HomeMy WebLinkAbout12-12732 CITY OF ZEPHYRHILLS
5335-8TH STREET
, �si3)�so-oo20 12732
BUILDING PERMIT
Permit Number: 12732 Address: 37420 TEABERRY LP
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: WEDGEWOOD MANOR
Est. Value: Parcel Number: 10-26-21-0120-00000-0140
Improv. Cost: 4,600.00
Date Issued: 1/27/2012 Name: BENNER, DUANE
Total Fees: 90.00 Address: 37420 TEABERRY LP
Amount Paid: 90.00 ZEPHYRHILLS FL 33542
Date Paid: 1/27/2012 Phone:
Work Desc: REPLACE 10 WINDOWS SIZE/SIZE
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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 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.
"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,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in acxordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONT O URE PERMIT OFFI R
R MIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Rec�ived phons Contact for Permlttin —
Owner's Name 1�Q� Owner Phone Number
Owner's Address � 1 f�(' Owner Phone Number � —1
Fee Simple Tltleholder Name � Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS U �� �F LOT# �
SUBDIVISION , PARCELID# ��• • V ( �-I
(OBTAINED FRO�1 PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR e ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR Q COMM � OTHER
TYPE OF CONSTRUCTION �� BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK �� �� Sl Z ��
BUILDING SIZE � SQ FOOTAGE� HEIGHT
BUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ � J��"�n
/ l.�
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATI ��� -�/
/ �i
OGAS Q ROOFING Q SPECIALTY Q OTHER G�
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER � _._ � �COMPANY `
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
. .
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# —�
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Bullding Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Requlred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Pians 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 commeroial requirements must meet compliance
SIGN PERMIT Attach(2)sets ot Engineered Plans.
'"'"PROPERTY SURVEY requlred for all NEW constructlon.
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..+.... �„�,����.,��.��������„���
D�rections. '+"' �
Fill out application completely.
Ovmer 8 Contractor sign back of application,notarized
If over;2500,a Notice of Commencement is requfred. (A/C upgrades over 57500)
*" Agent(for the contractor)o�Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Appiication Only)
Reroofs if shingles 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 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 Iocal 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 fvr 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
Counry.
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 buiidings, 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 Transpo�tation 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 a�e due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction I also
certify that I unde�stand 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 8 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 uA" 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 p�omise 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 N ICE OF COMM NCEMENT.
FLORIDA JURAT(F.S. 11 . 3� ; � _
� � �
OWNER OR AGENT CONTRACTOR
Subscribed and swom to(or afli e b t s Subscribed and swom to(or afflrmed b re me
bY by .
Who is/are personally known to me or has/have produced Who Is/are personatly known to me or has/have produced
as idenBflcaHon. as identification.
Notary Publlc Notary Publlc
Commission No. Commission No.
Name of Notary typed,P�inted or stamped Name of Notary typed,printed or stamped
Pasco County Parcel: 10-26-21-0120-00000-0140 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, January 21, 2012
Parcel ID � 10-26-21-0120-00000-0140 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
BENNER DUANE E Ag Land �p
37420 TEABERRY LOOP ��d $21,025
ZEPHYRHILLS FL 33542-8605 Building $76,050
Physical Address Extra Features $361
37420 TEABERRY LP
ZEPHYRHILLS FL 33542-8605 7ust Value �97,436
Assessed (Save Our Homes) $97,436
Leaal Des ri�tion (First 4 Lines) Homestead 196.031 - $25,000
See Plat for this Subdivision�" Non-School Additional Homestead Exemption - $25,000
WEDGEWOOD MANOR PHASE I&II
PB 27 PG i1-14 Non-School Taxable Value ;47,436
LOT 14 School District Taxable Value �72,436
OR 5159 PG 993 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 OOR4 4,500.00 SF $4.65 1.00 $20,925
�� 0100 SFR OOR4 345.00 � $0.29 1.00 $100
Additional Land Information
Acres 0.11 Tax Area 30ZH FEMA Code �Residential Code WDGWLPl
Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1989 Stories 1.0
Enterior Wall 1 Above Average Exterior Wall 2 None
Roof Strudure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet
Fuel Electric Heat Forced Air- Ducted
A/C Central Baths 2.0
� Line Description Sq. Feet Repl.Cost New
1 FEA 96 $3,869
Z B� � 1,434 $82,814
� 3 � FGR 340 $7,854
4 FOP 20 $289
Extra Features (Card: 001 of 001)
Line Description Year Units Value
� 1 DWSWC 1989 260 $361
Sales History
Previous Owner BENNER DUANE E FAMILY LIV TR
�- Year � Month Book/Page Type Amount
2010 10 8460/0660 (�C $p
2005 04 6329/ 1118 � �p
2002 �- 11 5159/0993 � �p
http://appraiser.pascogov.com/search/parcel.aspx?sec=10&twn=26&rng=21&sbb=0120&b... 1/26/2012
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
f
Contractor/Homeowner: :�1./�'►'IQ-j'I ��S 7�'Z�CY��
Date Received: � �.3-��
Site: _ 3 7�ZU ��"J�l✓�( L-/
Permit Type: /� �aYl C�G'�t� ��llCeix�(�5���/S`�-
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or plans.
r-2��
Kal n Sw' -Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
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� .j/����, ���i.
��'��'2'��l
Resicleratial Division
License # CB C035134
INC.
10/12/11
Mr. Benner
37420 Teaberry Loop
Zephyrhills, Fl 33542
Re: Replaceinent Windows and Water Heater
The following is an email to addressing the previous signed contract for work at
Mr. Benner's home. Due to an uncontrollable, manufactures, price increase on windows,
Ryman Constructions cost to complete this project has increased. Listed below are the
corrections we will be inaking to the contract and what item we are backing out in order
to complete this project. The total sum for the revised contract will be, Six Thousand,
Two Hundred and Eighty-Five Dollars. ($6,285.00) Adjustments are as follows:
Inclusion
• Remove a total of 10 existing windows and install new, vinyl double hung,
insulated windows. These windows are to be energy rated windows with internal
colonial grids. A manufactures price increase of$400 has been added to this
window bid.
• Remove existing water heater and install new, 40 gallon, energy efficient, water
heater
Exclusious
• Insulation shall not be included in this contract due to price increases. A separate
contract shall be drawn up for the insulation in order for USDA to apply for
additional funding.
Price Breakdown
� Material Labor
Windows $4,600.00 $1,000.00
Water Heater $535.00 $150.00
Insulation Removed from Contract Removed from Contract
36�13 SR 54 • Zephyrhills, Florida 33541 • Telephone 813/782-0825 • Fax: 813/788-6773
www.rymanconstruction.com
Upon signing of this contract, Mr. Beruier agrees to have Ryman Construction,
Inc. furnish all inaterials and labor necessary to complete the above mentioned work.
This contract is contingent upon the approval of the USDA board. Once contract has been
approved, Ryman Construction will begin work. A check will be made payable to Ryman
Construction, Inc. for the total amount of contract after completion. Thanks for the
opportunity and we look forward to working with you.
� _----
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I�e RX an Date uane Benner Da ev/3
Ryman o��r�e�i n, Inc. Home Owner
President
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FLNumber Series Model Type HV}{Z Size +DP -DP Glass Notes
FL-6136.1-R4 2800 2802 HS no 72"x so" 35 35 SS[G Nail Fin
FL-6136.1-R4 2800 2802 xs no so"x bt" 20 2o SS[G Nail Fin
FL-6136.2-R4 2800 2802 Hs �o so^X 60° 2o zo ss« Flange
FL-6136.2-R4 2$00 2802 xs �o �z^X so^ ao ao ss ic Flange
PL-6136.3-R3 2800 2803/04 Hs �o ios^X s9^ is �s ss�c rr��F��
PL-6136.3-R3 2800 2803/04 xs no 90"X as" so �o ss[G rra�l Fin
FL-6]56.1-R2 2100 2130 Fw no �z"x�3" ao so DS Temp F�an�e
FL-6156.1-R2 2100 2130 rw �o �z°X�s° so so Ts tG Flange
FL-6156.1-R2 2100 2130 Fw �o �z^X�s° 2o zo �s iG Flange
FL-6156.1-R2 2100 2130 Fw �o sr�X 6z° ss 3s �s tG F�a��e
PL-6156.1-R2 2100 2130 Fw no �o^X�a" so to DS Temp Flange
FL-6156.2-R2 2100 2t30 Fw ves n°r�3° ao so DS Temp Flange
FL-6156.2-R2 2100 2130 Fw ves �z°X�s^ 3o so Ts tc Flange
FL-6156.2-R2 2100 2130 Fw ves �z°x�s° 2o zo DS IG Flange
Fj,-(15(.2-R2 2��� 213� FW Y es 56"x 57" 35 35 DS IG Flange
FL-6163.1-R1 2100 2111 sy No 36"x62" 50 so DSIG Flange
FL-6163.1-R1 2100 2ll1 sH No as�X6z° ao ao DSIG Ftange
FL-6163.i-R1 2100 211 l sH No sr�X�r� so �o os�c Flange
FL-6163.2-R1 2100 2ll 1 sH ves 3�^X 6z^ so so �s tc Flange
FL-6]63.2-R1 2100 2ll 1 sH ve5 sr�X 6z° ss �s �s�c Fia��e
FL-7599.1-R2 8500/9500 g52� DH no 48"x 72" 50 50 DS IG Buck Fra�ne
FL-7599.1-R2 8500/9500 g52� DH no 54"x 90" 30 30 DS IG Buck Frame
FL-7599.2-R2 8500/9500 8501/9500 DH no 40^X 62" 45 45 SS IG Buck Frame
F[,-7$99.2-� 8500/9500 8501/9500 DH no 44.25"x G2.50" 45 45 DS IG Buck Frame
FL-7599.2-R2 8500/9500 8501/9500 DH no 4425^x�zso�� ao ao ss tc fluck Frame
FL-7599.2-R2 8500/9500 8501/9500 DH „o as^x so^ sn so ss ic Buck Frazne
FL-7599.2-R2 8500/9500 g5�1�9rJ�� DH no 54"x 65" 25 25 SS IG Buck Frame
FL-7599.2-R2 8500/9500 8501/9500 DH „o as°X s�° Zo zo ss�c 6uck Frarne
FL 7653.1-R1 5800 5810 Fw �o azs°x ao o�• so so DS IG Flange
FL 7653.2-RI 5800 5810 Fw no a�s"X so o" so so �s�c N�i Fin
FL 7653.3-RI Jr80� 5840 FW no 50.0"x47.5" 50 50 DS IG Nail Fin
FL 7653.4-R1 5800 5840 Fw �o so o°X azs° so so �s ic Flange
FL 7653.5-R1 5800 5810Impact Fw �o a�s^X ao o° so so DS Lami Nail Fin
FL 7653.6-R1 5800 5810Impact Fw no a�s°X so.o° so so Ds Lem� Flange
PL-8063.1 -R2 3000 3051 Fw no 7�"x��^ so so Ts�G N�]Fin
FL-8063.1 -R2 3000 3051 Fw no 9�^X sa^ so So Ts ic N�il Fin
FL-8063.2-R2 300� 3052 Fw no 96"X��" 40 4o D5[G N�il Fin
FL-8063.2-R2 3000 3052 Fw no 9G�X aa° so so �s ic Nail Fin
P'L-8063.2-R2 .3��� 3�52 FW no 76"x 57" 50 50 DS IG Nail Fin
FL-8063.2-R2 3000 3052 Fw �o �s°X es° so so DS Temp N�i F��
PL-8063.3 -R2 3000 3053 Fw �o �os^X�s^ 4o ao os tc N�;t F��
FL-8063.3 -R2 3000 3053 e•w no 1os°X�3" sa so os�G N�i Fin
FL-8324.1 -R2 3000 3��1 DH no 48 00"x 76.75" 25 25 DS Nail Fin
FL-8324.1 -R2 3000 3��1 DH no 38 00"x 76 75" 35 35 DS Nail Fin
['L-8324.1 -R2 3000 3001 DH �o s�oo°X�6.�s� so so Ds Nail Fin
FL-8324.1 -R2 30�� 30�1 DH no 48 00"x 56.95" 35 35 DS Nail Fin
FL-8324.1 -R2 3�0� 3001 DH no 38.00"x 56.75" SO 50 TS Ntil Fin
FL-8324.1 -R2 3��� 3�01 DH no 36 00"x 72.00" 45 14 45.14 TS Nail Fin
FL-8324.2-R2 30�0 3�02 DH-2 no 76.00°x 76J5" 40 40 SS Natl Fin
FL-8324.2-R2 3000 3002 DH-2 �o �z.00°X�6.�s° ao ao ss uazi F��
PL-8324.2-R2 3��� 3��2 DH-2 no 96 00"x 56.75" 35 75 SS Nail Fin
PL-8324.2-R2 3000 3002 DH-2 �o ��oo°x ea�s^ so so ss N�il Fin
FL-8324.2-R2 3�0� 3�02 DH-2 no 7G 00"x 56 75" 50 50 SS Nttil Fin
FL-8324.2-R2 3��� 3��2 DH-2 no 72.00"x 72 00" 45 45 SS Nail Fin
FL-8324.2-R2 30�� 3�02 DH-2 no 96.00"x 76'IS" 25 25 SS Nai1 Fin
FL-8324.3 -R2 .30�� 3003 DH-3 no 108.00"x 76 75" 35 40 DS Nail Fin
PL-8324.3 -R2 3000 3003 nx-s �o �ozzs°X�6�s° ao ao ss Nail Fin
FL-8324.3 -R2 3000 3003 DH-3 no lo�.z5"x s��s^ 5o so ss Nail Fin
FL-8324.3 -R2 3000 3003 DH-3 no �o�.zs^X 56�s" as as ss t�ta��F�n
FL-8478.1 Rl Impact Mullions
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Generalized Building Schematic
10-26-21-0120-00000-0140
Card: 001
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2012012113
Rcpl:1411156 Rec: 10.00
Effective: october I,2011 DS: 0.00 I T: 0.00
xetumto. 01/24/12 K. Garcla, Dply Clerk
NOTICE OF COMIvvIENCEMENT
State of Flor' Permit No.
County of��(} Tax Folio No.
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713,Florida Statutes,the following infortnation is provided in this Notice of Commencement:
�[t,'�,SZ ='�', i�' Z� • Zl • O l a C�' ��� . Cjl�'()
1 �scriptionofProperty� ���a� ����r•t,� L2C�O� ���,��5 � 33Sya
2. Gene e r a�s�ph'�o�n_�of im�p�e ments:����F � � p`� 1 �� (( ( lUt- �+-1
3 Owner Information or Lessee information if the Lessee contracted for the improvement:
a. Name and Address�Y\� �"�p �r�p�/
3--�U a� ��e�:�c� ��, , �-a p •Z-e,p.v�c.�r�i�.l.,c S ;�-fl 3�s�l Z
b. Interest in Property• (`7��'y��-
c. Name/address of fee simple titleholder(ifdifferent from Owner listed above):
4 Contractor•
a. Name and Address: K-Li��'�(1 �.SDy1�,�1'(„�[�c1C'1 T1/1L _ � 1 C
b. Phone number , ��US _�` �3 J� �
a =Zcil '
5 Surety(if applicable,a copy of payment bond is attached):
a. Name and Address:
b. Phonenumber PQULR S 0'NEIL,Ph D PqSCO CLERK B COMPTROLLER
01/24/12 Ql�g?p� i of 1
Amount of bond: $ OR BK $ 4 pG ���+�
v
6. Lender:
a. Name and Address:
b. Phone number•
7 Persons wiihin the State of Florida designated by Owner upon whom notices or other documents may be
served as provided by Section 713.13(1)(a)7,Florida Statutes:
a. Name and address:
b. Phone numbers of designated persons:
8. a. In addition to himself or herself,Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(i)(b),Florida
Statutes.
b. Phone number of person or entity designated by owner
9 Expiration date of nodce of commencement(the expiration date may not be before the completion of
construction and final payment,but will be 1 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 IMPROPBR PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,
FIARIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY
A NOTICE OF COMIvvffiNCEMENT MUST BE RECORDED AND POS'CED ON THE JOB SITE BEFORE THE FIItST ,
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMIvvf�NCING WORK OR RECORDING YOUR N07'ICE OF CO�NCEMENT
Under penalties of perjury,I declare that I have road the foregoing Notice of Commencement and that the facts stated in it are
true to the best of my knowledge and belief. '~
� h,.�,,� �,(�','�/
(Signature of Owner o ssee,or Owner's or Lessee's
Authorized OfficedDirector/ParmedManager)
Signatory's Title/Office:
STATE OF T� l 't.i
COUNTY OF
The foregoing instrument was acknowledged before me this�day of• 20� by�,j���-�
for
Notary Public,State of i
Printe arn,e��i-/
Personally Known OR Produced Identification �� t ,nl�l
,Ty��4f�dentification Producecl � �-.� . � f
� .
My Commission Expires:
- - ._ ::�'";":,�+;�;: HOLLY FiUp �p "IR
�' *w MY COMMISSION�EE0704B8
�'�?q.k,� EXPIRES May 16,2015
(407)398-0753 FloridaNd� &erv�•�,ppry�
,
. ��i�
, � .
STAT�QF FLO�tIDIq,CQUNTY OF PAaCO
THIS J�T0 CERTIFY THAT THE FaRCG01NG IS A
TRU�AND GORRECT COPY OF 7H�CIQGUM�NT
ON F1LE OR 0�pCJ�BI:IC R�CQRp IN TyIS QFFICE
WIT S Y HAIdD �FFiCIAL S�'AL THIS
P-�DAY b� 2 G�
ULA 5�.�.g'NEIL.�C &C PTROLLER
BY � . � � �/' � DEPUTY CLERK
..t''