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HomeMy WebLinkAbout11-11949 CITY OF ZEPHYRHILLS • 5335 - 8TH STREET ' , . (si3)�8o-oozo 11949 BUILDING PERMIT Permit Number: 11949 Address: 3851 LACOSTE ST LT 133 Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: MAJESTIC OAKS Est. Value: Parcel Number: 24-26-21-0030-00000-1210 Improv. Cost: 9,360.00 Date Issued: 6/03/2011 Name: NHC FL 115 LLC (JOY GARRETT) Total Fees: 127.50 Address: 3851 LACOSTE ST LT 133 Amount Paid: 127.50 ZEPHYRHILLS, FL. 33542 Date Paid: 6/03/2011 Phone: (941)343-3993 Work Desc: 18 X 37 SCRN RM �. � �-��" � �-� _�( �, , N 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." �G��- � �� � ��-1 CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City ot �epnyrnnis rerr�u� hNN���a����� : Building Department Date Received �j " _1 � Phone Contact for Permitting ��� �d � �v / Owner's Name � U'"��r� Owner Phone Number �`�� 3 y3 `� Q� Owner's Address 3�''l �J Owner Phone Number � y! �`r — 9 Fee Simple Titleholder Nam • � Owner Phone Nurriber Fee Simple Titleholder dress . JOB ADDRESS ��� � d � J �� � � � � � LOT # �� , ,, /�` . � ��' SUBDIVISION �-i� PARCEL ID# � -" • (OBTAINED FROM P ERTYTA CE) 2� • !� (70� L" WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGN 0 MOVE Q DEMOLISH vt?�' � � INSTALL B REPAIR PROPOSED USE � SFR �- COMM 0 OTHER TYPE OF CONSTRUCTION 0 BLOCK 0 FRAME 0 STEEL Q OTHER DESCRIPTION OF WORK SC'� n r� � BUILDING SIZE �� Xc7 7 5Q FOOTAGE CL��� HEIGHT [�] BUILDING $ ��O VALUATION OF TOTAL CONSTRUCTION ' AMP SERVICE PROGRESS ENERGY [� W.R.E.C. � ELECTRICAL $ L� �' PASCO PERMIT SERVICE PLUMBING $ (813) 788-5314 � MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION F� 1 '� - 824-7894 � GAS Q ROOFING � SPECIALTY � OTHER 'C' � w ��� FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES QNO BUILDER � I �/� ��� i� � v COMPANY � � K /T • ���- SIGNATURE / `"r'� ' {�EGISTERED Y/ N FEE CURRENT Y/ N Address � '� License # ELECTRICIAN • COMAANY SIGNATURE REGISTERED Y/ 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 Y/ N Address License # � RESID�NTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) worl<ing days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumps�er, Site Work Permit for subdivisions/large projecEs COMMERCIAL Attach (3) complete sets of Building Plans pl4s a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construcfion. Minimum ten (10) worl<ing days after submittal dafe. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilittes & 1 dumpster. Site 1Nor1< Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attaeh (2) sets of Engineered Plans. '*""PROPERTY SURVEY required for all NEW construction. Directions: Fili out application completely. Owner & Contractor sign back of application, notarized • If over $2500, a Notice of Commencement is required. (A!C upgrades over $5000) ** Agent (for the contractor) or Power of P;ttorney (for fhe owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITf'ING (Front of Application Only) � Reroofs Sewers Service.Upgrades A/C Fences (PIot/Survey/Footage) Driveways-Not over Counter if on public roadways.:needs ROW NOTICE OF DEED RESTRICTIONS: The. undersigned understands that this permit may be subject to "deed" restriction$" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any appiicable 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 727-8�7- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advise.d to have the contractor(s) sign portions of'the "contractor Block" of this application for which they will be res�onsible. 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 Statufes, 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 aiso 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 bufi 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 Unifi-Wells, Wastewater Treatment, Septic Tanks. - US Env.ironmental 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" wiil be submitted at fiime of permitting which is prepared by a professional engineer licensed by the State of Florida. lf 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 wifihin the stem wall. If fill material is to be used in any area, I certify that use of such fill will nofi adversely affect adjacenf 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 OWNoR�t� p tion! I l u de�stan that permit may be requg ed for cal�work, this affidavit prior to commenci g plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. permit issued shall be construed ch b cal c hall s�SUa a permit�prevent the i ding Officeal from thereafter set aside any provisions of the te requiring a correction of errors in plans, co{ s s x of perm pssua work authorized by unless tlie work authorized by such perm the permit is suspended or abando the Buildp g Off� ial fo6a per o not exo ed�n n ty days and will demonstrate m a y b e r e q u e s f e d, i n w r i t i n g, f r o m t h e o b i s c o n s i d e r e d a b andone . justifiable cause for the extension. If work ceases for ninety ( 9 0) consec u t i v e d a y s, � j WARNING TO OWNER: YOUR FAILURE YOUR PROPERTY. YOC1 INT D E TO OBTAIN F NANCING C U T PA Y I N G T W I C E F O R I M P R O V E M E N T S T O WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y O U R N O T I C E O F C O M M E N C E M E N T. FLORIDA JURAT {F:S. 117.03) , � � �� ��A C � �J�J , . CONTRACTOR OWNER OR AGENT r-� S bscribed aq sworn to (9r affirfned) bgfore e S�1�bscribed ��l bywor Jo�fo rAffrmed)�for m�fhis /d � bY �� r ;��� ��f-i. �� [ ,� lC �C-- Who /are personallv knowr�to me or has/have �7roduced Wh slare personally known to me or has/have producetl as identiflcation. as identifcation. Notary Public Notary Public �RIDA Com ission No. Commission o. NOTARY PLBLIC•S �3ahr ,",,., Suzanne Bahr ,,,��".,, Suzanne '�� �' Name of Notary typed, prir� �IOB�ssion � d 2, 2014 : Expires: ���• 2z� 2014 Name of Notary typed,",, , . VOV. 2 '•.,, ,. L*�c. '"��� TL9.�'f1C BUSDL�G CO INC, g0\'DFS� T�lRI' ATL: �'i IC BG�UL�G CO., 80'�'DF TxRC A Pasco County Property Appraiser - Physical Address List for: 24-26-21-0030-00000-1210 Page 1 of 1 Welcome : Records Search : Parcel Details : Physical Addresses Physical Address List for Parcel: 24-26-21-0030-00000-1210 Displaying 25 records View in groups of: 10 25 50 100 500 Street Number Street Name ♦ Unit 3803 LACOSTE ST 3807 LACOSTE ST 3811 LACOSTE ST / (��. 3815 LACOSTE ST ��j ( � 3819 LACOSTE ST � � 3823 LACOSTE ST � 3827 LACOSTE ST 3831 LACOSTE ST 3835 LACOSTE ST 3839 LACOSTE ST 3843 LACOSTE ST 3847 LACOSTE ST 3851 LACOSTE ST 3806 QUAKER RIDGE ST 3810 QUAKER RIDGE ST 3814 QUAKER RIDGE ST 3818 QUAKER RIDGE ST 3822 QUAKER RIDGE ST 3826 QUAKER RIDGE ST 3830 QUAKER RIDGE ST 3834 QUAKER RIDGE ST 3838 QUAKER RIDGE ST 3842 QUAKER RIDGE ST 3846 QUAKER RIDGE ST 3850 QUAKER RIDGE ST Pasco County Property Appraiser Page Layout Modified: 2/17/2009 1:10:37 PM The Local Time Is: 6/3/2011 10:34:19 AM http://appraiser.pascogov.com/search/physadd.aspx?parce1=2126240030000001210 6/3/2011 , ..,4 p ���1` _ � .. SY'�', 7 �j/%;'� ,ia,� �,� � l,ts: k„� �. �i��(p, .��t�' � ��r City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: � Date Received: �� �j � �� � J _ S � Site: � ��J� `� Permit Type: l(� x 3 7 5 Cl�� ��jjy� Approved w/no comments. Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment sh t s e k with the permit and/or plans. _/ ,� Kalvi wi er — xaminer Date Contractor and/or Homeowner (Required when comments are present) � �� ��� �� PERMIj� THAT PART OF EAST 80.00 FT OF NW1/4 & THAT PART OF WEST 1/2 OF ��; � NE1/4 OF SEC 24 LYING NORTH OF ZE�HYRHILLS eYPASS EAST AND �'�� LYING WEST OF MAJESTIC OAKS COMMUNITY-PHASE ONE AS PER PB 35 �<� '� �� PGS 107-112 EXC NORTH 20 FT THEREOF FOR RD R/W & MAJESTIC OAKS COMMUNITY PHASE ONE PB 35 PG 107-112 LOT 1 THRU 16 INCL & LOTS 19 THRU 24 & LOTS 26 THRU 31 & LOTS 33 THRU 74 OR 6825 PG 87 NOTIC� OF COMMENCEMENT IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 2011080736 PermitNo Rcpt:1369386 Rec: 10.00 DS: 0.00 IT: 0.00 Property Ident�fication No el- �/-p2.� -021 jj(J�-�Q/�_ � 05/25/11 K. Garcia, Dpty Clerk THE iJNDERSIGNED hereby gives not�ce that improvements will be made to certam real property, and m accordance wrth Section 713 13 of the Florida Statutes, the following mformation is provided in this NOTICE OF COMMENCEMENT 1 Descnphon of property (legal description :) Oft2 ��� �e � �.,6� L� �� � „/� �� a) Street Address 3�d'l L� [� Q</' �cp� ° r 2 General description of improvements r, c f 3 Owner Information a) Name and address �/ � �/��i 3��� ��� � f'r� � � /u-l!J /�/ ���' b) Name and address of fee simple titleholder (if other than owner) c) Interest in property 4 Contractor Information a) Name and address.O Cfy�� ,,�� . ,Zjl�' . G'�S" ,�'.�'�G � �_/ � %/, ���� b) Telephone No ��� �� 5 Surety Information Fax No (Opt.) _ a) Name and address b) Amount of Bond c) Telephone No Fax No. (Opt.) m D 6 Lender � � p�r a) Name and address D ��� Phone No � ,.. o 7 Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served ~� a) Name and address �m � b) Telephone No Fax No (Opt.) �� 7 8 In add�tion to himself, owner designates the followmg person to receive a copy of the Lienor's Notice as prov�ded in Section �� � 713 13(1) (b), Flor�da 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 recordmg unless a different date is ��+ � Spec�fied) �F.. 4� n N� WARNING TO OWNER: ANY PAYMENTS MADE BY TAE OWNER AFTER THE EXPIRATION OF THE NOTICE OF ° COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, r 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. STATE OF FLORIDA COUNTY OF PASCO S n e of Owner or 0 ner s Anthorized O ficer/Director/Partner/Manager Print Name The foregoing instrument}��s acknowledged before me this /1 of � , 20 , by � /I� ��'/'tT7J as t�v�!' in ct) for —� (type of authority, e.g officer, trustee, artomey (name of party on behalf of whom mstrument was executed). Personally Known OR Produced Identification /� Notary Signature �\'�- (�-- ���1 Type of Idenhfication Produced �C/�-- Name (prmt) _ ��-"�-c� � L��.ea'-y ,r �--- Verification pursuant to Section 92.525, Florida Statutes Under penal 'es of perjury, I declare that I have read the foregomg and that the facts stated in it are true to the best of my knowledge and belief. FORMS/NOC rvsd2007 igna r f Natural P rson S�gning Above NOTARY PLT31.ii -��, i' 1'rr, ,�f�;7,��DA =�,;`�-, Stacie Ha��ib .,�", ,, :'cr?mi�sion#13I)926164 �. : };xpir��s ;: T. i6, 2013 BoxD�v •rax c :�,•c.�:ti1,,, ;.,.:� co., �rc t ,'� � - ` w STATE QF FL�f�fitSA� GOUN'fY Q�y �'A�i�Q THiS IS TU CER7IFY TWATTH� FC}R�40�NG IS A TRUEPct�1D CORRE,�T �.4PY`QF TH� OC�CUMENT ON FILEpR OF PUBLI� IN THIS OFFICE WITNE MY H�Np A QFFI�;lAL SEAL THIS !`k� � �AY OF ' 2 L/�T PAULA 'NEIL, CLERK COMPTROLLER gY DEPUTY CLERK � r a� o s tt 1 Page No. of Pages =��.�;-� , Aro� . ���� ��.������x ���.. ���� r�� ��n �� � �����-€���i���, r�. � �:s�� _�� �;�, - ��g.•�'�m� PRQP��o�� ITTED TO HONE � DATE + � + ~� `' � _.�` � 1 r � _ .]� � � 4 i � � + ~� ``�.� � � � STREET ,�*''} , � JOB NAME ' � �y)�.. i .�/ ` �� r ' "�i i E � � "` ��{� �? � CITY STATfi,and ZIP CODE �. ` JOB LOCATION � �. 4 ( � ' { i — � ��-...f �S� � ARCHITECT DATE OF PLANS '`�- JOB PHONE We_,p,greby submit specific:ations and estimates for� , , � � µ � ✓t l`3. ; � � 1 � � L �^'��., �--`' {-. �;.�._-a ...,...- , - ' _-..�„�,, �--.. , -� �� p `�\ �V'�a� �l"i vl^' � 7� L �` , � ��� � � �•_,A�,- =._ .._ , �,---�--��' v,-.... � ; L�+' .__� `-_.....,._„� ; � , ..�-- ��� � ,� j ;�.�� � ��: � -.. t-��3�"..� �": � �''�. r .�? � � �.!-J 1 -� ; ' ` r "'"'� _ ` � �„>+--� _ �.�.�`-�i �:y` _ i ` =� ;� °`�l�j �':�" 1 `` } '` � � � � p`'�� _ ` ' ; '�-.,�'� `.""a=.�. � '-�,..�1...7'-`"." ' E ^�, r ; �+L. v *+ r'Y + � � i � � ;; �- ;� . �3� � �:�- �:! � � ' � -� � �' �� ;:�°`-� � � � , �. -_- ,� t _---- � _�''a �,�- - - ;.:. �..� r.:� �.� � �1��� ,�� �`� � l � � _ �����.--�.= �-�-��'�-�. �P �TO�JDSP hereby to furrfi�tZrrlaterial and labor �-;complete in accordance with above specifications, for the sum of• ' �,< , L , �,� ' -�._. , � Payment to be made as foilows: dollars ($ t� ° ) � � All material is guaranteed ti� be as specified. All work to be completed in a workmanlike manner according to standar i practices. Any alteration or deviation from above specifications AuthOriz 1 �„�-'^�� � _.� -��� ��t involving extra costs will be execufed only upon written orders, and will become an extra Signature � / r. + char�e over and above the estimate. All agreements contingent upon strikes, accidents `•, / or delays beyond our control Owner to carry fire, tornado and other necessary insurance. Note. i� pfoposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us i r{ottaccepted within d1yS. `.! �CPP�tMIjCP O� �rD�1DSFII —The above prices specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: — Signature I I ' � /7C. W �C V 1 /� ��/ �-- - - - - _ u ,_._, �� � � I � -- �-�' S ' (� .S .__ -�-- - - �3 . p�-, --- --- ------ �P � ` _� _ � ' I � � o � w v ; � N ; � � ;- � � � ' y �� � � � � ' 1 '� Q �� ' � v \ �, ' �. � � � �d � � U � � i� � � � � � � � � , ; � ', � � �� � � � � � � � �� � a �� i `� � � 1vIPLY WITH ALL `"� � , � � ING CODES, FLORI � � �-� P � v �' ELECTRIC CODE AND � ' ' ' CODE,NATIONP► �' �`' � CITY OF ZEPHYRHILLS ORDINANCES o, C �" ° I r-� � � `� �, , � i . �'v �` � `� y� �' - REVIEW DATE r r � CITY QF ZE�MYRF�I�.�.� � PLAN8 EXANIIN��.._� <- - � °� ��� � �� �,�""� IIIIIIIIIIIillllllllllllllllllllllllllllllllllllllllllllllll MAJESTIC OAKS COMMUNITY- Fiv( �.�,�7� PHASE ONE 2011085958 ,_���� PB 35 PGS 107-112 ` LOT 121 THRU 145 INCLUSIVE Rcpl. :1371042 Ree: 10.00 D5: 0.00 IT: 0.00 C ��� EC7 ,� n 06/03/11 A. Giard, Dpty Clerk �v NOTICE OF COMMENCEMENT PAULR S 0'NEIL,Ph D PRSCO CLERK & COMPTROLLER 06 0R BKi ���� 1PG� 2��� Permit No. 0��� l�� Property Identification No e2. �/—o2 ��l'���8� (� THE UNDERSIGNED hereby gives not�ce that improvements will be made to certain real properiy, and m accordance with Section 713 13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1. Description of property (legal description :) �22 ��� �e � �AQ' �� /� � 1 �(,C �Q� a) Street Address• LQ �' Od' /��e �• 2. Genera( description of im sF�ri nts f 3 Owner Information �// , j�" �" " . a) Name and �ddress: �/ G� �/+�.TI� ��d�d7' L.GC.c�c6� �',�-,�(I- �D �/' /��� /t� ,�i� , b) Name and address of fee simple trtleholder (if other than owner) U c) Interest in property 4 Contractor Information ' r / � a) Name and addresS� CtS��C, �� .Z/1C ( y�/ f /� �� � � �.�/!f �''-�`�' b) Telephone No . Fax No (Opt.) 5 Surety Informahon a) Name and address b) Amount of Bond. c) Telephone No • Fax No (Opt.) 6 Lender a) Name and address• Phone No. 7 Ident�ty of person within the State of Florida designated by owner upon whom notices or other documents may be served a) Name and address. b) Telephone No . Fax No (Opt.) 8 In addition to himself, owner designates the following person to receive a copy of the Lienor's Nottce as provided in Section 713 13(1) (b), Fiorida Statutes. a) Name and address: b) Telephone No Fax No (Opt.) 9 Expirat�on 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. STATE OF FLORIDA COUNTY OF PASCO S n e of Owner r 0 ner s Authorized O ficer/Director/Partner/Manager Pnnt Name � fore�ng i�rumenty,��as acknowledged before me this /(r� day of , 20 , by �r�- TTJ as dv�(,��' t e of authori ( yp ty, e.g. officer, trustee, attomey in ct) for (name of party on behalf of whom instrument was executed). Personally Known OR Produced Identification Y Notary Signature �\'�- C'i� ��i�a���) Type of Identification Produced ��- Name (prmt) __ ��'K-�-�''� L���j�(��, � -- Verification pursuant to Section 92.525, Florida Statutes Under penal 'es of perjury, I declare that I have read the foregomg and that the facts stated in it are true to the best of my knowledge and belief. STATE OF FLORIDA, COUNTY OF PASCO ; a f Natural P r5on s� nin Above FoRMSiNOC,�� IS TQ CERTIFY THA7 THE FOR'tG01NG IS A � g g TRUE AND CORR�CT COPY OF THE DOCUMENT NOTARY PL'BLIC-� � �Tr., o^ n,oiuDA ON FILE OR OF PUBLIC RECORD IN THIS OFFICE •"""' Stacie Hart:vig WITNESS MY HAND AN OFFICIAL SEAL THIS � ' ommission #DD926164 ., �,' �:xpir��s �i�T. i6, 2013 DAY OF 2 �� soriDEV TxRU nrra�ti�r,c L co., �a PAU O'NEIL, CLE C�3 LLER r . • - TY CLERK to - n �x m O Z n r �m oD —I O Z N � W X 4 A (n W N X m t 0 0 N XD C co X m Z C0 V) < O O 0 m r 3X3X.093 9' - 3" 10' -0 - TI m Q _ O o0 I W � O II � 0 Z _ X - D W D r C 3 O In -I in N a m m D �m 'r II m < o — O Z v L4 OX X W L4 (n X O � U! 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