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Home My WebLink About15-15964 CI OF ZEPHYRHILLS 5335-8TFi STREET �(813)780-0020 1 59 4 B ILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 15964 Address: 5047 17TH ST �' Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 11-26-21-0010-21300-0030 Improv. Cost: 6,350.00 OWNER INFORMATION Date Issued: 1/29/2015 Name: MORGAN DAVID & SHELLY , Total Fees: 105.00 Address: 5421 GENEVIEVE CIR Amount Paid: 105.00 ZEPHYRHILLS FL 33542-6107 Date Paid: 1/29/2015 Phone: 308-631-9772 Work Desc: REROOF 17 SQ SHINGLE 3 SQ RUBBER CONTRACTOR S APPLICATION FEES RYMAN RO FIN INC REROOF RESID NTIAL 105.00 �� .� - q - � � �j;�3 Ins ections Re uired DR IN ROOF INSP TAPE JO TS ROOF INSP FINAL �' � -1 .`� REINSPECTION FEES: Reinspection fees will c mply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one of the foll wing reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corre ions not made when inspections called d)work not ready for inspection when called e) permit not post d on job site f) plans not at job site g)work not accessible. NOTICE: In addition to the requirements of this per it, there may be additional restrictions applicable to this properly that may be found in the public records of this county, nd there may be additional permits required from other governmental entities such as water ma agement, 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 inte d to obtain financing,consult with your lender or an attorney before recordin your notice of commencement." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with City Codes and Ordi ances. NO OCCUPANCY BEFO C.O. I I I � CONT CTOR SIGNATURE PERMIT OFFI R ' PERMIT EXPIRES IN 6 MO THS WITHOUT APPROVED INSPECTION CALL FOR INSPECT ON - 8 HOUR NOTICE REQUIRED PROTEC CARD FROM WEATHER � 813-780-0020 City of Zep yrhills Permit Application Fax-813-780-0021 Building Department Date Received �2 z —�S phone Co act for Permitting U�3 �0 2 — cp�� Owner's Name �V�� •'�'wr � Owner Phone Number Uv��(�13�� 2 Owner's Address �v"f� �� • Owner Phone Number Fee Slmple Titleholder Name Owner Phone Number �— I Fee Slmple Titleholder Address JOB ADDRESS �b�� S t. � �11 l�S/ I�c� 3357�- LOT# � I I -__-SUBDIVISION —_ - P CEL ID# �(� �" 2�� j�O �� 2�360 � dc5 30 (OBTAINED FROM PROPERTY TAX NOTICE) `I WORK PROPOSED NEW CONSTR A D/ALT � �`G�N � Q DEMOLISH INSTALL B R PAIR PROPOSED USE Q SFR Q C MM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q F ME � STEEL Q DESCRIPTION OF WORK �ritl' l�T� d' fe'��"� �� •��0 � 1'(�b� bJ�/ 35 . (�-�''(e�c �(�D BUILDIIdG SIZE SQ FOOTAGE HEIGHT QBUILDING $ �, 3�� VALUA ION OF TOTAL CONSTRUCTION � QELECTRICAL $ AMP S RVICE Q PROGRESS ENERGY Q W.R.E.C. �PLUMBING $ �1�� QMECHANICAL $ VALUA ION OF MECHANICAL INSTALLATION \; � _ / Y C(�,�" QGAS � ROOFING Q SP CIALTY 0 OTHER ' ��'i FINISHED FLOOR ELEVATIONS FL OD ZONE AREA QYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# ELECTRICIAN COMPANY SIGNATURE REGISTERED Y J 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 I N II Address License# OTHER � t COMPANY �"� ! �n r �C • SIGNATURE REGISTERED Y N FEE CURRE� Y N Address ,3�o`F�3 �- 5� o � ��s� rL v 3`J�I License# CC� 13 Z.�5d� 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 dat . Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster;Site Work Permit or subdivisionsAarge projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Li e Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum ten(10)working days'after submittal dat . Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster.Site Work Permit or all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. **'"PROPERTY SURVEY required for all NEW co struction. Directions: ' Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C pgrades over$7500) '* Agent(for the contractor)or Power of Attomey(for the owner)wo Id 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 Ee ces(PlobSurveylFootage) � - _ , :� �� , , .. , - . . ., � , , . � Driveways-Not over Counter if on public'roadways..ne'eds ROW � _ ' , ,. - k�, • .� � , . ,,. „ . � ._`> �" � . . � ' . -. ° :3 n, ; ,,.'Js'i,,.. ,. . . _ • '`-'i i;,�..y-�y:.,!?.'`"'a;:e•.- -:r:<,a,.:.�:-.+;av:Yt�-+:e�. . �'. „ � ._ .� . . ,�,� �.�: v i ... e ,. "�S`• [, � �- . '_ _ L NOTICE OF DEED RESTi21CTIONS: 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. UNLICEFISED CONTRACTOFtS APID COWTRAC'TOR RESPONSI�ILITIE�: (f 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 �vill be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly I�censed and is not entitled to permitting privileges in Pasco County. - TRANSPOIt'TATION IMPACT/UTILITIES IMPACT AYVD RESOURCE RECOVERY FEfES: 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, fhat 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. COWSYRUCTION LIEN LAIfV(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'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. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating construction, County ancl Gity�._codes, zoning regulations, and land development regulations in the jurisdiction. f also certify that I understand that the'regulations of other government agencies may apply to the intended work, and that it is I my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: - De artment of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive P 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 & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill:� - Use of fill is not allowed in Flood Zone"V" unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a ��, "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer ' licensed by the State of Florida. - If the fll 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. I 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 authoriry 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 a ndoned. justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the�ob is considered ba W�►RNING TO OWNER: YOUR FAILURE TO RECOI2D A NOTICE Oi� COMMEtdCEMEWT 141�AY RESULT IN YOUR PAYINC TWICE FOR IAAPROVEf1AENl'S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIIV FIFIANCING� GONSULY ViIITH YOUR LEIVDER OR AN ATTORYVEY BEFORE RECORDING YOUR N TICE OF COMMENCEMENT. FLORIDA JURAT(F.S. 1� 3) _ _ 01RINER Oii AGEN7 COFITRACTOR Subscrlbed and swom o r affi )be ore me this Subscribed and swom to or affi before me this 1-2t-l�{ by m � 1-ZZ'��f bY � d``zc`,r° Who lslare personally known t e or has/have produced Who ts/are personally known to� e or haslhave produced as Identlficatlon. --- as identification. � / � te. �'� � ' Notary Public Li" C� ��/ � �"�`"—� Notary Public Commissfon No. -° - Commission o.��'�, ' -•� -- c- `�4P�y.,;��,, ��v.,r✓�AHiE LY CH TERRY ;p�PR1�N�B�ii ;r°. „`�: Notary Public-State of Florida __� .�: Notary Public-State of Florida PJam tff' pEdMprG(te�of�4,2016 Name of Not ; P. pr , %;q, P;= Commission#EE 166865 �'%�OFF��p�`` Commission#EE 166865 �.FOF c�� '��` Bonded Through National Notary Assn. '��`�� Bonded Through National Notary Assn. 0 � , �5��% t f",,._ ' ::f: ... l� w . �` •sf `°`....�:: _...'.� _ ' City of Zephyrhills BUILDIN PLAN REVIEW COMMENTS I'� ; Contractor/Homeowner: �GP.Vt �� Date Received: � — _t $� Site: " '�� Permit Type: � , �jb.�,� Approved w/no comments:❑ Approved w/t e below comments: ❑ Denied.w/the below comments: ❑ ; , This comment sheet shall be kept with the permit and/or plans. I' � I Kalvin Switzer—Plans Examiner Dat Contractor and/or Homeowner ! (Required when comments are present) s I , ' � .0 1U1�1��.C1 1J U11U,LL1��✓vuv vxiivav -� r �H ' �.°�S'.�`�.°"rzE"'�;'�y. �;;4 � �• _- ':L• :i?„ �s`�,:=..?�::-.t,sr'�'c='r.�.^'t'<✓+�',..=* .,' s.�Ft�'.si�ys�.�.'_c.�t'F- � ,�3z��_ . �.ay. �.. c,.f�� k;c�._��:.n'r7r:o:.�.+� . �t^�Z-:,;3�:°x`y-� �e�q �Y. `�yk��%�'�,� �-:q�'= �r', � L.�� .ry.�..�.r ;��e�.,� �"^r��,.i.Y.n�:;t:.,£y-,'::{._.i :�`4,v �r„�4�ttY"`��*r�+�, '�.�' � ° �s � t7 �� '• ';;K.+r�,wr�� > r �.�a��"p�e�.,`?S..L* ��F= '�'�A '" �'"^ �� ' �7't'^c �':>v � �l^� �£ 0 3 a ¢ �,�r `^-c �-�`'��'4:&:. `��,�"e�e ^r°°'. P ;` �+, � � :e;. lz-�.,.v„-�„,�_� ��.:.�� .i5,a�`''x: '�; {. `�w��,e��,�i��-��1 u.� ��. `�,+ F.s-•:',�a'.''.„�`-"�:i:a.+'"^t'-°4;' -M-r:��^, _ - , '�:zA.� r�.'�� .a ?6�. � .,3.+' a `R�v,,,�';y :�s_F�;-.-...s�_.:.k:�^_.^`._� .,- :�.},,.�""`,��3'�''°��.._ '--"'`', T.,,^.�� 9�''ti£"�:n�:,��^�"�� '�..�5� r_. ,y,7:`„�i;� �, i.�.� �. .7� K. �: �,. d�.r�fi.ss '`^� rJ'`,s .�'rd �t sr�� i•�� ;�� . ��d�� i.�.::..�. � -�.^.fl;"��(�i��fC(i':Eflt�f.— 8Ci5 Home i_Log In i User Registration °tt Tcptcs (Sn6m[t Surcharge �Stats&Facts i Publlcatlons �F8C Staff ;BCIS'Site Map'�Uriks'j'SeaTCh"�'= --' Busines f��?} ��__ __ _ _ �rafessi��a� ��''�^��1 praduct Approva! �U58R:Publlc User Regulation ��, '�� Pmduct AoQrovat Menu>Product or A Itca on earcfi>Apoflcat(on Ust>Applieation Detait Es�-...--.��..�,.�,��a'�«��'ri'<3 • ��;=, •�:• FL# FL6943-it3 �:°�'"ci'7..r � ro �-��•�;�:3�..��'�-� Applicatlon Type Revtsion �:.�_} rs-� '�;'�rM��`=�y;:�`.` `��`' Code Verslon ��2010 " '`'��`-"—`�'�"L�� Appiication Status Approved Comments Archived r ��L��'1a�5��.�,L�C75��3.`��IT�� Product Manufacturer GenFiex.ftoafing SysCems,LL�L�,�L��jJZj,i,T�Tr Address/Phone/Ematl SUO 1�96th Street ��C.,��CAL,��'� fndfanapoi{s,IN 46264 �t��hT**' ' (317)$Z5-3$46 mcquillentim@flrestonebp.com Authorized Slgnature tlm mcqulllen mcquillent(m@flrestonebp.com ��'�!'l�� r�'1��. '''��` C�� Techntca�ftepresentattve Tim NlcQuilien �;��}�{�� YRI!�L�� Address/Phone/Emall 250 West 96th Street Indianapolis,IN 46240 P�j�� Lc��ER � ,� (S00}443-4272 Ext 538db a� mcquillenCim@flrestanebp.com ; Quaflty Assurance Representat! e David Wally AddressJPfiane/Emaii 393 Denton Circle Tuscumbia,AL 35674 {256)386-8383 david.we!!ey@omnova.com ' Category Roofing � Subcategory Single Ply Roof Sysrems Camp►lance Method EvaivaClon Repart from a Fiarida Regfstered Architect or a Llcensed Florida Professlonal Engineer r Evatuat(on Report-Hardcopy Received Florida Engineer or ArChitect ame wtro Robert Nteminen developed ttre Eva(uatian Rep rt Florida License PE-59166 Quality Assurance Ent�ty Undarwriters La6orataries Inc. QuaUty Assurance Contract E plratlon Date 03/30/20i3 ( � VaEidated By , , ]ohn W.Knezevich,PE !� VaUdatlon Checkllst-Hardcopy Recelved CertiflCate of Independence FL6943 R3 COI TrlNtv ERD CI-Niemtnen,pdf � Referenced Standard and Ye r(of 5tandard) Standard Year ' ASTM D6878 20d6 FM 4470 1992 FM 4474 20Q4 http;i/www.floridabuilding.oxglprlpr pp_dtl.aspx?param=wCrEVXQwtDqu°fo2foRM43U... 3/14/2012 T , • ,r Lu1�lu�L,J Ul1l.Llils .,.,uv �,.uaai.. r a �',• � � I I . , zoii , TAS 114 Z004 ` UL 1897 ___ Equlualence of Broduct Standards � —--- _. -- _,_.._Certifled By �----- - Sections from the Code Product Approval Method Nlethod 1 Option D ' Date Submitted 12/12/2011 Date Valldated 12/14/2011 Date Pending FBC Approval 12/20/2011 Date Approved 01/31/2012 Summary of.Products FL# Model, umber or Name Description 6943.1 GenFle� TPO Single Ply Roof Tfie�rriopiastic.polyolifin,singie-ply roof systems 5ystem Limits of Use Installation Instructions Approved for use in HVHZ: o FL6943 R3 II Ai er120911FINAL GENFLEX TPO FL6943-R3.Ddf Approved for use outside H2:Yes Verified By: Robert Nleminen PE-59166. Impact Resistant:N/A Created by Independent Third Party:Yes Design Pressure:+N/A/-29 •5 Other: 1.)The DP In this app Ication refers to one Evaluatian Reports specific roof assembly. Refer t ER AppendiX for all FL6943 R3 AE er120911FINAL GENFLEX TPO FL6� assemblles and mex design pr ssures. 2.)Refer to ER ��ted by IndependentThird Party:Yes Section 5 for Limlts of Use. _ ---- Back Next Cant Us::'1940 North Monroe Street Tallahassee R'3Z399 Phane:85�24 The State of Florida Is an AA/EEO emp oyer.Coo�rlaht 2007-2010 State of Florlda.::Privacv Statement::Accesslblli�Steten'?"t::Refund Sta[ement Under Flarida law,e-mail addresses a e publlc recards.If you da noh ne or by tradltlonal mall.Ifly uehavera y questlans regarding DBPR suADA web t send elecFronlc mall to[his entity.I stead,contact the offlce by p ccesslbllity,please can[act our Web Master at wehmaster[ad6or state fl.us. ProductApprovalAccepts: � � cCticik -.�-�s � SL'Clll1t�H]tTItEC:i YerlStgn� -� Truzted � venicr� http:/lwww.floridabuilding.org/pr/pr app_dtl.aspx?param°v�'GEVXQwtDqu%2foRM43U... 3%14/2012 `;- �,� ERICAN ,�.;; I �i� � ' D�RES V/SA� �_.�'` � ��ta� �� /�� C� 5%fee for credit cazd processing. �� ADivision ofRyman Constructio ,Inc. Proposal# f � il 36413 SR 54 •Zephyrhills, Flo ida 33541 0 6 � O INC. phone(813)782-6094 • Fax(81 )788-6773 Estimate# i 1-855-Go-Ryman (1-855-467-9626) • ic.#CCC 1325505 Serving all of Centr I Florida Job# OwnedPurchaser. ��,�� In.�'` �� /� Date: S I Claim#: ��ln Insu anceCompany: /��L1 Policy# �� Address: S�7 ��' City: �'�p�� <<� Zip:�� Home#: Cell #: � � �� Business#: � E-Mail Address: t�- J '� Complete tear off of existing �3'�f� �� Additional Notes/Special Concerns: � Secure all loose roof decking as needed according , 1x . to Florida Building Codes ��" ❑ Roof dried in with - � �� /' � �y� (/�n� '� Install new valley metal with galvanized metal �� U+�� ,�. ��c�.� �-1 I ��n��,.� i �. Install new 1'�e� ( "drip edge color: � �L�� C 'i � � Install new lead boots /� � � ,/� , , '�, Install all new general roof vents �) � f �'��- ��J�- f' �S��1 �� r� � Install new C,��J.3 �� y �'�4� ' la,�G�-�'�-�— r�- � t 0�� t, '� Manufacturer: � � Color: �n h�P� , r�All roof related debris removed from job site, pick-up oose nails using commercial grade magnet ' � All materials, labor and permits furnished /' ��'� � Provide a ��L�� labor war anty Total Investment$ v� Additionalltems: � G� ' 1p � � r �� C� �� 6�/� ��{�' � � � � �� /\ `�� 'C � � � _v\� � �/ I. • 'r-�-rn C�. - �0.-F � � ` � �' J �� ,�� -i� �� .r � f �� cr� s�- �I' �, �.� �� Payment Method: ❑ Check# �Ca h ❑ Financing ❑ Insurance Claim '� � ❑ Credit Card# � Exp. Date CC ID# Down Payment:$ �. �1 ( '�� Amo nt Financed:$ Approx. Monthly Payment:$ PaymentTerms: t ; �l� U� �� `"/� L '� Y � �l �r, Extras: � `� ` � ❑ Deficient 1/2"plywood replaced at a cost of$ per sq.ft. in the roof field,which includes labor&materials.All other wood work/ad- ditional labor, such as, but not limited to,valley rebuilding, r fter replacement, 1 x decking,etc.will be a rate of$ per man hour plus the cost of materials. THIS BECOMES 1A`BINDING CONTRACT UPON ACCEPTANCE 0 PROPOSAL.PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTRACT. I ACCEPT TH P 0 OSAL AND HEREBY CERTIFY THAT I HAV READ AND FULLY UNDERSTAND THE PROVISIONS OF THIS CONTRACT. � � Purchase : � �`� /- Date: �� °"""�--�� Purchaser: Estimator: � . i�' , , \ , '! * '. � I IIIIII Illll IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII � .� � 2015014046 Permit No. Parcel ID No ��'�O J Z�- bbl b-Z('J' bb�Ub3 O NOTICE OF COMMENCEMENT State of r !��C`' County of �'"�� THE UNDERSIGNED hereby gives notice that improvement will b made to certain real property,and in accordance with Chapter 713,Florida Statutes, the following information is provided in this Notice of Commencem nt: 1 Description of Property� Parcel Identification No. �('� J 2l— (�1� " 21 301�—* �30 StreetAddress SU4� �1� Sk• h h�ll� 335�2— 2. General Description of Improvement �e-- �b0� 3. Owner Information or Lessee information if the Lessee c ntracted for the improvement: - - _ __ �Gtui�, b( � • ' — �JO�� I'�-t�'Na �c��'hI�L� � 3�✓S�Z. Address City State Interest in Property� l.U�-1 Name of Fee Simple Titleholder: (If different from Own r listed above) Address City State •�' '�{` Contractor � �►'�� V1 ��-' .r` , '�j `�(3 Na R- 5�[ �hc�✓1-��(l s �Z 33j�f i Address �I,3✓ �� , / O �/ City State Contractor's Telephone No.: �' �� `� 5. Surety� Name Address Rcpt:1656981 Ree: 10.00 — state Amount of Bond: $ DS: 0.00 I T: 0.00 01/29/2015 D. B. , Dpty Clerk I 6. Lender. I Name � PRULR S O�NEIL,Ph D PRSCO CLERK & COMPTROLLEF Address 01/29/2015 02:05 m 1 of 1 OR BK g 14�' p� 1624 State Lender's Telephone No.. 7. Persons within the State of Florida designated by t e owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)(7),Florida Statutes: Name Address City State Telephone Number of Designated Person: 8. In addition to himself,the owner designates of to rec ive 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 wner• 9. Expiration date of Notice of Commencement(the expi tion date may not be before the completion of construction and final payment to the contractor,but will be one year from the date of recordi g unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE B THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UND R CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROV MENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFO E THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE OMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalty of perjury,I declare that I have read the oregoing notice of commencement and that the facts stated therein are true to the best of my knowledge and belief. STATE OF FLORIDA � ��f'jv� _ COUiVTY OF PASCO �� $j na re of Owner o essee,or Owner's or Lessee's Authorized Officer/Director/Partner/Manager , Signatory's Title/Office The foregoing instrument was acknowledged before me this � day of � ,20��by �"� �r �L as (type of authority,e.g.,o icer,trustee,attorney in fact)for _ - " (name of party n behaif of whom instrument was executed). Personally Known�OR Produced Identification❑ Notary Signature - � � Type of Identification Produced Name(Print) �,��a;;P�� ANNA MARIE LYNCH TERRY :2°; ;`c�'; Notary Public-State of Florida : :•5 My Comm.Expires Apr 4,2016 ` Commission#EE 166865 ,��'%�°��P`` Bonded Through National Notary Assn. wpdata/bcs/noti cecommencement�c053048 � i . I � { j . : � 4 � � �. ti � i � � , � ,� � , ; , f � � � � � . ; ; ., _ : ...: :�_,_ �r ; , � ,..._,_ 4 � � � - - � � - � � . � -� � = -�: � � �, . , � „ � . ._. _ I ' I � " (