HomeMy WebLinkAbout12-12953 CITY OF ZEPHYRHILLS
� 5335-8TH STREET
�si3)�so-oozo 12953
BUILDING PERMIT
Permit Number: 12953 Address: 7050 GALL BLVD
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD/ALT COMMERCIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-10500-0000
Improv. Cost: 135,000.00
Date Issued: 4/06/2012 Name: FL HOSPITAL ZEPHYRHILLS
Total Fees: 1,107.12 Address: 7050 GALL BLVD
Amount Paid: 1,107.12 ZEPHYRHILLS, FL. 33542
Date Paid: 4/06/2012 Phone: (813)783-6189
Work Desc: UPGRADE SYSTEMS IN CATH LAB FOR NEW EQUIPMENT
BORRELL ELECTRIC CO PLUMBING FEE 60.00 MECHANICAL FEE 60.00
DIVERSIFIED GLOBAL PIPING 8 CONS FIRE PLAN REVIEW FEES 42.12
COASTAL MECHANICAL
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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 wmply with Florida Statute 553.80(2)(c)when e�ctra 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 f) plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"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."
Complete Plans,Specifications Must Acxompany Application.All work shall be performed in ac:oordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
2'(/�' !� v�"!- �
CO TRA OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF / / / / � BUILDINti
ZEPHYRHILLS D�PARTMENT
OF ADDITION OR CORRECTION
� • • - •
�DRE AT PERMIT t/ z�53
��� �-t-�" f� r---tf i? `� � 2.��
THIS JOB HAS NOT BEEN COMPLETED. The foliowing additions or corrections shall be made before tha iob
wiil be accepted.
� "Z�--(� S a�t� [ `''- � � C S'C�S -
� z-� S �- c ���� �S. {-c�;� �c��'�,�- � �
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It is unlawful tor any Carpenter,Co�tractor,Builder,or other persons,to AFTER CORR CTIONS ARE MADE CALL
cover or cause to be covered,any paR of the work with flooring.Iath,earth 780-0 0 E-INSPECTION
or other material,until the proper inspector has had ample time to approve
the insfallation.
�FFICE HOURS 7.30AM-4 30 PM MON-FRI INSPECTOR ,
Zeph�rhills Fire Rescue
6�)U7 Dairy Road, "I_ephl'rhills, I�L ��5=�2
Fire Chief' 13us (8l�) 78{)-00�1
Keith Williarns I'a� (813) 780-Q044
5 April 2012
Plan Number 12-013
Project: Interior Renovation, Florida Hospital- Cath Lab 7050 Gall Blvd, Zephyrhills
Number of Pages: 39 pages
Date received: by this Office 03-27-2012
This Officer has reviewed the interior renovation plans for the Cath Lab at Florida
Hospital Zephyrhills, 7050 Gall Blvd. Following the review, a conditional approval to
proceed is given. Payment for permit acknowledges acceptance and complianr.e of the
conditions noted herein. The following items shall be considered:
1. Assurance of fire safe practices and in place in accordance to NFPA 1
2. All renovation work to Fire Sprinkler System and Fire Alarm s,ystem must
be performed by Florida Licensed Fire Sprinkler Contractor and Fire
Alarm Contractor, respectively.
3. To facilitate work and prevent damage fire sprinkler heads being relocated
may be removed to prevent damage.
4. Unless excluded by Code or ACHA a fire alarm strobe shall be located in
Cath procedure room. Plans will not be required for this additional device.
5. Sprinkler plans submitted for review and approval.
Inspections Required:
1. FinalInspection.
Review and approval of the submitted plans does not relieve the contractor from the
responsibility of correcting any deficiencies noted during inspection.
Respectfully submitted on 5 Apri12012 by,
��� f
Keith A. Williams, EFO, CFO, CMO, MIFireE
Fire Chief
Fire Safety Inspector, #148104
' ZE��iYRI�ILLS FIRE DEPARTMENT
69d7 Dairy Road, Zephyrhiits, FL 33542
Fire Chief Keith Williams Bus (813)780-0041 Fax (813)780-0044
FIRE SERVICE USER FEES
Occupancy No.: / �
Plan No.: - /.� Contractor: od ,�c�.��,
Business Name: c�:- o �' �,�/s Billing Addre : � � �
Business Address: U� C�-1 �3 dd �
Business Phone No.: _ 5�L3- 783•�18� Billing Phone No.: �(,�� -b�p�-�l�6
Business Fax No.: Billing Fax No_:
Contact: ���`� ,q-.- ,�gnn,, Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
�Site Plan N/C Annual N/C SprinMer $50 1st Alarm N!C
MuRi-FamiylCommercial .06 sf 1 st Re-inspeCtion N/C Standpipes $50 2nd Alarm N/C
(Minimum Charge$25.00�� 2nd Re-inspection $100 Fire Pump a50 3rd Alarm N/C
� Plan Revisions DBl 3rd Re-inspection $250 Hoods a50 4th Alarm $�pp
4th Re-Inspection a500 Fire Alarm a50 5th qlarm a�Sp
SPRINKLER SYSTEMS (Business clased until LP Gas $50 6th Alarm $2pp
0-25 Heads �550 violations corrected) Natural Gas aSO NON COMPLIANCE $150
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- �v�k $50
STANDPIPE SYSTEM Hydro Undergrounds $45 Spark�e�s a�pp
�Per Riser $50 Hydrostatic Test 365 Per Sy�, Fire Works a500
FIRE PUMP Acceptance Test $45 �r syscem Camp Fire $25
�Per Pump $100 Hydrant Flow $75 Controlled Bum $100
FIRE ALARM SYSTEM Hood/Duct $5p
BU-25 DeVICes $50 F1RE ALARM SYSTEM PIeCe Of Assembly $50 Annuai
26 plus Devices $100 System Acceptance $50 Fire pr�eCtion $25
SUPPRESSION SYSTEMS Recall Acceptance a50 Flammable Application $50 Annual
Wet $50 OTHER Waste Tire Storage aSO Annual
Dry $50 Fire Wall/Srtwke Wall $15 per wa11 Genefator<KW $100
CO2 $50 LP Gas $25 Pe�m�k Generator>30 K4Y 150
Othe� $50 Netural GaS a25 persystem Bio-Hazard Waste $100 Annua�
KITCHEN EXHAUST Fumigation Tenting $50
�Hood/Ducts $50 Tent 10'x10'or greater $15 Per tenc Torch PoUApplied y50
OTHER Fire Pump a45 Haz.Materials $100 Annual
LP Installation per lank �50 Flfe SuppfeSSion S30
Fuel Tank Installation $50 System Acceptance
❑ (Per Tank) S5o 8 E�diaust Hood/Du�t $30
Natural Gas Ir�sMallation $50 Re-inSpeCtion DBL
{Per System) (other than annual)
�Spray Booth $50 �Inspection scheduled DBL 8
and cancelled less than
24 hours
, /� i 2 8 Construction Insp. N/C
� • �
Emergency Vehicle Ac� $50 FALSE ALARM
PLANS TOTAL� INSPECTION TOTAL� PERMIT TOTAL� TOTALC_�
GRAND TOTAL �%���
`7'�"�iS"-
Comments:
Date: s ZU�Z
Ins�ctor:����
_ 813-780-0020 City of Zephyrhills Permit Application Fax-II13-780-0021
Building Department
Date Received ,�j - �� L" G �j /
Phone Contact for Permitting Q O -- O F�
Owner's Name Z I � Owner Phone Number �_� � ��O�
Owner's Address ��O � h f�/�/S � Owner Phone Number C
Fee Simple Titleholder Name Owner Phone Number �
Fee Simple Titleholder Address
JOB ADDRESS a5o � f B l� Z I� J, S � � / LOT# �
SUBDIVISION PARCEL ID# ��" ��� ��I� ` (SO 'OC/vO
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEw CONSTR�ADD/ALT � SIGN � � DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR � COMM �� OTHER !
TYPE OF CONSTRUCTION 0 BLOCK Q FRAME �� STEEL 0
DESCRIPTION OF WORK � !+�-(1 � S �rV�_S �/� (_'.Pn' Cl.� i� � P L(�� /k en
� r�
BUILDING SIZE SQ FOOTAGE Q� HEIGHT
�BUILDING $ J`�R OO(� a VALUATION OF TOTAL CONSTRUCTION
r ��
�ELECTRICAL $ �� 60O A P SERVICE / �� � PROGRESS ENERGY � W R.E.0
�PLUMBING $ ,.- �I��' �� C_ �`;�
a5 ooc� �.� �' ;-��v�
�MECHANICAL $ ALUATION OF MECHANICAL INSTALLATION Za l��� � � C
a�.5� OoQ �-/� J,��,,�,. r�l
�; ��t
AS � ROOFING Q SPECIALTY � OTHER �I ����
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
BUILDER , COMPANY � G{C. /tZ}
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
` r L.�/� �L���' �CGL'd�n I�!�lCo
Address � License#
E�ECTRICIAN ` `,�o COMPANY ��,� � t�r Lp.
t �� •,-�•
SIGNATURE �� REGISTERED Y/ N FEE CURRE� Y!N
Address �(zy( �(• � r l�/ 3�+f'j License# E� (3�0 Z��$
�
PLUMBER ,D COMPANY D1�(� �� � ��
SIGNATURE T � REGISTERED Y/ N FEE CURRE� Y/N
,; _ � ¢�lress �/(�S' S1C4L cY.t� �1J1/ LAKG' F 'J�'bl License# �.FC J y 7�'j�j�
l���}S�-dtaC
4
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 Building Plans;(1)set of Energy Forms, R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster; Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms. R-O-W Permit for new construction
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities& 1 dumpster Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
**"PROPERTY SURVEY required for all NEW construction
Directions:
Fill out application completely
Owner&Contractor sign back of application, notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
'" Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways. needs ROW
NO710E O� 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 responsibiNity for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009 Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction af new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended) If valuation of work is$2,500 00 or more, I
certify that 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 understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance Such agencies include but are not limited to
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
- Department of Heatth & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill
- Use of fill is not allowed in Flood Zone"V" unless expressly permitted
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension If work ceases for ninety (90) consecutive days, the job is considered abandoned
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENT TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER O AN ATT EY BEFORE RECORDING YOUR NOT E OF MMENCEMENT.
FLORIDA JURAT(F S 117 0 i � � '
� +,
OWNER OR AGENT /�' � rt►e : � CONTRACTOR C��G�.-�.c�'nS�""�ti
Subscribed and sworn (or affirmed) f re�.�e�hSs,. ,. Su scrib d and s or to r �rmed) f e his
.��-�l�-/f by %r`"�/�l�ii�,`< _(�f)~U�'�/ � .`3 0�.'� �t O
Who is/are pgrsonally known to me or has/have produced Who is ar ersonally known to me has/have produced
as identification. � as identi�f aHOa`�.
__�
�'�'� ' '2f otary Public �!'�/!i'� Notary Public
� r
"�Commission No~ � -"� Commission No.
SUSAN l.BENNETT . . MOlYy rYONC-3qN Of pofN�
Name of Notary r��dbllC-St�te ot or � Name of Notary typed,printe �
• • My Comm.Expirea Aup 11.2012 ,�,� Cen�nhdo�I EE ti0�pd
Cqpmh�bn+�DO f12112
/oM�01M�wOh IatlaW Natxfi Aun.
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�- � RODDA
CONSTRUCTION INC.
GxNnl Cantr�aors 8 ConMiclion Many�n
POWER OFATTORNEYAND AUTHORIZATION
Date: March 22, 2012
I, Jr�hn Rndda, President of Rodda Construction, Inc. hereby name, constitute, and appoint
tJze employee(.$) listed below to act as my attorney-in fact for the purpose of applying for and
receiving permits in my name. The Tcrx I.D. Number for Rodda Constructiorz is: 592932983,
Florida G.C. License Number is: CGC061996
Signature of'President, John Rodda
f•
Signature of Designaterl Attorney-In-Fuct, Wayne Feaster
i�-��.. G _ _. ._.__s----_.
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STA 7'r." O.�'FI,ORID�1
�:OL;�-�YOl�P�)I.K
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NO 1?YYUBLIC .
KATMIEEN S.MCCALLUM
.•'�Iy C.lr�i►rtiss�ion I:xPireS: ��_�a�
� Mly Con�.ExPires J�n 17.2016
ComnN��ion I EE 160106
250 E Highland Drive Lakeland, FL 33813 0 863-669-0990 f•863-667-3778 Lic. #CG-0061496
�t,act�!..r.,,:.n.:xe� ._...:ro,<..�p�.�_9s....w».�`�-�Nt�..axf............�
'Y ' .� .�,y .,y i"^ +!
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
�, ' ,.
Contractor/Homeowner: , 'i}LS�Zt��, �,�
Date Received: �- 2- '�- �2-
Site: �� L�'� C. � r� l � �� � �
s
Permit Type: ��,��_ !-�J (,t 4��1�"c�t
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.
� ����Z
Kalvin wit r Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
?his Instrument Prepared By: IIIIIII IIIII IIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIII IIII
Name: x'�_�da C'onstruction.Inc..250 E.HiQhland Drive. Lakeland FL 33813 2012047701
Permit No. Tax Folio No.
NOTICE OF COMMENCEMENT
STA7E UF Florida
COUNTYOF Pasco
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement
1. Description of property: (legal description of property,and street address if available)
Florida Hospilal ZephyrhiUs Cath Lab Legal: 35-25-2I-0010-10500-0000
7050 Gall Blvd
Zephyrhills,FL 33541
2. General description of improvement: Upgrade systems for new equipment
3. Owner/Tenant information
a. Name and Address: Florida Hospital ZephyrhiUs, 7050 Gall Blvd,Zephyrhills,FL 33S41
b. Ir.terest in property:Owner
c. Name and address of fee simple titleholder('f other than owner):
4. Contractor:
a. Name and a�: Rodda Construction,Inc.,250 E.Highland Drive,Lakeland,Fl,33813
b. Phone numbec:g63-669-0990 Rept:1423730 Ree: 18.50
S. Surety DS: 0.00 I T: 0.00
a. Nameundaddress:N/A 03/23/12 J. Farias, Dpt,y Clerk
b Amount of bop�d$
c. Phone number:
6. Lender
a. Name and address:N/A
b. Phone number:
7. Persons within the State of Florida designated by O►vner upon whom notices or other documents may be served as
provided in section 713.13(1)(a)7.,Florida Statutes:
u. Name and address:
b. Phone number:
8. In addition to himself, Owner designates the following person(s)to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b).,Florida Statutes:
u. Name and address: Rodda Construction,Inc.,250 E.Highland Drive,Lakeland,F133813
b. Phone number:863-669-0990
9. Expiration date of notice of commencement(the ezpiration date is 1 year from the date of recurding unless u rlifjereiTt
date is specified)
WARNING TO OWNER:ANYPAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PA YMENTS UNDER CHAPTER 713,PART I,SECTION 713.l3,FLORIDA
STATL'TES,AND CANRESULT IN YDUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPF_CTION.IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANATTORNEYBEFORE COMMENCING WORK OR RECORDING
YOUR NOTIC OF COMME MENT
4
• PqULA S 0'NEIL,Ph D PqSCO CLERK $ COMPTROLLEh
(Signature of Owner or ner's Authorized Officer/Director/Partner/Mana er 03/23/12 09:51am 1 0 ��
g I OR BK ���� P� 1�
(Signatory's Tit1P/Offtce)
The foregoing instrument ivas acknoivledged before me this �,3 day of MPRCH ,2012,by 41AVN� fEqi'��R
(name of person) as (type of aut/iority,... e.g, officer,trustee,attorney in fact)jor(name of party or:
behalf of whom instrument ivas ezecuted).
r�t�ro.�v+:
3�a,t�'�ccc. �✓ v�,wo� U,n�r:�� � � �-�{TA:St�*a
� , .x .,� �
(Signature of N ar Public-State of Florida) ,�4 �., . ,, �
�f �.,,
6$Pl:J-NU i, , •
;'9P'�+"rI9. •, .F`� 4`.i`ird�.f"a1'k�
(Print, Type,or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification '� Type of Identification Produced D. L. FoZ36��q� $o-6d-o
LEGAL DESCRIPTION FOR PROPERTY ID: 35 25 21 0010 10500 0000 PAGE O1 OF 01
SC TP RG SUB BLOCK LOT
* * * *
ZEPHYRHILLS COLONY CO LANDS PB 1 PG 55 FOLLOWING DESC PROP
LYING W OF DAIRY RD R/W AS NOW LOCATED TRACTS 103, 105, 106, 119
, 120 & 122 & E 100 FT OF TRACT 104 & E 105.76 F"I' OF TRACT 121
EXC W 187 FT OF E 267 FT OF N 172 FT OF TRACT 103 & EXC US
HWY 301 R/W & EXC R/W FOR DAUGHTERY RD;& ARBOR RIDGE
SUB PB 22 PG 44 LOTS 5, 6,7 & 8 OR 3041 PG 160
OR 3154 PG 65 OR 164 PG 724
.�3 PG 1914
OR BK �� of 2