HomeMy WebLinkAbout14-14941 �,
CITY OF ZEPHYRHILLS
5335-8TH STREET
(ai3)�so-oozo 14941
BUILDING PERMIT %
Permit Number: 14941 Address: 5135 SUMMERHILL DR
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: SUMMERHILL
Est. Value: Parcel Number: 12-26-21-0100-00000-0200
Improv. Cost: 10,100.00
Date Issued: 2/13/2014 Name: SNYDER, CLARENCE J & CHRISTINA J
Total Fees: 135.00 Address: 5135 SUMMERHILL DR
Amount Paid: 135.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/13/2014 Phone: (713)919-0697
Work Desc: POOL CAGE 22 X 46 X 23
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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 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 pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONTRACTOR SIGNATURE
PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-002Q City of Zephyrhills Permit Application FaX-a���-�so-ooz�
Building Department
Date Received I� � �� f -��� ��� ���5_
Phone Contact for Permi n '
Owner's Name � r "� S 1� '�' �"
Owner Phone Number "
i - _..�. �.._ _
Owner's Address f 3� ,5c j � i --�._____ ... _•-_-.._--
Owner Phone Number � �� -( � '�,l�p��
Fee Simple Titleholder Name �'"'� ` � ��.�
Owner Phone Number
Fee Simple Titleholder Addresa
J08 ADDRESS �� � �
LOT#
SUBDIVISION S� � � I PARCEL ID# ��1'-'vZ�O�o�� °(j �(�(�l '��7Qp� -(����
(OBTAINED FROM PROPERTY TAX NOTICE)
1MORK PROPOSED B NEW CONS7R ADD/ALT C� SIGN Q � DEMOLISH
INSTALL B REPAIR
PROPOSED USE Q SFR Q COMM � OTHE
TIPE OF CONSTRUCTION Q BLOCK �] FRAME � STEEL [�
DESCRIPTION OF WORK �C( (�'1 d� � i C(� • � �, �� � e� �
BUILDING SIZE �x � �a3 SQ FOOTAGE�� HEIGHT � � !
�J
BUILDING
$ f� ��b - U�' VALUATION OF TOTAL CONSTRUCTION
�]ELECTRICAL $ AMP SERVICE
� PROGRESS ENERGY � W.R.E.C.
QPLUMBING $
QMECHANICAL $ ����
VALUATION OF MECHANICAL INSTALLATION
QGAS ROOFING CJ° �U
O Q SPECIALN � OTHER �
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA l.� 1 �
[�]YES NO � ( � �
I
__�
BUILDER � � ' ' ��� i COMPANY ��rn l �1'� ��v%'Yl(i�Um T ,
SIGNATURE REGISTERED Y/ N FEE CURRE�
Y/N
Address .� � �� �� f rJ � � � �
License# C,
ELECTRICIAN COMPANY
SIGNATURE
REGISTERED Y/ N FEE CURRE� Y/N
Address
License#
PLUMBER
SIGNATURE COMPANY
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 Building 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 Facflities&1 dumpster;Site Work Permit for subdivislonsflarge 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. Requlred onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compiiance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"'"PROPERTY SURVEY required for all NEW construcUon.
Directlons:
Fill out application completely.
Owner&Contractor sign back of application,notarized
*. If over 52500,a Notice of Commencement is required. (A/C upgrades over s7500)
Agent(for 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 Applicatlon 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 �estrictive 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 unde�take 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 misdemyan�oP�iolation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements ma a i 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 IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understan s
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 "ce�tificate 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 appiicant 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'SIOWNER'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. � 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:
- Depa�tment of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Wate� 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 ihe 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�tructi n'S I'u derstandhthatna�s pahat permit tmay be req ued for'electrcal work,
this affidavit prior to commencing
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application.
permit issued shall be construed to bcal codesenor shall ssua'ncehof a pe mitpr vent thehBu ding Officeal from therteafter
set aside any provisions of the techrn ermit issued shall become invalid
requiring a correction of errors in plans, construction or violations of any codes. Every p
unless the work authorized by such defor'alS e od of six(6) mhonths a er the�mpe thetworkas commenced Anhextension
the pe�mit is suspended or abandone p
may be requested, in writing, from thwork 1cela es�or'ninety(90)rc nsecutive days, the job is�ons de ed bandonedstra e
justifiable cause for the extension. If
WARNING TO OWNER: YOUR FAILU TO YOUR PROPERTI(.TIF YOU INT�ENDETO OBTAINnF NANC NGTCONSULT
PAYING TWICE FOR IMPROVEMENTS ��
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y UR NOTICE OF COMMENCEMENT.
T F.S. 117.03) - , �
FLORIDA JURA ( M
OWNER OR AGENT ` CONTRACTOR
� Subscribed nd swom t a(fl ) �r me . �^
Subscribed and swom (or ffi S bef Ih$ ,�� b {� r ' �'� �
(�lZ-I� by �JU`
Who' ar ersonally ►�own to me or hasl ave produced Who�re,Rers�o�na y known to me or has have pr duced
� �' (.r t� ��/ as identlfication.
��.�.��- ���rSR as identlfica6on. �
l �� Notary Public
u Notary Public
a�� ��Y�Ni
" "" s J QUELINE B0�3E commis � , BOGES
comm = mm ssion U4Q520 i � �mn�is�jon#
`= Expires December 12 2014 Name of Not ' ►�� ,Hy,� r 1�',,2U1� ,r
�o�e y hx�rran:� �: �
Name 49h�' arr.;�W,yn+�
.. 'iCAqp� .
. . .. .:..�._,_. .._ .... _...._.....w.�.�...�^^
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��� S �'-�
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il!!!�: • �
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractar/Homeowner: /Cg yy�t � �-��jy�f n��
Date Received: _ � _ Z 2_ ��.
Site: S', 5 r���� �,�_
_ �3 �i�..-,�►�„�
Permit Type: ����Cc C� /17�si 7 � `�'G`� �� �
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.
/ — �
Kalvin i er s Examiner Date Contractor and/or Homeowner
(Required when comments are present)
� L1 vf' " °� � v�-7' v� v� � v .•
1
Spec alizir,y In �i������ ��������� Screen Enclosures
Custom Poo' Enclosures j E Vinyl&Glass UVindovvs
Carports-Reaairs
3onded Ir.su:ed �
�c���� ���-���� 1Zeferred b
�o. goX 2ooE y:
Land O' Lakes, i=L 34639 °Cusfomer Satisfaction is Our Gaai"
Ceil Phone (813) 997-0285 �,,�.,�,/,,,,f�����'�� � �
rax {813) 996-375fi Date ��
���Licer:se No. CRC132°806
Praposal Submittec� ta: Jo� Name:
�treet �I�J�.._�?�')''1 ���' � Jcb Location: ���� I c
City, State, Zip � Teiephon�1�� –7 � � ^��q�
co� PRQ��'�SPeI./I �1�3C� `���MS: NE�' �'W� F161E�Et�� � .�
Ro F STYL We hereby submit specifications �-���L ���S WI�.�.. I3E �,���� �
E o w �T • ` and estimates for: T� ,��.L P�S�' I�t]E B�L�.�. � �
RISER WALLS
�.
ELITc ROOF ` ------°—.--------------------°°---°— -------- ---------- ----
_T_
PAN ROGF '
FANBEAMS __________________________�--___..___—_—_____�—
DOORS �� ; —__..—_—_—^—°--------
; X CHA1R RAIL � � �� � "1.I1./�(,�� ° I, ���"�;
; vUTTER . �
j DOWNSPOUTS r , ���`, �,
! KICKPLATt �•� , . '�/�✓��-______�_—_—___—____�_
FLA GLASS � ---------------..._—_ � __�___--
PCSTSI _.• �—�__�_—..__�_..�______.•—__�-----------------------
� CARRY BEAMS �
PERNfIT YE5 NO ���y��� iM -
� '�1 U ��( �- ,�i
� �� ' � �t,�. r�'� - -��`-------
� BLDG�EPT I ��-� /"`7 ` �J
SI,B �✓ . �_—_
; LOT BLIt_UNIT �ACCORDING TO FLORIDA'S CGNSTRUCTION LEIN LAW (SECTlONS7'F3.001-713.37, �LORI�A
� APFROX ROOF 5Q F-f fPAID UN FU�LLHH�AVE A R Gf HT TONE�ORCE�THEIRYC A M�OR PAYMENT AGAIN�TPYO�R
APPROX WALL 5Q FT 'PROFERTY.THiS Ci�U�15 i<NOWN AS A°CONSTRUCTIrJN LEIN'.iF YOUR CO�!TRACTOR OR,�.
� SUBCONTRACTOR �AILS TO °AY SUBCONTRACTORS OR MATERIAL SUPPUERS OR
NEGLECTS TO MAKE O�HER LEGALLY REQUlRED PAYMENTS,THE PEQPLE WHO ARE OWED
I MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMEIVT, EVEN IF YOU HAVc PAID YOU=�
— _ ,CONTRACTOR IN �ULL. IF YOU FAIL TO PAY YOUR CONTRACTOR,YOUR CONTRACTOR MAY
The 6ittemessofpoorquality ALSO NAVE A LEiN ON YOUR PROPERT`f. THIS MEANS I�A LC1N IS FiLEO YOUR PROPER'Y
remains lon after the COULD BE SOLD AGAINST YOUR WILL TO PAY FOR L.ABOR,MATERIALS OR OTHER SERVE CES
I sweetness oflowprice THAT YOUR CONTRACTQR OR A SUBCON i RAC-fOR fv1AY HAVE FAILED TO PAY. FLORlQA`S
� is forgotter,.' CONSTRUCT!ON LE1N LAW 1S COMPLEX AI�lD !T IS RECOMMENDEQ THAT b'UHENEVEP, .4
R.em,ington's AJuminurrt SPECIFIC PROBL�M ARiSES YOU CONSULTAI�.S�TORNE,_
� 995-2883 _— � i T v
Gi�'c PRGPOSE hereby to furnish material ar,d labor - campiete in accordance evith the above specification�,Ofo�tfie sum�of:
- — -- DQLLA�S ($ �°� *� }
Payr��nt io be made on compietic;n of ic;b o� , '�`� '1sL�—� 1--�l1_��1►�-'�,1 �� �1.�
B�'vv�;�`-,R� OF UN�I��NSED CONTRACTO�S � ��
All material is guaranteed to be as specified.Ali��crk to be�ompleted in a workmanlike manner acco;ding to star.dard practices,An�;
alierati�ns or deviations from the above specificaucns invo�ving �;tj-a costs will be executed or.!y upon �-vrirten orclers anu ;-:;��
become an extra charge over and above tl�ie esumate. Al! agreements contingent upon strikes. accidents or delays beyend our
conn-ol. Owner to carry fire, wind damage and o#h2r necessary insurance. Our workers are iu11y c vered by '�r'otkman';
Compensation insurance.Standard l wo Year Warranr,�.
�uthorized Signatu?�e _ � ,
�CCE?TANCE O�PROPCSAL-The a�ove prices, specificatiors and conditior.s are satisfactory anc3 ure he;eb �ccepted, You
are auit-,orized to perfo:m the work as specified. Payment���il; be made as outlined above. �,ht�,.�"U�,��� :/ �.
Date of
Signatu:e �
Hcceptance __JanUa2� 13 2n� 14 Si�nature
M/tr V�c rL.4' �nCRCVr !iJ tCt l.VrcUC[/ l!V Y(1y! (7VVIl J/,
PAGES 38 & 39, PUBLIC RECORDS OF PASCO COUNTY, V lV �"� `'v
FL ORIDA. G�4
.PvEYO
PARGIEL �12-26-21-0000-04200-OOOp �
,a
�
F.I.R. N.89'S444 F 75.21" (FJ i.� v
_ _ _ s�e- N.89''S5'26"E. 75.00' (P) ° 5je � �
0.3 — -
LOT 20
���yt... �1 a ��. R V �
'.Y.•�(.l�Y� ��aM' ^� Q��
k b * �' � ? 3
O �
� t,�
� � .s r^,R �,� -ir..
�� ��
7 � � eaa�,� � .�,_ v 17.4'
oO 40.2. P� �
o PUMP �
00 ��� ^
ON
LOT 19 � W ONE STORY � o 0
A'� ^� MAS RES � ^ "
� � 2� �
$.� j��ah! h Z 0.5� LOT 27
� O p •--..-.._.,._
� V q���
p 4.9� N
� � � i �N
�I 2 3' � :� S�
. ; � A �
��s• r2.r � •". �
SCR£EN 20.0' 7 7' tl
ENCL. Vj
CONC. a,
o CONC. �
BROADBAND N �!� fLEC7NIC �0
R/SER BOX �.�, �F� P-K
45 33' (P) NAIL
F.I.R. 5/8- f N.89'55'26`E. 75.00' P) � �+«�£ --�
L8 6382 o N.89�5'26� 75.16' (F) ;p RISER
� w F.I.R. 5/8"
L8 6382
EDGE OF PAVFMENT
24'ASPHALT 60"RLIV
�� � ��� ����
CfRAF1ED TO: � �
CLANENCE J. SNYDER, lq
CfIRlSANA J. SNYDER
STEWART 717LE
BfARINGS AR£BASED ON 7HE N0147H R/W LtN£ OF SUAlMfR HlLL ORlVE AS BE/NGy N 89'55'26£; P£R PLAT.
� �� � � � Surve or's Notes•
PC :PoiM of Curvoturo (P) :Pbt
P�RC :Point ��Am�1e (D) �sd J��Y shown herson appeors to be located h flood Zane 7C par F.lR.Y. Na 120235 0053 Dotsd f2-17-91. fih
PCC :Potnt of Compwnd Cun�oturo �Dax):OmMpffon 1'�makd no guorm�tses as to tAe ooaun�cy of the aboNe 'rnlormotion. Loc�F.EY.A ogenf sAouM be confoetsd
a.c •Po;nr or Inar.e�Kon C�) !CoN.vwe�«� ta.re.�ncatron.
S/R :Sst Cappsd Morr Rod 1/2'j8962 �`7 �JNd Ysosurod 2}No und�gro�d utBJtiea, u»drpround hcroodrmsnta or bri6'ding lfoundotiana wsro msoaarod or locntM as port of
�7R :Found!ron Rod �C. :,5�dy,� ���'�Y• �roes and ahnrba wero not loeatsd un/sss othawlms ahown.
`LItI •FouiW I�Alonument �" :TOrraAtp 3) 7/�k aumy Moa conduefed wlthorit the bsnefit o/an ababoet of Htlq, fAsretnro thsra may be otAer eaa�n=a
� � �of woy, seGbodr IAes, ognee�menta. rsxiwtlon; restrlctbna or oMer s3nlm motters ol Pub/ic mca'd not sAown
i.C.M. :S�t Conent�Monumant
iET DlSK :Sst P—K NaJ!3 pJak C� '�'�"O 4) Unlesa othxwise nctod dlytaues afiown harbon ro/er to p/ot and/Feld meowramerits o�Qro m��� U.S fest
7VD qSK :Found P—K Nall d Dhk �A ��Condition�r 5)Rs—uae of tAJs aune for
ND RRS :Found RoT1rooC Y P+�rP�sa othar than tt ros Artsnded N/fhout rAttan wiNcation, w8l be !he rs—usara ade
� :No Lbmv F�w Sst � :Conerode rJak ond wlthoert/bbA/ty to the svrwycv. Nothhy haroh ahd/be conabued to connt on
YtM :Pbnnanevrt Re/vsnee Ilonument AP.Q :A Pmf Of other fhan Mose ta rhom thla wrwY N'a*ort9hd/y oertlFad Y Y�fa or banellts to onyone
�/H :Owfisod M7na L1DY. :Cowsd
:LF. :LYrobi UnkFenee MAS :Ma+onry
:oe. :p�t of Bqhnhg � :�� 5�IT� DA VID L. SMITH
—K� �PMcer-Kdonmeneament PC :Poge
:R.B. :OHk/o!Ruwnia Book rrP :rX,row SURVEYINC .41VD MAPPING, INC.
:G :Concrob ✓oNsy GLtts wF :Wood Fenee LA �
°" .-.�.....�..,o�............, EL. :E�'swuon G,^ .�4 1406 W. UNEBAUGH AI�E: Tompo, F/. ,�3612
o��.... Ins z) n ra_snan c,.,, /ae r) n zz- nw,�a.
J / .... . . ._.
�� ..._ ' �. ._
`\ ``'�ry`� III�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIII
-- , ~v~��-- 2014022132
' Rcpl:1681838 Rse: 10.00
D5: 0.00 IT: 0.00
02/13/14 B. MeB�s, Dpty Cls�k
PRULR S.0'NEIL�Ph.D.PR5C0 CLERK 6 COMPTROLLER
02/13/14 8:4 a 1 of i
OR BK �9�� P� 2615
Pattnit No.
NOTICE OF('n�,tMEN �rtbtr�'rr�r
Property Identification No. �l�J -�(p'�..(71n(��(r�-��
�',�"'Z ...'"�_ ^'� .
'I'I-IE LJNDERSIGNED hcieby grves notice that improvements wil!be made to certain real property,and in accordance with Section
713.13 oCthe Florida Statutes,the following informacion is provid in t e NOTICE OF C MMENCE ENT.
1. Descri tion of ro s�'f S � �� ���I PC� -39
P p perty(lega/d� Hon:) � ,,,, L
a) Street Address: �7�(�-�
2. General description of"improvements U
3. Owner Information � �35.� �r
a) Name and address. ^ � �
b) Name and address of f simpte title olde (if other oW�r�
c) Interest in property t�
4. Contractor Inforroation
a) Name and address: � pi � � ��
b) Telephone No.: Fax No.(Opt.)
5. Surety Information
a) iVame and address:
b) Amount of Bond:
c) Telephone No.: Fax No.
6. L.ender �OPt•)
a) Name and address 11��_
� I1
7. Identity of person within the State of Florida duignated by owner upon whom notices or other documents may be served;
a) Name and addrcss: � � � n
b) Telephone No.: �V{ Fax No rn.,��
8. In addition to himself,owna designates the following persan to reccive a copy of the Lienor's Notice as provided in Section
713.13(t)(b),florida Statutes:
a) Name and address:
b) Telephone No.: Fax No.(Opt.)
9. Expiration date oCNotice of Commencement(the expiration date is one year from the date oCrecording unless a different date is
specified):
WARNING TO OWNER:ANY pqy11'[E;YTS MqpE BY TNE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMEIVT ARE CONSIDEP.ED IMpROPER PAYMENTg UNDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES AND Cp1V gESULT IN YOUR PAYING TWICE FOR IPROVEMENTS TO YOUR PROPERTY.A
NOTICE OF COMMENCEMENT MUST BE RECORDED AIVD POSTED ON T$E JOB SITE BEFORE'I'HE F[RST
INSPECTION.IF YOU INTEND TO OBTAIIY FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOU NOTICE OF COMMENCEMENT.
STA7'E OF FLORIDA
COUNTV OP PASCO �
� nr
��� v�w�t�a nui�enzea Ot6ca/DuectodPaMw/Mmager
r�3�jHq �I SK�/QPr
Prmt Name
The foregoing instrumrnt wes acknowledged beforo me this�day of p/FA/�Ula Zp �lr,by
u
(ty of aulhoriry,e.g.oflicer,trustee,aKomey in fact)for
- (name of party on behalf of whom insWment wu wceouted�
Personally Known_OR Produccd ldentification � Notary Signabue ``��r'�-�./�,�'l
Type of Identification Produced � �V�eA-� Neme(print) 'I1'C�1 c� f �C�
V erification pursuant to Section 92,525,Florida Statutes.Unda alties of
in i1 aze true to Ne best of my ktrowledge and belief. � ary°�'��declare that I have read the(oregoing and that the Cacts statcd
rortrasn+a.��ao� �
s+p�.n�orr+.nwe�,o�sp� e,,,.
. g'�„�y, �� a F�or�,
�a�� Exo�MsC �91�If A 7 A A ��
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G�FiCU,T' * STAl'E OF �1-aR1aA,COUN1'Y OF PASCO
G�'. TNIS IS TO CERTIFY THA7 THE FOREGOING IS A
Q�. � � TRUE AND CORREGT C�PY OF THE OOCUMENT
; � �� � � pN FILE OR�F PUBLIC RECORD IN THIS OFFICE
_ �� ,. WITNESS MY HANR AND OFFIGIAL SEALTH�
� �c�, �� ,Q �D E OFC COMPTROLLER
��• .�r��1 • � PAULA
� � � EPUTY CLERK
� * . .�� BY_.____.
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