HomeMy WebLinkAbout12-13316 CITY OF ZEPHYRHILLS
5335-8TH STREET
, � (si3)�so-oozo 13316
BUILDING PERMIT
Permit Number: 13316 Address: 5321 5TH ST
Permit Type: ACCESSORY BLDG. ZEPHYRHILLS, FL.
Class of Work: SHED INSTALLATION Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-12400-0050
Improv. Cost: 3,725.00
Date Issued: 8/10/2012 Name: WHITE, CASSIE
Total Fees: 82.50 Address: 5321 5TH ST
Amount Paid: 82.50 ZEPHYRHILLS FL 33542
Date Paid: 8/10/2012 Phone: 8137784263
Work Desc: INSTALL 10 X 20 SHED
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SHEATHING
FINAL�o - 2—1 __
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 aommenoement 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 wmmencement."
Complete Plans, Specifications Must Accompany Application.All work shall be performed in accordance with
' Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONTRACTOR SIG AT E PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
,
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813-780-002D City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received /.� y 9 ��3 `��g � ��S
�( � Phone Contact for Permittin
� ,/ /� � _^ 2
Owner's Name � �SS l� ,�Y /"l f � � Owner Phone Number ,.!77�" �
Owner's Address J �a- 1 �� s � Owner Phone Number �
Fee Simple Titleholder Name � owner Phone Number � �
Fee Simple Titleholder Address �
JOB ADDRESS � 3��` � �� LOT# �
�/ a- -�YL7-r�a c-�-��c7
SUBDIVISION � PARCEL ID# ��v� �
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED � NEW CONSTR B ADD/ALT � SIGN Q [� DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK �� �( '��
BUILDING SIZE �� � a� SQ FOOTAGE �� HEIGHT � � �
(�BUILDING $�"-7a��� VALUATION OF TOTAL CONSTRUCTION
��
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � / ��I�
1
QGAS � ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
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.� �% ConI,S�G.ilJ�ea �.�/�x.�i�.S
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 ftEGISTERED 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/Siit 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 construc6on.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Pians w/Siit 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 constructlon.
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 37500)
"* Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMI7TING (Front of Appiicatlon 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 s�bject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compli�nce witt� 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, bvth 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 contracfor(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 permiEting privileges in Pasco
County.
TRANSPORTATION IMPACTIUTILITIES 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 appiicable 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 Fiorida 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. Appiication is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or instailation has
commenced prior to issuance of a permit and that all work wili 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 Health 8� Rehabilitative ServiceslEnvironmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
1 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 �II 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FL�RIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed and swom to(or affirmed)before me this
by bY
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/F►ave produced
as fdendflcation. as identification.
Notary Public Notary Public
Commisslon No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
o�
, ' ' � �
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
/� y .
Contractor/Homeowner: /�C�iC.�' �
Date Received: �' ��Z
Site: �JZ� � � �
Permit Type: ����� ���� ����
Approved w/no comments:❑ Approved w/the below comments: l,� Denied w/the below comments: ❑
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This comment sheet shall b kept with the pernut and/or plans.
_ ,�` ���/�-
Ka1vi Swi er ans Examiner Date Contractor and/or Homeowner
�°' (Required when comments are present)
--�------------CI'T'y •OF .ZSPHYRI�II.LS BUII,ll.ING .DEPl1KTliStST
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OWNE�t 5 / E'. IC °� h/ !'' �Yl % � �
JOB I.00ATZON v �°� �� � � � �
PARCEL I.D . ' ��$ _ I � ^°ZC,° '°'Z-1—' C��/U---- I��O O � UO��
SIi0i+1 AI,L S%IST'ItTG bc .PRUPQSFIll STRU(_"TURE,'S GIVING DIHSNSZONS Sc SSTBACRS.
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UTII,ITY HUII,DINGS .
MUST SHOW SIZE &
FOUNDATION INFOR— �
MATION. FRONT PROPERTY LINE
(:1�OT�E E%AILiPLES 1 & 2) STREET S�''1 ,
1 . SETBACKS FOR R1, R2 ZONT_NG 2 . SETBACKS FOR R3 ZONING
60 ' 60'
1Q� 10' _
P E
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�� � P S ��' 10 ' EXISTING 10'
O T 1 p � 1 0 '
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D G PROPOSED
Z�� 20 ' SGL FAM 30'DUPLEX
FROii'�' PR�PSR'TY LINE FRONT PROP��[ L�g
Pasco County Parcel: 11-26-21-0010-12400-0050 001 Page 1 of 2
uata Current as Of: Weekly Archive - Saturday, July 28, 2012
Parcel iD 11-26-21-0010-12400-0050 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
WHITE CASSIE A Ag Land $0
5321 5TH ST Land $15,120
ZEPHYRHILLS FL 33542-4043 Building $23,855
Physical Address Extra Features $992
5321 5TH ST
ZEPHYRHILLS FL 33542-4044 7ust Value ;39,967
L@Qal DeSC�IDt10�1 (First 4 Lines) Assessed (Save Our Homes) $39,967
See Plat for this Subdivision Homestead 196.031 - $25,000
CITY OF ZEPHYRHILLS Non-School Additional Homestead Exemption - $0
PB i PG 54 LOTS 5 &6 Taxable Value �14,967
BLOCK 124 Warning: A significant taxable value increase may occur when sold.
OR 6170 PG 1926 Click here for details and info. regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
Line Use Description Zoniny Units Type Price Coedition Value
1 0100 SFR OOR3 8,400.00 � $1.80 1.00 $15,120
Additional Land Information
Acres 0.19 Tax Area 30ZH FEMA Code �C ZHLHLP2
Buildin� Information - Use O1 - Single Family Residential (Card: 001 of 001)
Year Built 1966 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None
Roof Strudure Flat Roof Cover Built-Up Tar and Gravel
Interior Wall i Plastered Interior Wall 2 None
Flooring 1 Terrazzo Monolithic Flooriny 2 None
Fuel Electric Heat Forced Air- Duded
A/C Central Baths 1.0
Line Description Sq. Feet Repl.Cost New
1 �S 840 $29,568
2 � 96 $2,358
3 SJS�@ 264 $2,781
4 � 120 $634
E�ctra Features (Card: 001 of 001)
Line Description Year Units Value
1 DWC 1966 178 $93
2 UDU-M 1978 1 $104
3 F N 2005 720 $795
Sales History
Pr�vious Owner MITSOS MARY&
Month/Year Book/Page Type �e Condition Amount
12/2004 6170/ 1926 Warranty Improved $71 700
Deed �
Order
12/2004 6163/0431 determining Improved $0
Homestead
Real Estate
Warranty
http://appraiser.pascogov.com/search/parcel.aspx?sec=11&twn=26&rng=21&sbb=0010&bl... 8/1/2012
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� � ' Vista Marketing
���u � 3161 Hwy 301 South Zephyrhilis FL 33540
` � Phone 813-788-5459 Fax: vistama;-t@msn ccm
� Vista Authorized Agent of Weather King Buildings (CARL)
SELECT ONE � cnsH sa�e .� RENTroo��an, BUILD AT MONTEZUMA GA PLANT�—
SALESMAN CARL CASTEN� DATE. IO7 _ 3� ZO�Z
Choose Bwlding Sale Tyoe INVENTORY#��L�._��, ��.�����/� ��/� I
New-On Lot Sale Please Select One Of The Building Types �Treated Econ o Bwidings �', RTO HO�DER Consolfdated Rentals
� Painted C Vinyl ��1 Treated '� Metal _ �— � U I
S"��E OF B�DG Choose S��E �- ,-. SIDING COLORS TRIM CO�ORS ROOF COLORS'
BARN ,.,,s,om�'ze ---- — �i a.ff-. �..�,f'��/'��
CABtN - - - ---/ �
COTTAGE SHED "EXTRA OPTIONS"DESCRIPTION COST
GARAGE � $O 00
LOFTED BARN _ $O OO
Lofted Bam Cabm � Side LBC $0 00
S�de Lofted Eam 10x20 $0 00
UTILITY $O OO
Uulity o'�Valls $0 00
S�de Ut�l�ty 8'Walls $0 00
SELECT YOUR PAYMENT DUE DATE � - n TOTAL $0 00
_____ __ _ 1ST___.' STH__y lOTH ___ 15TH _
PURCHASER NAME RICHARD WHITE JR �o,RGNTER _
' -�e'I CJ-Employer CO-Wk?h
MAILING ADDRESS DELIVERY ADDRESS
5321 5TH STREET 5321 STH STREET
Ciiy ZEPHYRHILLS ❑exemptstace State: Florida Zip: 33542
Councy PASCO �J eXemPt councy County Pasco
State Flonda ZiP 33542 .�eXempt C�cy Ciry ZEPHYRHILLS
HOME PHONE 813-778-4263 Own !Rent. Land�
WORK PHONE Landlords Phone
Cel� 813-777-2049 Landlords Name
Employer
CASH SALE RENT-TO-OWN-SALE SLB-10X20
1 sa�ES aRiC"c
$0 00 i SALES PRICE $3,725.00
= �F�icn,cesT,oesc,�be�oo�e� 2 OPTION COST (Descnbe Above) $0 00
� 3,725 00
I3 r��r,��FRErwti_��r�uNe�,.�'NE z; $O 00 3 TOTAL COST (LINE 1 + LINE 2) $
s�'�es-��Re.�K�o�+�� 4 Cost Reduction AMOUNT
-� 5�._s s�a;e-�� �rvE:{ o�=, �0 00 5 NET Cost Reduction(LINE 4=1.0+tax rate 1 07000 $0 00
5 _z �edz � �me°z�ate �0100� ���0 6 AMOUNT TO RTO(LINE 3-Line 5} $3,725��
� _�;v=ode #N!A �ine 3x Pate 0�0000 $0 00 % MONTHLY PAYMENT(LINE 6=21.6) $172.45
- -=r,�c.,��c-aK,�i,y�s� 5 5 c', $0 00 SALES TAX BREAKDOWN
g -..-�_CJS- ^ r..x;_in:�3�- $0 00 8 M/State SALES TAX(LINE 7 x 0 06) $10 35
� c.asH�ec=_�v_c 9 Co.Code 0 Line 7x Rate 0 01000 $1 72
�o ;�cr.;roiour�r�ve i�_w=a-ur�e s $0 00 10 City Code #N/A Line 7x Rate 0 00000 $0 00
FOR ALL REPAIRS FAX 888-695-7616 i i TOTAL SALES TAX(LINES 8,9 8 10) $12.07
DRIVER TO PICK-UP REMAINING "BALANCE" iz TOTAL PAYMENT(LINE�+urvE i,� $184 52
DUE AT DELIVERY OF"BUILDING"," LINE '!0 " �s To�a�coS�ssMO��hSP�t��co�«a�tc���e,zx�� $6,642J2
ESTIMATED DELIVERY DATE 14 SECURITY DEPOSIT $150 OO
10 TO 15 WORKING DAYS FROM PURCHASE DATE. 15 rOTAL RECEivED;Show Metnod.Ckx-CG Cash $334.52
OPTION DP.v,WI�G.SF+OW STANDARp'pO0RiS1'THEN PLACE VOUR'OPTIONS'
P�NCiL m�NHERE 3 give Measur=men[s from END or SIDE of BL�G.ro PLACE options DOORS FACING
PREFERRED DELIVERY TIME
DIRECTIONS
�e�tner King Portablz Buildings antl ds agents a�e not r25ponsible for permrts,setbacks res[nctions,or covenants Please contact your local
s�ce=_department or Homeowners Associat�on It is up to the customer to deade whether ground conditions are
;u�ta'ole for delivery Weather King Portable Buiid�ngs is not responsfble for yard or driveway damage. Free dehvery and t up
��c'.udes one trip addrtional trips may ircur charqes to?he customer I the customer,have read the disclosure above, �
aro fully accept the ierms prov�ded therein Customers Signature. � ;' /'� �—`
=i�st 50 miles Free Delivery From Lot Thereafter S3 OC Per Mile '
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STATE OF FLORIDA
DEPARTMENT OF COMMUNITY AFFAIRS
„Dedicated to making Florida a better place to cal!home"
RICK SCOTT
Governor
March 09, 2011
Matt Barnes
Consolidated Industries, LLC
3322 Mennonite Scool Road
Montezuma, GA 31063
RE Manufacturer Certification,ID MFT-7345, Expiration Date March 18, 2014
Dear Matt Barnes
It�s my pieasure to �nform you that Consolidated Industries, LLC, located at 3322 Mennite
Schooi Road, Montezuma, GA 31063, has been approved under the Manufactured Buildings
Program, as provided for under Chapter 553, Part I, Florida Statutes,to manufacture Storage
Sheds for installation in Florida
Construction or modification on a manufactured buiiding cannot begin until the Third Party
Agency has approved the plans in accordance with the current Florida Building Code. Your Third
Party Agency is a contractor for the Department and has statutory authority and responsibilities
that must be met to maintain approved status. You may expect and demand quality plans
review and inspections.
Each Code change will make your plans obsolete until they have been reviewed, approved and
indicated [on the cover page of the plans]for compliance with the Code by your Third Party
Agency for plans review Please ensure that your plans are in compliance and are properly
posted on our website. All site-related instaliation issues are subject to the local authority
having�urisdiction.
The DepartmenCs contractor will make unannounced monitoring visits at IeasY once each year
You must grant compiete access to your manufacturing facility and records to remain in
compliance with the rules and regutations of this program
Your certificat�on is approved for three years from this date You will receive a renewai notice by
Email generated by the BCIS(tivwUV flo�idabw'C�n �r^)for online renewal If you have questions
you may contact me or Leola Baldwin at 850-921-0956 or our FAX at 850-414-8436.
Please visit our website at:^;�.v�.�:.F.o-Cabuiidi�� oro to see valuable information on the Florida
Manufactured Buildings Program A copy of this letter must accompany applications for local
bwlding permits.
Sincerely,
���" � `f CS�
Robert Lorenzo
Manufactured Buildings Program
cc NaUOnal Desgn and Inspection, Inc.
2555 SHUMARD OAK BOULEVARD • TALLAHASSEE. FL 32399- 2100
850-488-8466 (p) ♦ 850-921-0781 (f) ♦ W e b s i t e. v.v:•w dca state fi.us
•COMMUNITY PLqNNING 850�88-2356(p) 850�088-3309(f)•
• HOUSING AN�COMMUNITY DEVELOPMENT 850d88-7956(p) 850-922-5623(f)•
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i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii i�ii
2012130839
Rcpt:1452227 Rec: 10.00
DS: 0.00 IT: 0.00
08/03/12 C. Miner, Dpty Clerk
PAULq S 0'NEIL,Ph D PqSCO CLERK & COMPTROLLEh
08/03/12 11:08am 1 of 1 +�
OR BK g735 P� 2�4L
NOTICE OF COMMENCEMENT
Permit No
Property Identification No �( `�a(p�•a� —'d�lQ- ���� --�sO CCI/'�I f,,v Lr>�� � ����
THE UNDERSIGNED hereby gives notice that�mprovements will be made to certain real property,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� ��.T �� !�S PQ 1 P� s� �.�s ���
a)Street Address $� ' � �O�
2 General descnption of improvements• r � � `'�
i�or �
3 Owner Information
a)Name and address C, �q S S t �� ��� �� �� ��� �� �� �(�/� �/IS
b)Name and address of fee simple trtleholder(if other than owner) '���`-"—�`��J
c)Interest in property �/
4�ntractor Information 1it/�,�`{ " v
a)Name and address• G�O��/S�L�D� e1 �i1//.�vST/'e��S � 33Sf/
b)Telephone No $f 3 — $g— c�GS Q Fax No (Opt.) --�. •�
5 Surety Information
a)Name and address•
b)Amount of Bond.
c)Telephone No • Fax No. (Opt.)
6 Lender
a)Name and address
Phone No
7 Identity of person withm 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 foliowmg person to receive a copy of the L�enor's Notice as provided in Section
713 13(1)(b),Floricia Sta�ule�
a)Name and address•
b)Telephone No • Fax No. (Opt.)
9 Expiration date of Not�ce 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 C,*OMMENC,�MEN� �
t! '� '% �
STATE OF FLORIDA f
i
COUNTY OF PASCO �.. c' �j ��/ ,
KORI N.SPEEGLE � ��
����� NOtflry PubliC,State ot Florida ignature of Owner or Owner's Authorized Officer irector/Partner/Manager
Commission#�EE 114626 C, � j_ C A 5�
My comm.expires July 21,201 ;nc Name
1
T oregoing i ument was�aQknowledged before m �s day of 20�,by
� =�J as � �, (type of authority,e.g. officer,trustee attorney
in act)for (name of party on behalf of wh m instrument was ex�uted). �
,
Personally Known�R Produced Identification Notary Signa ��,_ �-�
�
�
Type of Identification Produced Name(print) �� �, �
Verification pursuant to Section 92.525,Florida Statutes Under penalt�es,of perju , dec are th/�t I have read the foregoing and that
the facts stated in rt are true to the best of my knowledge and belief.� � " �" /
E U' ' � �
\ �•r�. ��� k'� ,
FORMS/NOC,rvstl2007
S�gnature ofNatural Person J�ig i bove
STATE OF FLORiDA,_ �CPA�'�
���;� �
THIS IS TO C�RT���'�`�!� � ����� �' `�^;��p-t:' ?,
T�'I!r"!); � (,'��,.14'l,� �/+ (..�' .i 'l'�%1i6, ��V'TI'��
� �- , ,,.. , . r-��a;�_i��.�-;-��� 'r��',�-'�F'��:i�F 'E
„i�`-t i�ti�ll,t.��� `,.�t�1� � aLT�•�I�;;
:-.� a ;,�, ...z� '�:- '
N�:ULA S '�,iw1�� •`
BY ��"1�s( " ' '� ry DEPUTY CLERK
�
�.w���c�i�r..