HomeMy WebLinkAbout14-15104 CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oo20 15�
BUILDING PERMIT '
Permit Number: 15104 Address: 37527 GILL AVE LOT 279
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: MOBILE HOME SUBDIVISION Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34-25-21-0170-00000-2790
Improv. Cost: 1,725.00
Date Issued: 3/20/2014 Name: ELLSWOWRTH, WM & JUDY
Total Fees: 67.50 Address: 37527 GILL AVE LOT 279
Amount Paid: 67.50 ZEPHYRHILLS, FL. 33542
Date Paid: 3/20/2014 Phone: (931)261-3107
Work Desc: REPLACE 3 WINDOW SIZE/SIZE
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FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b)condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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NTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
ais-�so-oo2o City of Zephyrhilis Permit Application Fax-813-780-0021
Building Department
Date Received 3��— l !
Phone ConWct for Permittin
�rT rr r r�
Owners Name /t- - � Owner Phone Number �� - �
Owner's Address �� L Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Addreas
JOB ADDRESS , /�U � LOT# ��
SUBDIVISION YUIQ " �' PARCEL ID# � • =a/-o
(OBTAINED FROM PROPERTY TA7(NOTICE)
WORK PROPOSED B NEW CONSTR B ADD/ALT � SIGN � Q DEMOLISH
INSTALL REPAIR
PROPOSED USE 0 SFR Q COMM � OTHER 1..2�i,...+ t_e.�
TYPE OFCONSTRUCTION � BLOCK Q FRAME � STEEL Q
DESCRIPTION OF WORK Q C e � " J�1 �P ,� 'f'-�
BUILDING SIZE SQ FOOTAGE� HEIGHT �
T
�BUILDING $ ,; VALUATION OF TOTAL CONSTRUCTION
�ELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY 0 W.R.E.C./
-j'` t/
�PLUMBING $ �"I� 2 �,Q r ,S
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � / ' y� � � ��
� , �� �
�GAS � ROOFING Q SPECIALN � OTHER �� �
� �. (,
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO ��� ' �I"�/
(-`/ � I
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BUILDER q � COMPANY ,`�' (� �A E w �w uC)��S
SIGNATURE t V REGISTERED Y/ N FEE CURRE� Y/N
Addresa License# �
ELECTRICIAN � � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER COMPANY �
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I I I 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
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Fortns;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed,
Sanitary Facilities 8 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)
"" qgent(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 P,pplication Only)
Reroots if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey(Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which �may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and 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.
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.
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.
FLORIDA JURAT(F.S. 117.03) ,
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed a sworn to r a�rtned)before me this
bY ' — by �
Who is/are personally known to me or has/have produced Who}'�/�re rsonally known to me or has/have produced
as identification. P'Z � �/l�f.✓�it iuS� as identification.
Notary Public ' !� / Notary Public
Commission No. Comm' '
;�ti�iiy�_ JACQUELINE BOGES
�=.: Commi
Name of Notary typed,printed or stamped Name '� �p&tjJjf68�d09�$Q14
�'�,?��!�'�' BaWed Thu Tro�Fein kwranas L00-385�7019
• `, c`� �
1, �
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
.
Contractor/Homeowner: ��G�Q-�-s'`� lrvi�'(�d�c��S
Date Received: ;3— �y��
Site: � 7 S�2� �� (( 7'�``�
Permit TYPe� ,.� lTL�?��S ,��f'��C� S � 2 P��li�Z�
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.
�a,��;,, • MAR � 9 2014
Kalvin Switzer—Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
Pasco Countv Bui!ding Schematic Page 1 01�1
Generalized Building Schematic
34-25-21-0170-00000-2790
Card: 001
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Pasco County Property Appraiser
Page �ayout Modified: 9/6/2013 8:36:26 AM
The Local Time Is: 3/13/2014 9:29:55 AM
http:/hvww.appraiser.pascogov.com/search/traverse/traverse.aspx?parce1=2125340170000002790&showcards=001 3/13/2014
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. ordable Windows &
' of Tampa Bay, LLC
28870 U.S. Highway 19 N, Suite 300 �`�
Clearwater,FL 33761
Lic. #CGC1520791 727-437-0017
727-725-2933 (Fax) }3%- Z C > � � `� � �'
1(we)hereby contract with Affordable Windows&Doors of Tampa Bay,LLC the following work and authorize Affordable Windows&Doors of Tampa Bay,LLC to furnish al
materials,labor and workmanship,to install,construct and place the improvements according to the foilowing specifications,terms and conditions on the premises below descri
"C.t�iis contract, rnade this � �7_ Day of ' ��^'�l'�/�`7 , 20 / 7
O��ner's Na►71e �/ � �%/f'^'--''z f'� Ph# Home Work Cell--
�
�1cldress �.1�' ) (; �/! �'.�,��4._ - City `' �,, j7, ,f;� t State�_Lip--
1ob address. (If clifferent than above) � ��'`—� ' �
c��ti"f ItACTOh'f0 FUi:NISH&1NSTALI_MATLRIALS AS FOLLOWS.
fordable Windows & Doors of Tampa Bay will remove 3 old windows and install the following_
Affordable Windows & Doors of Tampa Bay replacement windows to existing jambs,headers and sills as
f scr�en cnd ci�us eoior FnuteJ Mexsurement �.i, F Measurement u.i. Descrip�ici
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TERMS OF SALE NOTICE
The Buyer(s)agree(s)to pay a sum as follows ..� �" ANY HOLDER OF THIS CONSUMER CREDIT I}iAVE K1:.4
A�"� CONTRACT IS SUBJECT TO ALL CLAIMS AND AGI2C:1
(Aj Cash Price of Work $ 't'FIE"CERM'.
�;.� �jV'-�"' AND DEFENSES WHICH THE DEBTOR ����NniTtn��
(B) Downpayment Made by Owner ��,� $— COULD ASSERT AGAINST THE SELL FR�F
(C)Unpaid Balance
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ApplicaCion Status Approv d
*App oved by DBPR.Approvals by DBPR shall be reviewed and ratiFied by the POC
an or fhe Commission if necessary.
Comments �
Archived I
Producf Manufacturer Gorell Windows and Doors
Address/Phone/Finail 10250 Philipp Pkwy
i� Streetsboro,OH 442a1
(330)528-3400 ExC 1150
delder@sofDlice.com
Au[horized Signa[ure I Derek Eider �EviEW p,�-T.� MAR� � g 2014
delderClsoft-liCe.com
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CafegorY Windows .� � '^ �;�' i r ..�
Subcategory DoubleHung �'�� ! T� � ��.:�'� L � �}�, � ,7 !���.
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CerCificalion AgencY American ArchitecCural ManufacWrers Assoaahon
Validated BY American ArchiCectural Manufacturers Association
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Referenced Standard and Year�of5tandard) Standard Year
� AAMA/WDMA/CSA101/I.S.2/A440 Z005
ASTM E1886 Zpp2
ASTM E1996 Zppz
7
Equlvalence of Product S[andarl�s
Certi(ied By '�
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Product Approval Method � Method 1 Option A
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Date SubmiCCed OS/16/2012
Date Valitlated 03/28/2013
Date Pending FBC Approval
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http://www.floridabuildii�g.org/pr/pr_a�p_dtl.aspx?����aram=wGl��VXQwtl�q�iDEJErtOSCeq7dROr.fYlihwSCvSCyWIrCf39up... 7/30/2013
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Summary of Products i
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FL# �odel,Number or Name Description �
_____-.._._.___.._._._._.___.....___�.__._____-_
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14263.1 . )G5305 Double Hung G5305 Double Hung 44x84 DP 50
-- ---�- ------...---------.._------------- -------------------�--_-----------.__._------.....
Limits of Use � Certification Agency Certificate
Approved for use ia HVHZ��,No f=L14263 R2_�,_.CAC_G5305 Double_Hun�_�L4xJ4 UI'S0_,13_i_i._l0,_��df
Approved for u5e outside VHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistant:No 09/14J2014
Design Pressure:i-50.0/-5�.0 Installation Instructions
Other. � FLlh2(i3 R2..�1 P�30�DP5!)�(asLenerret_i1,,.44xti41G�
Verifled By:American Architectural Manufacturers Association
Qeated by Independent Third Parcy.
Evaluation Reports
Created by Independent Third Party:
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14263.2 . )G5305 Double Hunq G5305 Double Hung 52x72 DP 50
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Limits of Use Certi/ication Agency Certihcate
Approved for use in HVHZ No FL142G3 R2 C CAC G5305 Double rh��u�Zx72 DI 0 01-44 udi I
Approved for use outside VHZ:Yes Quality Assurance Contract Expiration Date �
Smpact Resistant:No 10/09/2013 i
oesign Pressure:+50.0/-5�.0 Installation Instructions I
Other. FL14263 R2 II P5305 DP50 imoacl(as[ener S2 x i2 J:14_12.dwq
,Model l.od!
Verified By:American ArchitecCural Manufacturers Association
Created by IndependenC Third Party�.
Evaluation Reports
Created by[ndependent Third Party:
--._�---._......__ ...----.- . .-..-------------�-----�---'-----'--_.�.-._._
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14263.3 . )G5305 Double Hung G5305 Double Hung 44x63 DP 50
_.___ ...._.-'______.._____. __-_____. . ...__._.. .___..__..."-'-9__y--._-_.__._._ .-.____._ __.___
Limits of Use Certification A enc CertiFcate
Approved for u �.in HVHZ��No fL142G3 fl2 C CAC 1,5305 Double I-IwiU 44x63 DPSU SOl��h4.udl
Approved for u��.�outside VHZ:Ves Quality Assurance Con[ract Expire[ion Date
Impact Resistan2:No OS/04/2013
Design Pressure: r50.0/-5 .0 Installation Instructions
Otber: �'. FI 1'4263 R2 LI I �3US DI SU faslener cleCail 4n x 6 7.�l-1G.[Iwcl
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Mod,el._(_l.�d(
!� Verifled By:AmeriCan ArChiteC[ural Manufazturers Association
CreaCed by Independent Third Parry:
Evaluation Reports
Created by Independent Third Party:
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14263.4 . )G5305 Double Hung G5305 Double Hung 52x72 DP 35
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Limits of U+„ Certifica[ion Agency Certifiwte
Approved for us� o HVHZ'No 1=L14263 R2 -�� CFlC G5305 UouUle 1-lunu 52x72 DP35 501��44.uUf
Approved for us� �utside VHZ:Yes Quality Assurance Contract Expiration Date
Impact Resistan No OS/04/2013
Design Prescure. 35.0/-3 .0 Installation Instructions
Other. FL.14Z63 R2 !I P5.',OS DP35 fasfener w wood slop5 i 6-12 dwq
MUCIf�(1.UCI(
Verified By:American Architectural Manufacturers Associalion
� Created by Independent Third Party�.
�' Evaluation Reports
� Created by Independent Third Party:
___. _.___ ___.___._..__________'___-._......______.___-__�_.'__`- --___..____...._'_.___._.._____.___-
_'____.____..... .............. ...._._....
14263.5 . )G5305 ImpacC Double Hung G5305 Impact Double Hung 52x72 DP 50
.._.._._...._..._...__.__..____.___.. ._........_.._. ..._...__.....___".___'_....._._._.........................._.___............._......... __."._"'.._.__._..._............__..._..._.."_"_'.._.._._..._._._......_.._..__._._................_'__'_..._____.__.
Limits of Use Certification Agency CertiFicate
Approvedfo� use HVHZ No FL1�263 R)_ (��nC G5305 Imoact bouble Huno 57x7:DP=O SO1- �
Approved fm use rtside VH2:Yes 44.uClf �
Impatt Re6istant: es F'L14263 RG l CAC 1�5305 imOaCl cllazinU delitilS.nd�
Design Pressure: �0.0/-5 .0 Quality Assurance Contract Expiretion Date
Other: 08/OS/20Y3
Installation Instructions I
FI�h263 R2 II P5305 UP50 imoacl fasCener 52 x 72 3-14-12.dwa
; Model(1.udf
II Verlfied By:Amerlcan ArchlCectural Manufa[turers Association
Created by Independent Third Party:
Evaluation Reports
CreaCed by Independent Third Party:
___ _._ ___�__....___..._._.____.._._____-.__._._.____.-_______ . _ -.-_.-____.____._-__.
....._...._..__'."_'."'__, ._._.... .....
14263.6 . )G5405 Double Hung G5405 Double Hung 44x84 DP 50
__"._'_.._._..___....... ........_ .... .. .._.._._._.._._.._......___...._"..."'__........_......._........_......................_..____..._.._._._.....'__9._'_..Y...__."_'_'._..._.____-_.___.._..___.._._.........__....__.._._.._.......
Limits of Use Certification A enc CertiFcate
Approved for w •in I HZ No FL14?.63 f22 C CAC G53U5 C7oUble P�una 44xt14 DP50 T29�-lO,Ddf
Approved for w .out de VHZ:Yes Quality Assurance Contrect Expiration Oate �i
Impact Resista .:No 09/06/2014
Design Pressw :+50 '-5 .0 Installation Instructions
Other. P�14263 R2 I[ P5R0 i 44xU4 FaSCener InslallaUon,pd(
verified By:American Archifec[ural Manufacturers Associalion I
Created by Independen[Third Party:
Evaluation Reports
Created by Independent Third Party�.
II
Contact Us.:19�0 North Monroa Street Tallahassee Fl.32399 Phone:O50-AB]-182�
�he Sta�-e�� rri�a I�aii AA/[t0 einployer.Coovriqlit 2007�2010 5[nte of FIorIUa.�.�Prlvacv SlaCemen[�.�.Pccesslblll[v Slalamen[::Nefuntl 5[atement
Ur -orltla law,enia l hdics e p bllc ie 5.I!you�o n want yoii�x-nall a< ss releasetl li�esponse to a yubllc�iecorrl�reyues[� r�e[senrl e ec[ronlc n tl[y.1
�contacl the olllce i�y�j>honeso� �pra�I[lonal�n ail.If v�u have�any Qi�astlons,please'con[act OSO.nO'1�1195.'Purs�an[to Sectlon 455.2�5(1)�Flo�1tle Statu[es,a fe<t�lve[October t,2012�ea,
ilcensees IiccnseJ iintle.Chaptei 5.i�ust provirle Che DeOartment wllh an emall address If they I�ave one,TM1e emails Vrovltletl may be�setl'or�Hlclal commiinica[Inn wlth[M1e Ilcenaee.
lioweve�emall�tltlresses are pul' � c irl.I!you n�iiu wlsit to siipply a personal atl�ress,plaase provl�e Ine De�artm�ne wi[I�an email ad[Iress wlilcn can be ma[Ie avallahle co t�e �
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f Oeeernilne il you�ra a ilcensee untler C�apter 955,F.S.,please cl��ck�eie.
Prod�ct Approval Accepts:
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2014039449
Rcpt:1588486 I�O0.00 00 '
D5: 0.00 Clerk
Permit Number - -x�
03/14/14 K. Kraengel , Dpty
Parcel ID Number ,j �- �:_.o�_�— D1�0 -PQJlX1-��f��
pqULA 5.0'NEIL,Ph.D.PASCO CLERK & COMPTROLLER
NOTICE OF COMMENC ;EMENT 03oR BK ���� 1PG� ���
State of Florida
County of Pinellas
THE UNDERSIGNED hereby gives notice that improvements W��CE OF COMMENCEMENT roperty, and in accordance with Section 713.13 of t e P631�
Florida Statutes,the following information is provided in this NOTI �� �o�'a�oe$[o�G �
1.Description of property(legal description): �R A��_ /��R��� �h����e� P�3 �G _
LG�_� �,L-. 3.3-�Y/
. h�h._
a)Street�job)Address: �7��� �7 i. �.L ..../4 l�_Q.. ..__.�/� __
2.General description of improvements: __ -�� -S . ��C _ __
� .�/ _. ._
e Lj'►�.__ � •_ _
-_ _ R�p�C�tc�_ 3._ �v.�..d a.cu.� -� L
3.Owner Information or Lessee information if the Lessee contracted for the improvement: �L` r, , � � ry J
c.�'�7..
a)Name and address: �'L(.__�L�$_tuo 2�- -�
7.5:a71�►1LL _A�_� Z$�`'�ia_h�• � a
b)Name and add�ess of fee simple titleholder(if different than Owner listed above) �L• �3,�/
c)Interest in property: _ _ _ . _ __
_._
4.Contractor Information f N• G�°A�����
6 O U.S. 1�,-,S�w� . �i
a)Name and address:(.�Ff Q,Q�J4b� � W�'"°�'O�� ag ,Fax No.:(optional) �—�p �— _
b Tele hone No.: —�� - -
0017 _ _
� P /o�tah� a men bond is attached)
S.Surety(if applicable,a copy p Y
.
_
O�l/!�"
-_.
_. __ _.
_.
a)Name and ad ress: - --- - -
_. ._. _....__. _.
b)Telephone No.: ___ .____ _
_
__ _ __
_.
___.
c)Amount of Bond: -- - -
6.Lender .
__.
_...
a)Name and address. -- � -
_ _
__.
.
-.-
__.
9 y p y p ec io
b)Telephone No.: -
. .__.
7.Persons within the State of Flonda desi nated b Owner u on whom notices or other documents ma be served as rovi e
713.13(1)(a)7.,Florida Statutes: _
�� _
_ ..__._.
_. _.._ __ _. _ .. .
a)Name and address: __ --
_ _. _.
Fax No.:(optional _ .. __.... _ ... ..
_ ____ o{ _ _
b)Telephone No.: .,._._ . . _. _ _ _ _
__...
_.
- ___ _
8.a.ln addition to himself or herself,Owner designates
__ .
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
__._ _
_.
__ __
b)Phone Number of Person or entity designated by wner.
__..
_._
9. Expiration date of notice of commencement(the expiration date may not be before the completion of construction and final paym�o o e
contractor,but will be 1 year from the date of recording unless a different date_is.specifie _ ,. ..
___
_.... __.._.
- --
. ...
WA
RNING TO OWNER: ANY PAYMENTS MADE BY, THE �W P RT I,SECT ON 713IR3, F'L�OR DA STANU�TESEAND ANMRESUP�TSNED ON
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,
PAYING TWICE FOR IMPROVEMENTS TO YOiR�NROPYOU INTENDITO OBTAINM NANCINGT CIONSULT WITH YOURL ENDER OR AN
THE JOB SITE BEFORE THE FIRST INSPEC --
--__ -- ---._._ ._.. _�. .
---__ .._ ... _.
_..._ _..____ _._ _.. .. _..
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENC_ •
_...
____..__ .---.----
_. .__
Under enalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my
knowled an belief. ��//�/pl� �_ (�J���� -- --
, _ ..._�.._.
,`f� _....___. print rtame and Provide Signatory's Title/Office)
� �,�,,,1 �� �.__ . _ __
_. _ , 20 %y
(Signa ure of Owner or Lessee, wner's or Lessee's( uthorized Officer/Di�t�P�er/Maa yrof �/f N-
The foregoing instrument was acknowledged before me this ` ��ype of authority,e.g.o�cer,trustee,attorney in fact)
bas ..._. . _.__.. __
y warz i/-� , as ('jG-�_NC�_ _
�..._.. — ' ' (type of authority,...e.g.officer,trustee,attorney in fac
for �/G��A�__C'• EG _
(Name of Person)
(name of party on ehalf of whom instrument was executed .
for
Personally Known �Produced ID ❑ o � _ ___
Type of ID _ Notary Signature __ _ _ .. . � _.
-
- Print name -A��`' � `"��
_._
_.._ _ PEGfiY 6.f00'fE �
_�* r � pot�ry Public-State of Florid�
•s.My Comm.Expires Jul 22,2015
:;� f' Commissian#�FF 030201
�''%�.°����`� Bonded Through National Notary Assn,