r= :� Commission # DD 740187 �'" °� ��`' Bonded Through NaGonal Notary Assn. Trust the Triangle" � � � C� � - � w � � � Q � � � � :� a � ''� ru w • E., a' o � � �a o _ M vu ��,°,- ~ 'z o _ m w� � s-+ rct �r 'w...-• H z w �i�'� �o o ° ° a� r,= '-' � U1 f=7 C.�� f.� c!) � •,� G: :� E � � q .'7 C3 C c 0 . r � Wa� WH ��- [z,� O�Y' O q Pt^� G7� W r'��F H � W r"a 9 4`3 W W � � �� °� � N L] �� Q � s � � � � a �� E�"' t�.i E+ �p H 'r � 1 O u bA c�n� won u � ?� i-i U ' �O � !�: W�Z `�.,..� H t 1'� f-' H r.f, I] �—i �3 �� 2J� c!� U� � � W � �� H � �, � �, � �� . �, � �� t , OCtS �0'.1 '",�H� Q ~ � 47 n 3W F+ � UH C7� ��-r"UN U v a � � H W� v� (=� '� r Fi W ��-I � O W � W � � CY� .-1 � U H c��i f�t t� H � �? cn �� °' x � a c�a � po�� r � ' �i.��J . �H H � ��U W ��0� W z rnv w �'W�Q cn , �-+x� a whap � �� OP ID: DI ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDM/YY) 04/18l11 THIS CER7IFICATE 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 CER7IFICATE OF INSURANCE DOES NOT CONS7ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTiFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certi�cate does not confer rights to the certificate holder in lieu of such endorsement s. PRODUCER 727-d47-6481 CONTACT NAME: eouchard-Clearwater 727-449-1267 PHONE F,vc 101 Starcrest Drive ac No eM : ac No : P O BOX 6090 A DRESS: Clearwater, FL 33758-6090 PRODUCER Dru Cameron Wilson cusr nneR io u: BAYAR08 INSURER S AFFORDING COVERAGE NAIC q INSURED gay Area DKI INSURERA:SteB(�fBSt IIISUr'dflC@ COfl'1 an JEMM of Pinellas INSURERB American States Insurance Co 19704 MrMark Spicola INSURERC Zurich American Insurance Co 390 Scarlet Boulevard Oldsmar, FL 34677-3018 INSURERD. INSURER E INSURER F . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE A � POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ') �OOO�OO A X COMMERCIAL GENERAL LIABILITY GPL655839101 11/25/10 11/25/11 pREMISES Ea occurrence S 3�0,0� CLAIMS-MADE � OCCUR MED EXP (Any one person) $ � 0,�� PERSONAL 8 ADV INJURY $ 'I,OOO,OO GENERAL AGGREGATE $ Z�OOO,OO GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPlOP AGG $ 2,000,00 POLICY PR � LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B X ANY AUTO 01 CI4098701 11/25l10 11I25/11 �Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUT6S BODILY INJURY (Per acGdent) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ B X NON-OWNEDAUTOS $ g X COMPREHENSIVE DEDUCTIBLE a1 000 S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S�OOO,OO EXCESS LIAB CLAIMS-MADE AGGREGATE $ S,OOO�OO A SE0655839201 11/25/10 11/25/11 DEDUCTIBLE $ X RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABIIITY Y � N X RY LIMIT R C ANYPROPRIETOR/PARTNER/EXECUTIVE WC655839801 'I'IIZS/'IO 11/25H1 E.L.EACHACCIDENT $ ��OOO�OO OFFICER/MEMBER EXCLUDED? ❑ N f A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ �,��,�� If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 'I ,OOO,OO q Pollution CPL GPL655839101 55,000 DED 11/25/10 11/25l11 Per Occ 1,000,00 Per Agg 2,000,00 DESCWPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, iT more space fa required) CERTIFICATE HOLDER CANCELLATION CITYZEP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF ZEPHYRHILLS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5335 8TH STREET ACCORDANCE WITH THE POLICY PROVISIONS. ZEPHYRHILLS, FL 33542 AUTHORIZED REPRESENTATNE \ � O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD � �,�., ; �� x � I `-' ' u �-�'''��f�'�' �e'�'.!?� + � �s� �d?.� :ti�: i#,j��,i �� ,,,,.� � �Y<r'� i*� ` �„�;.,..� 1„.: f r ' • �r r`� -�' .�` '�'.` [i"� 4i��`/+J+� ` ,1� ~ (3�� ,�„1. 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A � � � � � � � � � � ' P �' .e — PDF created with pdfFactory trial version www.pdffactorv.com PERMITS R US 4807 RIDGE POINT DRIVE TAMPA, FL 33624 813-269-9965 (PHONE) 813-269-9902 (FAX) FACSIMILE TRANSMITTAL SHEET T�� FROM Jackie Monica Watson COMPANY DATE• City of Zephyrhills Bldg. Dept. March 28, 2011 FAX NUMBER TOTAL NO OF PA6E5 INCLUDING COVER. PHONE NUMBER SENDER'S REFERENCE NUMBER. RE YOUR REFERENCE NUMBER. ❑ URGENT ❑ FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE Reinke, Clurence 6421 Huntington Drive Zephyrhills, FL Jackie, Attached please find a permit request to do repairs due to a leak at the above referenced address. Please review & give me a cnll if you have uny questions. Thanks! Monicn , �._ � NOTI CE OF COM ENCEM ENT IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII . j 2011071016 Permit No. j Rcpt :1366653 Ree : 10 . 00 Ta�c Folio No. — �' _ v�7 DS: 0.00 IT: 0.00 05/10/11 S. Shultz, Dpty Clerk c UNDERSIGNED hereby givesnoticethat improvementswill bemadetocertain red property, and in acoordanvewith Section 713.13 of theFloridaStatutes, thefollowing information isprovid intheNOTICE OF COMMENCEMEN . L��' dk'S/�� 1. Descri ption of property (legal cr�escri 'an : �� -�1 �� a) Street (jab) Address 2. General descri pti on of i mpro t - .� 3. Owner Informakion G a) Narrie and address � � � ��1� � b) Narrieandaddresso feesmpletitleholder(if therthano er) c) I nterest i n property 2 4. Contractor I nformati on �� a) Narrie and addres� Z � � �L �1�,6 �� b) Telephone No.: Fax No. (Opt.) �-- 5. Surety lnforrr�ation a) Narrie and address _ �, b)AmountofBond: aau�a s o 'NEIL,Ph D PASCO CLERK & COMPTROLLER c) Telephone No.: Faoc No. 05/10/11 09:5 1 of 1 6. Lender OR BK �5'T7 P � 2555 a) Narr�e and address Phone No. 7 Identity of person within the State of Florid desgnated by owner upon whom notices or other documents may be served: a) Narr�e and address b) TelephoneNo.: Fax No. (Opt.) 8. I n addition to hirr�elf, owner designatest efollowing person to reoeivea copy of the Lienor's Noticeas provided in Section - '3-13(1)(b), FloridaStatutes �/ a) Name and address b) Telephone No.: Faoc No. (Opt.) 9. Expi ration date of Notice of Commenoerr�ent (the expiration date is one yc�ar from the date of reoording unless a different date isspeafied): WARNING TO OWNER: ANY PAYMENTSMADE BY THE OWNERAFTER THE EXPIRATION OF THE NOTICE OF COM M ENCEM ENT ARE CONSI DERED I M PROPER PAYM ENTS UNDER CHAPTER 713, PART I, SECTI ON 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTSTO YOUR PROPERTY. A NOTI CE OF COM M ENCEM ENT M UST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FI RST I NSPECTI ON. I F YOU I NTENT TO OBTAI N FI NANCI NG, CONSULT YOUR LEND AN ATTORNEY BEFORE COM M ENCI NG WORK OR RECORDI NG YOUR NOTI CE OF COM EM EN . �� STATE OF FLORIDA � $�� 1 O. COUNTY OF No1My PueNe • SWt d FlO�fy � � �� SignatureofOwnaorOwna'sA izedOffioer/DirectodPartner/Man� - -- CO�IOIr� OD 7�/f1�4 �p�.� �i= - � �litLZ�€ — — e��M��r�y Pnnt Name The foregoi ng i nstrumen was acicnowledged before me thi s � day of _ ��ib�- 2p �( by l'�2 rt�'i-+zc.�' � y,,,u.�[ as ��/�l� (tYPe of authority, e.g offioer, truste� attorney in fad) for (name of party on behalf aF wh iristru , t s exearted). � r ' � -��' . Pers�nally Known�_OR Produced Identification Notary Slgnature� `� - - ,n, . ,- . •� , � Typeof Identification Produced Name(pri _ �� ; � � _ • ..✓ p,v.� un,, ' . _ . � ' ; ` ^ � . . 1 ' rl .'. v eri fi cati on pursuant to Secti on 92.525, FI ori da Stakutes. U nder penal ti es o j ury, I d e read the f.oregoi ng and that the facts stated i n i t are true to the best of my knowl edge and bel i�. 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