HomeMy WebLinkAbout13-13860 CITY OF ZEPHYRHII�LS
5335-8TH S7REET
(ai3��so-oo20 13860
BUILDING PERMIT .
Permit Number: 13860 Address: 5520 24TH ST
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: HAZEL HEIGHTS
Est. Value: Parcel Number: 12-26-21-0070-00000-0140
Improv. Cost: 52,294.00
Date Issued: 3/20/2013 Name: WORKFORCE HOUSING VENTURES
Total Fees: 685.50 Address: PO BOX 948
Amount Paid: 685.50 DADE CITY FL 33526
Date Paid: 3/20/2013 Phone:
Work Desc: EXTERIOR/INTERIOR REMODEL REHAB/REROOF SHINGLE
RG MCCARTY&SONS INC PLUMBING FEE 60.00 MECHANICAL FEE 60.00
DENNIS WILLIAMS INC REROOF RESIDENTIAL 60.00
SC SIGNATURE CONSTRUCTION CORP
LOGGERHEAD AIR INC
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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 wrrechons 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 acxessible.
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,Specifcations Must Accompany Application. All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRbCTOR 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 / / / / BUILDING
ZEPHYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION
� • • - •
ADDRE55 C DATE PERMIT�,
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THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before tha iob
. will be accepted.
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It is unlawful for any Carpenter,Contractor,euilder,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any part of the work with flooring,�ath,earth 780-0020 FOR E-IN PECTION
or other material,until the proper inspector has had ample time to approve
the installalion.
OFFICE HOURS 7:30 AM-5 PM MON.-FRI. INSPECTOR
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'�IGNATURE�
CONSTRUCTION
CORPORATION
GENERAL CONTRACTOR:? ROOFWG AND MARINE CONSTRUCTION
August 27, 2013
City of Zephyrhiils
8335 8`h Street
Zephyrhills, FL 33542
ATTN: BUILDING DEPARTMENT
I am requesting that the plumber on permit no. 13860 be changed to RJ Kielty Plumbing,9507 SR52 Hudson, FL 34669/
727-863-5486;for the projec . you have any questions piease do not hesitate to contact me.Thank you.
Sincer � �� ��
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eph Matissek
President, S.C.Signature Construction Corp.
8530 Oreto Dr � Port Richey, FL 34668 ( O�ce'727.842.5163 � �
CGC1514332 I CCC1328842
B13-780-0020 City of Zephyrhills Permit Application Fax-813-780-002�
Building Department
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Date Recelved + � � a'7 Y�:S/�
Ph e ContactforPermi n
Owner's Name l�. Owner Phone Number �� ��V
Owner's Address �J�� �� � wner Phone Number
Fee Simple Titleholder Name Owner Phone Number � '
Fee Simple Titleholder Address
JOB ADDRESS LlJ Z l i I I ^L LOT# �
SUBDWISION ��il ���� PARCEL ID# Z "�Z " �7 U'�J`
(OBTAINED FROM PROPERTY TA%NOTICE)
WORK PROPOSED B NEW CONSTR� ADD/ALT � SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE � SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION � BIOCK Q FRAME � STEEL �
DESCRIPTION OF WORK � 1 , �
BUILDING SIZE S�FOOTAGE C� HEIGHT �
�BUILDING $ .C��7 � O VALUATION OF TOTAL CONSTRUCTION
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�ELECTRICAL $ AMP SERVIC `� � PROGRESS ENERGY Q W.R.E.C.
PLUMBING $ `�0..`�� C"�� , •`! �,�I/5 I
� 2 ���oo ��wQ ,` /� f1�,-.-:
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�MECHANICAL $ r_ VALUATION OF MECHANICAL INSTALLATION
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OGAS ROOFING SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS LOOD 20NE AREA �YES NO
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BUILDER MPANY � ���(U UI�'C ��U.X IV �
SIGNATURE REGIS7ERED Y/ N FEE CURRE� Y!N
Address l.Jl � � ����ense# � ,L"}l�t��_�
ELECTRICI ��, ,(/�/,/f �[� � � MPANY . � � ��-3-'� l ��
SIGNATURE ' 'Y- -t -�.� � REGISTERED Y/ N • FEE CURREP /N
Address ��� �J_ GW1 �� License# G� �i2-� � _ I
PLUMBER � � � MPANY C ��,^4'�'
SIGNATURE � � � � `�' REGISTERED Y/ N FEE CURRE� Y I N 1� �_Zc�13
Address � �bb I License# l �
�eed
MECHANICAL �\ ���� COMPANY � ��•
SIGNATURE REGISTERED / FEECURRE� /N
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Address � 1 L �" � License# � ��b�� s�a R,��
OTHER y �8�P� ` � '� `��' lCl
SIGNATURE REGISTERED / N FEE CURREP Y/N J
Address tr�}' l�lCl�License p ���� "ZL��
RESIDENTI Attach(2)Plot Plans;(2)sets of Buiiding Plans;(t)set of Energy Forms;R-O-W Permit for new construction,
Minimum[en(10)working days after submittai date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&t dumpster;Site Work Permit for subdivisionsllarge 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!Siit Fence installed,
Sanilary Faci�ities$1 dumpster Site Work Permit for all new projects.All commercial requirements musl meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
`°`PROPERTY SURVEY required for all NEW construction.
1 1 1 � � 1 � 1 1 1 � 1 1 1 1 1 1 1 1 1 1 � 1 1 1 1 1 1 1 1 1 � 1 1 1 1 1 1 1 1 1 1 1 � 1 � � � 1 1 1 1
Direc[ions:
Fill out application completely.
Owner&Contrector sign back of application,notarized
� If over 52500,a Notice of Commencement is required. (A/C upgrodes over f7500)
" Agent(Tor the contractor)or Power of Attomey(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(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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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 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 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 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-Seawalis,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Welis, 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 Build'tng Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work eases for ninety(90)consecutive days,the job is considered�bandoned.
WARNING TO OWNER: YOUR FAI RE TO RECORD A NOTICE OF CO ENCEMENT M RESULT IN YOUR
PAYING TWICE FOR PROVEMEN S TO YOUR PROPERTY. IF YOU IN. TO BTAIN ANCING,CONSULT
WITH YOUR LEND R ATT NEY BEFORE RECORDING YOUR ICE OM NCEM
FLORIDA JURAT(F.S. 17 3)
OWNER OR AGEN ' CONTRACTOR
Su scri ed and swo ( ffirmgQ)b fore me is Su 'b nd s t ffi me for mg h' /
� by rrl �
re erso I to me or has/have produced r has/have produced
as identifica6on. as identification.
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Building Departrnent
Dffie ReCeived Phone Contact for Permitting
Owner's Name Owner Phone Number
Owner's Address Owner Phone Number �
Fee Simple Tkleholder Name Owner Phone Number �
Fee Simple Titleholder Address
JOB ADDRESS LOT# �
SUBDIVISiON PARCEL ID#
(OBTAINED FROM PROVERTY TAX NOTICE�
WORK PROPOSED e NEW CONSTR B ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q B�OCK Q FRAME � STEEL Q
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTA(iE� HEIGHT �
QBUILDING S VALUATION OF TOTAL CONSTRUCTION
QEIECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
QGAS Q ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY �
SIGNATURE REGISrs�D Y/ N �E c.�mr�n Y/N
Address Llcense# �
ELECTRICIAN COMPANY �
SIGNATURE rtEG�57ERED Y/ N FEE CURREn Y!N
Address License#
PLUMBER }�f �`�,�J �,`J�Q�v�C.-� COMPANY 1 S �l1\\0.(�S � I'C�� �`^" ""�
SIGNATURE �''���� rt�Gl5t� N �EE cuRREn N l��
Address S�C;P)�T►nst Z-riillS,� 3�iUa Ucense# � i'1�J�U�
MECHANICAL � � COMPANY
SIGNATURE aEGISTEREO Y/ N F�CuRREn Y/N
Addross License# �
OTHER COMPANY
SIGNATURE rtEGiS7EREO Y/ N �Cuar�n Y/N
Address License#
RESIDENTIAL Attach(2)Pbt Plans;(2)sels of Building Plans;(1)set of Energy Fortns;R-O-W Permit for naw constructlon,
Minimum ten(10)working days aRer submHfal date. Required onslte,ConstrucUon Plans,Stormwater Plans w/Silt Fence histalled,
Sanitary Fadlitles 81 dumpster;Site Wwk Permft for subdivisionsllarge projecls
COMMERCIAL Attach(3)complete sels of Buildinp Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit Tor new construcNon.
Mi�mum ten(10)ywrking days aiter submitfal date. Requfred onslte,Construdion Plans,Stortnwater Plans w!Stlt Fence installad,
Sanlfary FadBdes 8 1 dumpster Site Work Permit for all new proJeds.All oommerdal requirements must meet compliance
SIGN PERMR Attach(2)sets of Engineered Plans.
"••PROPERTY SURVEY required for ail NEW construcdon.
Dfroctions:
FIII aut applicatlon�mpletely.
Ovmer 8 Contrector sign back of epplicatlon,notar¢ed
If over 52300,a Notice of Commencemant is requirad. (AIC upgradas over 57500)
" Apent(for the contractor)or Power of Altomey(for the owner)would be someone with rafartzed letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PlotlSurvey/Footage)
Driveways-Not over Counter if on puWic roadways..needs ROW
_� �
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'�I�NATURE`'
. CONSTRUCTION
C O R P O R A T I O N
GENERAL CONTRACTORS C3Ef�lERA( c Ut�'1 F�A�10R�ROOFING AND MARINE CONSTRUCTION ROOE iN<:qND nnaRinfE c��t�s1r��c T ic�r.
City of Zephyrhills
Reference: State License—CGC1508I35
To Whom It May Concern:
I Joseph Matissek, Licensed General Contractor for SC Signature Construction
Corp. authorize Robert Koment, of SC Signature Construction Corp. to sign any and all
periinent documents for construction, including but not limited to the permitting process
that is required by the City of Zephyrhills Building Department.
��� J
h Matissek ,,
State of Florida
County of Pasco �
t�, 2013
Sworn to (or affirmed) and subscribed before me this �.0 , day of
by Joseph Matissek, who Produced Identification OR Personally Known �
NOTARY PUBLIC
��
�a MAR� �� � •i�ERF
My Commission expires: 1-2�"� � Not�ry Public•State o1 flonda
• •� My Comm.Expires Jan 2,2017
Commission �r tE 862165
'�,• 8o�0ld 111rouph Nauonal NMary Aasn
8530 Oreto Dr. I Port Richey,FL 34b68 I Office 727.842.5163
CGC1514332 + CCC1328842
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
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�, Contractca�ff-Iomeowner: - "��2, � ��c..i1l�u.c�LL�r- ( �,�'IS� -
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Date Received: ,-�'7� � �
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5ite: �� �� �� '{�'� -��
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PernutType: � `��7����' � ;'����.f���.�`;_��llU✓�.
Approved w/no comments:❑ Approved w/the below comments: ❑ Denied w/the below comments: ❑
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This comment sheet shall be kept with the permit and/or plans.
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-Ti�fzer I�4s Examiner ate Contractor and/or Homeowner
�
' (Required when comments are present)
Pasco County Parcel: 12-26-21-0070-00000-0140 001 Page 1 of 2
Data Current as Of: Weekly Archive - Saturday, February 02, 2013
r— Parcel ID 12-26-21-0070-00000-0140 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Property Value
WORKFORCE HOUSING VENTURES INC Ag Land �o
PO BOX 948 Land �i3,io3
DADE CITY FL 33526-0948 Building �2a,597
Physical Address Extra Features $519
5520 24TH ST
ZEPHYRHILLS FL 33542-6815 �ust Value �38,219
Le9al Description (First 4 Lines) ASSeSSeC1 (Non-School Amendment 1) $38,219
See Plat for this Subdivision
HAZEL HEIGHTS PB 6 PG 21 Taxable Value ¢38,219
LOT 14
OR 8522 PG 1597
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price Condition Value
�1 0100 SFR OOR2 9,000.00 SF $1.45 1.00 $13,050
�2 0100 SFR OOR2 205.00 SF $0.26 1.00 $53
Additional Land Information
Acres 0.21 Tax Area 30ZH FEMA �Residential Code ZHLGLPS
Code
Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1958 Stories 1.0
Euterior Wall i Aluminum Siding Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall i Drywall Interior Wall 2 None
Flooring i Cork or Vinyl Tile Flooring 2 Carpet
Fuel Electric Heat Forced Air- Ducted
A/C Central Baths 1.0
Line Description Sq. Feet Repl. Cost New
1 FEP �- 192 �—$5,380
2 FOA 96 $964 �
3 � BAS �- 784 $31,478
4 FSP 60 $843
5 � FCP 220 $2,208
6 UGR 252 $3,051
Extra Features (Card: 001 of 001)
Line � Description Year Units Value
1 —�� DWC 1986 �- 350 $433
2 UDU-M 1978 1 �— $86
Sales History
Previous Owner PASCO COUNTY BOARD OF COUNTY
Month/Year Book/Page Type DOR Condition Amount
http://www.appraiser.pascogov.com/search/parcel.aspx?sec=12&twn=26&rng=21&sbb=00... 2/4/2013
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R4 iChange FL#: FL12019.1 King, P.E. ,
H�� Model: "Triple 4" and "Quad 4" (813) 787- ;
; Description: 0,012" Thick Aluminum Soffit�8283 �
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Category: Panel Walls i
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MANUFAC.TUR�R PRODUCT FLM PRODUCT FL#
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CT20 2b XT XT30 b444.1 COUNTRY NWNSION �0124.1
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HAITERAB 5444.1 ORAN• CANYON 0124.1
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NOMARK 5444.1 GRAN SLATE 0124.1
LANDMARK PREMIUM 5444,1 ORANO SLATE II 10124.1
LANDMAR PRO 5444.1 MAJE3TIC �0124.1
LANDMARIC 30LARIS 5444.1 MAJE3TIC SO 90124.1
LANDMAFiK TL b444.1 AAARQUIS WEATHERMAX 10124.1
PRESIDENTIA SHAKE 8444.1 MONACO 90124.1
PRESIDENTIAL 3HAKE TL 5444.1 RIDG 10124.1
RIDGLAS310 10124.1
OWEN3 CORNI (3 BERKSHIRE 10874.1 RID(iWS312 10124.1
BERKSHIRE H1P 8 RIDC3E 10874.1 RIDGLA33 8 10124.1
CLA331C 10874.1 ROYA SOVEREIGN 10124.1
DURATIbW 10874.1 SEAL-A-RIDGE 10124.1
DURATION PREMfUM 10874.1 SEAL/4-RIDf3E ARMORSHIffID 10124.1
HIGH RI�GE 1�674.1 SEAL -RIO(3E IMPACT RESISTANCT IR 10124.1
HIP�RID(3E WITH SEALANT 10674.1 3ENTINAL 10124.1
OAKRIDG� 10874.1 SIAT LINE 10124.1
SUPREME 10874.1 TIMB�RLINE AMERICAN HARVEST 10124.1
WEATHER GUARD HP 10874.1 TIMB RLINE ARMORSHIELO II 10124.1
TIMB RLINE COOL SERIE8 1o12a.1
IKO INDUSTR) 3 ARMOURSHAKE 1b550,1 TIMB RIINE HD 10124.1
CROWN SLATE PREMIUM SBS 16580.2 TIMB RLINE NATURAI SHADOW 10124.1
ORANDEUR SBS 16550.9 TIMBERLINE NATURAL SHADOW ARTIC WHITE 10124.1
MARATHQN ULTRA AR&CRC 16580.4 TIMB�RLINH PRESTIQUE 30 10124.1
ROYAL ESTATE 15650.5 TIMB RLINE PRE3TIQUE 40 1o12a.�
TIMBERLINE PRESTIQUE GRANDE �o12a�
TAMKO ELITE GLASS 3EAL 1958.1 TIMB�RLINE PRE3TIQUE LIFETIME 10124.1
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HERITAGE 1958.3 TIMBERTEX HIP �p�pq,�
HERRAGE 30 1958.4 WOQDLAND �0124,�
HERITAGE 50 1958.b
HERITAGE PREMIUM 1968.8 ATLA GLASSMAS7ER 25 9782.1
HERITACiE VINTAGE 7154.1 aIASSMASTER SO 9792.1
HERITA(iE WOODC3ATE 1958.7 PINNACLE 8792.1
HERITA E XL 1958.8 PINNACLE 35 8792.1
PINNACLE HP 8792.1
PINNACLE LIFETIME 97gp,�
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� ; ��� PASCO COUNTY, FLORIDA
i V Y 1��11�I11������II III�������II�III
� — - ' DADE CITY (352) 521-4274, Ext.3445 PASCO COUNTY COMMUNITY
�
I! ��_ �......, � , LAND O' LAKES (813)996-7341 Ext.3445 DEVELOPMENT DIVISION
�� � NEW PORT RICHEY (727)834-3445 5640 MAIN STREET, SUITE 200
, . FAX (727)834-3450 NEW PORT RICHEY, FL 34652
� � �
"�ringing Opportunities,�Come"
ALLw OP:�SlI�1LL CC�����'I,�'�Y'I i Fl�'�LL
REHABILITATION I'� ��1���1°��UILDI��
COD ,� 1 � d L.CT�tIC CODE AND
C�ITY OF ZE�HYR��ILLS O�1N.'�NCES
Rehabilitation Bid Proposal for: Workforce Housing Ventures, nc.
5520 24th St.
Zephvrhills, FL 33542
Case# 10-6578 f
Date Due: Januarv 11, 2013 ��'`�!��'�' C��.T�_ _� � '_(�
'���`� �%� .�;E�,d��-i'Y6���-�it�'._::
Contractor's name:S.C. Signature Construction, Coru. ���,.s���� �;�����,�;�,4
�
Address:8530 Oreto Dr. Port RicheY,FL 34668 --- --- –
PROPOSAL
I, the undersigned contractor, having inspected the above referenced property; and having familiarized
myself with the requirement set forth in the work write-up, rehabilitation standards, and plans of the
above-referenced; and I understand the extent and character of the work to be performed, propose to
furnish all labor, equipment, and material to accomplish all work as described in the work write-up.
INITIAL PROJECT TOTAL $52,294.00
ADDENDUM TOTAL $
TOTAL $52,294.00 �
OPTION #1 $
For the sum of Fiftv Two Thousand Two Hundred Ninetv Four dollars
($52,294.00),with an itemized breakdown on the attached work write-up,to form this proposal. If my bid
is accepted,I will commence work within seven(7)calendar days after the Notice to Proceed is issued and
will complete the work within Ninety (90) calendar days after the Notice to Proceed is issued.
Indicate percentage amount that will be used for profit and overhead for allowance items only
20%.
COMMENTS:
Authorized Signature
Title
NOTE: This sheet must be attached to work write-up with the itemized breakdowns typed in their
appropriate spaces in order for us to consider your bid.
PLEASE NOTE: Pasco County Community Development Division will reject bids with
inaccurate totals exceeding 2% and line items with no dollar amount.
GDR/EFP/EF
'�asco County—�F'Corida's premier county for 6aCanced economic growtFi,envTronmentaCsustaina6iCity, and'first-cCass services."
UNLESS OTHERWISE NOTED, ALL WORK IN THIS WRITE-UP TO FOLLOW
THE STANDARDS AND GUIDELLINES SET IN BID SPECIFICATIONS 2011
SPEC # DESCRIPTION OF THE WORK LOCATION COST
EXTERIOR WORK
1 DEMOLITION /REMOVALS
Remove shed and concrete slab. Exterior 350
Remove existing wall where washer and dryer hook up.
Include back porch roof, walls, supports etc. Back Porch 250
2 FILL DIRT
Provide and install clean fill dirt installed and compacted
as required ready for sod. Shed Area 100
9 CONCRETE SLAB
New reinforced concrete slab on grade. (Fibermesh reinforcing
is permitted in lieu of welded wire with engineer or Architect
authorization). See 2012 Bid specs. Info Only Info Only
Provide and install new garage entry apron and extending
out from garage door 8'. Driveway 240
Provide and install new concrete walkway from driveway to
front porch. Include walkway from new driveway apron to existing
driveway. Walkway to house to be 4' at driveway and porch
tapered down to 3' in between. Walkways 380
11 CARPENTRY—GENERAL SPECIFICATIONS
Remove bottom 2' of siding on garage. Provide and install
new '/z" 4 ply CDX plywood and nailed 6" O.C. Include
plywood for interior walls of front porch and back porch
wall next to house. Include removing window. Frame in
opening with 2x4's and cover with '/z" 4 plywood in garage. Exterior 650
Remove all wood trim around windows. Provide and install
new P.T. wood around windows. Include replacing trim around
overhead garage door and rotten fascia on back porch. Exterior 630
General carpentry. All provisions apply. Info Only Info Only
PAGE TOTAL: 2600
CASE #: 10-6578 5520 24th St. DATE: O1/21/13 PAGE: #1
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
28 ROOF SHEATHING
Replace any rotted sheathing and/or sheathing inadequate for nailing
roof covering materials. This item is an allowance. Submit pictures
of replaced sheathing. Exterior $100.00
30 GABLED ENDS
After removal of existing siding. Provide and install `/2" 4 ply
CDX plywood and nailed 6" O.C. on all gable ends. Remove
exhaust fan and frame in opening. (3) Exterior 550
37 EXTERIOR DOORS
Replace existing garage entry door with new. The door
frame to be composite material and a 6 panel fiberglass
door and lever lockset and deadbolt. Garage To Interior 425
Replace existing back entry door with new. The door
frame to be composite material and a 6 panel
fiberglass door and lever lockset and deadbolt. Back Door 425
Replace existing laundry room door with new. The door
frame to be composite material and a 6 panel fiberglass
door and lever lockset and deadbolt. Laundry Room 425
Include all new lever locksets and dead bolts for existing doors.
All doors to have lever locks and deadbolts and keyed alike. Info Only
39 SCREEN—RESCREEN
Install new dark charcoal fiberglass screen and proper spline in
the rear screen room. Include replacing missing window
screen frames. Mesh size to be 18/14. Entire House 435
45 EXTERIOR SIDING—MASONRY FINISH
Provide and install wire lath on entire exterior of house
including gables and front interior of porch up to the
start of screen. Texture to be sand finish. Put masonry
finish on per 2011 Bid Specs. Exterior 4500
PAGE TOTAL: 6860
CUM TOTAL: 9460
CASE #: 10-6578 5520 24th St. DATE: O1/21/13 PAGE: #2
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
46 SOFFIT AND FASCIA
Remove all areas of rotted, decayed fascia and
soffit. Replace all rotted wood removed with
new pressure treated wood sufficient for nailing new
aluminum fascia and vented soffit. Enclose all soffit with
vented aluminum and enclose all fascia boards
with new aluminum baked finish. Soffit and fascia to be white. GarageBack Porch 1164
49 GUTTERS AND DOWNSPOUTS
Install new 6" seamless gutters and downspouts at all eaves
where water runoff from the roof occurs. Leaders and
downspouts to be 3" X 4" with splash blocks included in the
price. Color- White. Entire House 785
50/51 ROOFING-GENERAL SPECIFICATIONS
ROOFING-FIBERGLASS SHINGLES
Remove the existing roofing material and old felts. Replace any
deteriorated wood framing and sheathing. Install a new Class
"A" fiberglass shingle roof per all requirements of the
specifications and applicable codes. The secondary water barrier
to be peel and stick. Note: Existing 1 X 2 drip board may be
removed when new fascia& soffit is being installed. The
contractor is to submit the roofing inspection affidavit upon
completion of the project. Include installing ridge vents at all
peaks. Re-nail the deck to meet code. Roof color to be
Driftwood. Entire House 5750
Contractor to notify the Housing Specialist at the time of roof
installation so pictures of the substrate and water barrier
installation pictures to be taken to verify compliance of
specifications. Failure to notify could result in the roofing being
rejected. Info Only
PAGE TOTAL: 7699
CUM TOTAL: 17159
CASE #: 10-6578 5520 24`h St. DATE: O1/21/13 PAGE: #3
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
68 EXTERIOR CEILINGS
Provide and install new wood in place where existing ceiling is
missing and damaged. Wood to match existing. Front/Back Porch 350
70 SCREEN DOOR-ALUMINUM
Install new aluminum screen door. The screen door to be
Comfort-Built, Key West, or equal. ($75.00) Color-White Front Entry 265
72 GARAGE DOOR AND FRAMING
Provide and install new garage door opener,
one remote and keyless entry pad. Garage 425
78 ELECTRICAL
Convert existing outlets to waterproof GFCI. Exterior 65
Install a new exterior, waterproof GFCI outlet. A/C Condenser 120
Replace existing exterior light fixtures with new. Back Porch/
Assume cost of new fixture at $20.00 each. (2) Front Entry 120
Terminate electrical service for water heater, washing machine,
dryer, outlet and attic exhaust fan back to source. Exterior 80
Bring electric up to code in Utility room. Exterior 410
80/81 PLUMBING-GENERAL SPECIFICATIONS
PLUMBING FIXTURES
Install a new connection to the existing water service and meter
with proper size pipe. Water Service 400
Replace all existing hose bibs with new hose bibs and vacuum
breakers to code. Include a new lever handle shutoff valve at
water service entry and all new pipes. Exterior 140
PAGE TOTAL: 2375
CUM TOTAL: 19534
CASE #: 10-6578 5520 24th St. DATE: O1/21/13 PAGE: #4
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
87 PAINTING- GENERAL SPECIFICATIONS
Pressure clean, scrape and prepare exterior for painting. Paint
the entire exterior of the house including all exposed wood,
concrete, stucco, masonry and ferrous metal. All newly installed
wood shall receive one coat of primer or undercoat and two
coats of semi-gloss paint. Remove all nails, screws, brackets,
phone and cable boxes and wires. Color to be Body Antique
Chest ECG59-1D, Doors New Roof ECG59-3D colors from
Behr's color chart. Exterior 2000
Paint ceilings white. Back/Front Porch 400
Pressure wash and paint sidewalks, driveway and porches with
epoxy paint. Color to match body of house. Exterior 620
88 LANDSCAPING
Install landscaping in the front yard as directed by the Housing
Specialist. This includes providing sod where shed was located.
The allowance for this item. Yard $400.00
Cut and remove indicated trees in yard. Labor and equipment to
be provided by a properly insured, professional tree removal
company. Include stump and visible root grinding. (3) Back Yard 2100
Trim shrubs down to 4' across front yard and remove shrub
and grind stump by garage. Yard 650
90 MAIL BOX
Furnish and install a new mail box per our bid specs. Exterior 85
94 MISCELLANEOUS
Furnish and install new address numbers to code. Front 45
PAGE TOTAL: 6300
PROJECT EXTERIOR TOTAL: 25834
CASE #: 10-6578 5520 24`h St. DATE: O1/21/13 PAGE: #5
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
INTERIOR WORK
22 FLOOR COVERING/CERAMIC
After removal of existing flooring, install new ceramic tile floor
per the manufacturer's recommendation. Assume "cost of tile"
to be installed at $2.00 per sq. foot of area. Areas to be tiled -
Foyer/Bathroom/Dining Room/Kitchen/Florida Room, Area
between Living Room and Florida Room. Tile Areas 2625
Note: Existing ceramic tile to remain, use caution. Info Only
25 BASE & SHOE MOLDING
Install shoe molding on all walls in newly floored areas. When
new base is installed over flooring, no shoe is required. Include
new baseboard under existing A/C return. Entire House 150
36 WINDOW REPAIR
Repair the existing windows to proper operating condition. This
includes closers, springs, weather stripping and sashes. Interior 180
Replace all broken window glass. Entire House 130
56 CEILING INSULATION
Check existing ceiling insulation and add insulation as required to
achieve an estimated R-30 (Minimum 10.375 ") in pitched roof areas.
Insulation card to be supplied with final pay request. Entire House 675
58 INTERIOR WALL AND CEILING FINISH-
PLASTER/DRYWALL REPAIR
Install new drywall on walls and ceiling of bedroom closets.
Texture to match existing textures. Note: all textures to be
professionally applied through a spray texture machine
not a hand held hopper. Include repairing all cracks and
damaged surfaces to match existing finishes. Interior 1200
Include any damage caused from wainscot removals,
backsplash removals, tile removal, duct relocation, etc.
Include any additional damage caused by building
modification, etc. in price. Include hole behind oven. Info Only
PAGE TOTAL: 4960
CASE #: 10-6578 5520 24th St. DATE: O1/21/13 PAGE: #6
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
63 INTERIOR WALL FINISH-CERAMIC TILE (THIN SET)
Install a new ceramic tile backsplash. Assume the "cost of the tile" at
$2.00 per sq ft. of area. Color/design to be selected by the Housing
Specialist. Kitchen 375
64 FIXTURE SET
Furnish and install a new chrome fixture set. Bath 80
67 ATTIC ACCESS
Install a wall access panel to minimum clearing opening
of 22" X 36". Provide cover, and trim opening. Garage 80
69 INTERIOR DOORS
Adjust bedroom closet doors so that
they open and close conectly. Closets 60
Furnish and install new pre-hung hollow core paneled doors,
frame, colonial trim, door stop and lever lockset. All hinges
and hardware lever locksets to be Antique Brass in color. (4) Interior 650
75 CABINETS - KITCHEN/COUNTER TOP
Sand all cabinets then re-stain with light oak color and varnish.
Provide and install new end panel, quarter round, toe kicks, bumper
pads, caulk all joints, secure all shelves pulls for drawers and handles
for doors. Adjust all drawers and doors so they work correctly. Kitchen 1850
76 COUNTERTOP
Replace the existing countertop with 4" backsplash. Tops to be
Multi-ply furniture—grade plywood with standard 1 '/z" edging.
See Bid Specs 2011. Kitchen 690
77 CLOSETS
Provide and install all new brackets and metal
vinyl covered vented shelving. Bedroom Closets 160
78 ELECTRICAL
Install new hardwired smoke/carbon detectors to code. Entire House 425
Convert existing outlets to GFCI. Entire House 140
PAGE TOTAL: 4510
CUM TOTAL: 9470
CASE #: 10-6578 5520 24`h St. DATE: O1/21/13 PAGE: #7
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
78 ELECTRICAL CONTINUED
Install arc-fault circuit interrupters for each bedroom outlet
to code. Include sub-panel and separating circuits if required. Bedrooms 350
Wire new electric water heater to meet current
code requirements. This is being moved from back porch. Garage 180
Re-wire area to code. Include rough out and final. Contractor
to furnish any required documentation to Building Dept. Garage 400
Furnish and install a new ceiling hugger fan with light kit,
proper wiring and switch to code. Assume cost of fan and
light kit at $75.00. Include new fan box if required. (3) Interior 180
Provide and install new wiring and plug for range to code. Kitchen 295
Provide and install new wiring, plug, switch and box for
garbage disposal to code. Include new outlet for refrigerator. Kitchen 180
Remove ceiling light. Provide and install (4) recessed lights
with proper wiring and switch and j-box to code. Kitchen 600
Furnish and install a new wireless doorbell system. Entire House 80
Furnish and install new switches and receptacles. Include
all new switches, receptacles, co-axial phone and blank plated. Entire House 490
Re-lamp all new and existing fixtures with standard energy
efficient bulbs. Entire House 120
Wire new garage door operator to meet current code requirements. Garage 110
Provide and install a new fluorescent light fixtures, furnish and install
A new 4' energy efficient fluorescent fixture with light diffuser.
Include new j-box. (2) Garage 280
PAGE TOTAL: 3265
CUM TOTAL: 12735
CASE #: 10-6578 5520 24th St. DATE: O1/21/13 PAGE: #8
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
79 H.V.A.C.
Replace the existing air conditioner assuming to be a 2 1/2 ton
heat pump air conditioning system. (Can be larger or smaller,
depending on your sub-contractor energy cal) Replace the existing
air handler, condensing unit, controls, proper wiring.
Check all ducts for leaks or damage areas. Repairs to ductwork
will be paid by change order. Install new units in the same
location as the old ones. Minimum SEER required 15.00.
Heat strip is a 7.SKW. The exact size of the air condition to be
determined by the air condition contractor. Include eliminating
ducts in back porch area. Units to be moved to new location out
side garage and inside garage area. Include cost of moving duct
work. Entire House 4480
Include eliminating existing wall return ducts and relocating/adding
supply and return drops as required. New thermostat to be centrally
located between new ceiling returns. Info Only
Furnish and install a new recessed dryer vent box and exhaust
duct/vent to code. Garage 140
80/81 PLUMBING-GENERAL SPECIFICATIONS
PLUMBING FIXTURES
Install a new heavy duty stainless steel double compartment deep
bowl sink. Sink shall be installed complete with supplies, faucets,
fittings, traps, etc.. Supplies must be equipped with stop valves. Kitchen 675
Provide and install new supply lines, stop valves and extend
CPVC pipe into bathroom. Bathroom 300
Furnish and install a new fiberglass tub insert, drains,
plumbing, and showerhead and faucets. Bathroom 680
Install a new toilet seat complete with new supply line and
angle stop with new escutcheon. Include extending CPVC
pipe into bathroom. Bathroom 120
Provide all new copper water line complete with Hanson
type shutoff valve for icemaker. Kitchen 140
PAGE TOTAL: 6535
CUM TOTAL: 19270
CASE #: 10-6578 5520 24`h St. DATE: O1/21/13 PAGE: #9
Rev.3/10/11
SPEC # DESCRIPTION OF THE WORK LOCATION COST
80/81 PLUMBING-GENERAL SPECIFICATIONS
PLUMBING FIXTURES CONTINUED
Install a new 40 gallon up right electric water heater
to code. Protect water heater from vehicular damage.
(If required by code.) Garage 680
Furnish and install a new 1/2 H.P. garbage disposal. Kitchen 145
82 MAJOR APPLIANCES
Furnish and install a new 30" electric stove. The cost of the
stove to be $450.00. To code. Kitchen 450
Furnish and install a new duct hood. Kitchen 140
Furnish and install a new 21 cubic foot refrigerator with
icemaker. The cost of the refrigerator to be $750.00. Kitchen 800
All appliances to be of the same brand and white in color. Info Only
85 PEST EXTERMINATION
Inspect house for termite and/or other insect infestation.
If active infestation is found, treatment will be completed
by change order. Contractor to furnish an inspection report. Entire house 125
87 PAINTING- GENERAL SPECIFICATIONS
Plug, patch and paint the entire interior of the building
including all walls, ceilings, doors, trim, and baseboard
in accordance with the requirements of this section.
Stained ceilings are to be prepared properly to ensure
coverage of final coat. All wallpaper to be removed,
walls properly prepared and painted. Include the painting
of garage floor, porches, and screen porch. Interior wall
color to be antique white. Interior 2100
94 MISCELLANEOUS
Remove existing window treatments. Patch and paint to match
existing. Furnish and install2"white wood faux blinds. All Windows 650
PAGE TOTAL: 5090
CUM TOTAL: 24360
NAME: CASE #10-6578 5520 24`h St. DATE: O1/21/13 PAGE: #10
Rev.3/10/l 1
SPEC # DESCRIPTION OF THE WORK LOCATION COST
94 MISCELLANEOUS CONTINUED
Remove all old O.S.B. from garage walls. Provide
and install new '/2 O.S.B. on all walls. Garage Allowance 800
CLEAN-UP
Remove and dispose of all trash debris left by previous occupants.
Provide "Ready for Resale"professional cleaning service. Entire House 400
PERMITS AND FEES 900
PAGE TOTAL: 2100
TOTAL INTERIOR AMOUNT: $26,460.00
TOTAL EXTERIOR AMOUNT: $25,834.00
TOTAL PROJECT AMOUNT: $52,294.00
IF ANY ENGINEERING IS REQUIRED TO COMPLETE THE WORK IN THIS WRITE
UP, OR TO GET A PERMIT,THE CONTRACTOR TO FURNISH IT.
NAME: CASE #10-6578 5520 24tn St. DATE: O1/21/13 PAGE: #11
Rev.3/10/11
Permit No. Parcel ID No. 12-26-21-0070-00000-0140
NOTICEOFCOMMENCEMENT IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
State of FLORIDA County of PASCO 2013015558
THE UNDERSIGNED hereby gives notice that improvement 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� Parcel Identification No.HAZEL HEIGHTS.PB 6.PG 21.LOT 14 Rcp1,:1491992 Ree: 10.�0
DS: 0.00 IT: 0.00
Street Address: 5520 24th Street.Zeahrvhills.FL 33542 01/25/13 L. Ser i o, Dp1.y C 1 erk
2. General Description of Improvement Minor Rehab
PAULA S 0'NEIL,Ph D PRSCO CLERK & COMPTROLLEk
010R BK ���� 1PG�f��2�
3 Owner Information: Workforce Housinq Ventures Inc. a Florida not for orofit cor�oration
Name
P.O.Box 948 Dade Citv Zio Code 33526 FL
Add�ess City State
Interest in Property: Fee Sim�le
Name of Fee Simple Titleholder•
(If other than owner)
Address Ciry State
4 Contractor. S.C.Siqnature Construction Com-Mark ConnedJoe Matissek
Name
8530 Oreto Drive Port Richev Zip Code-34668 FL
Address City State
Contractor's Telephone No.. 727.842.5163 Fa�c No.. 727.474.0008
5. Surety�
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender
Name
Address City State
Lender'sTelephone No..
7 Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(7)(a)(7),Florida Statutes:
Pasco Countv Communitv Deveb�ment Attn� Eric Fetrow
Name
5640 Main Street New Port Richev Zia Code-34652 FL
Address City State
Telephone Number of Designated Person: 727.834.3445
8. In addition to himself,the owner designates Ed Pflieaer and/or ERic Fetrow of Pasco County Community Development
9 to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner• 727.834.3445
10. Expiration date of Notice of Commencement 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 1, 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
WIT Y U L D R9RAI�l,AII� COMMENCIN K RECORDING OTICE OF COMMENCEMENT
STATE OF FL IR��P"�°��,'•- e i i r�m
KARIN A
COUNTY OF �i(ip�,11'.""= �; �,, , � a�
' ". ` �Y,y � � „� t�,,.,r.s rvov 2,20 t 4 Signatu o wner or Own s Au oriz Officer/DirectodPartnedManager
`,';�`'� Comrtnssinn le EE 39453
,�", C�.UC���JG E'C�t
Signatory's Title/Office ,)
The foregoing instrument was acknowledged(�efore me this�day of 2p�,�by b��C,I�QCd !\. �,�m�
as C.X�CG��1 (Y C �� ( ofauthor' e. . officer trustee
�D�. � �y, g, , ,attomey m fact)for
� e � � (name of pa beF�,alf o�who�nstrument was executed).
Personally Known OR Produ d Identification Notary Signature yi.i.(�i, i
Type of Identfication Produced Name(print) (
Verification pursuant to Section 92.525, Florida Statutes. Unde�penalties of perj�f�y,Ld�Clare that I have r foregoing and that the fads stated in
it are true to the best of my knowledge and belief �/
PREPARED BY&RETURN TO �"�'
Pasco County Community Development Sig ture Natural Person Sig i g A, e
5640 Main Street .
New Port Richey,FL 34652
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