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�� Iilllllllllllllllllllllllllllllllllllllllllllllllllllllllill � <br /> � � 2016030903 <br /> � , Rcpt:1751357 13ec: 10.00 <br /> � DS: 0.00 IT: 0.00 <br /> ' 02/29/2016 B. M. , Dpty Clerk <br /> ����������������� �'�r� <br /> PAULp S 0'NEIL,Ph D PqSCO CLERK & COMPTROLLER' <br /> ---- i �2/29/201��� pm 1 ��1 <br /> Fermit Nn. OR BK �� p� � <br /> Property IdeniificationNo. I D"'Zrs'`2 t ��()Q '['Q�6 D '�!� � .. <br /> "tT-IE iJIQDERSIG:`TEI11�ereby give informs you that the improvement ts�ill be made to certain r�l proPerty,and�accordance wi;h <br /> Sectinn 713.I3 ofthe Floxida Statutes,tha fu7Pnwing informativn is provided in this Pt�TIC;%;flF�O .1Hi4'i-f�NC�MEi�'T. <br /> 1.Descrietion ofproperty(&�;nl descriptian)�o Ili II�S G/tf,�$G l,la� �� ! �d a La(.J' °�l <br /> a}St�et Address: • - a 'j'J����P,��°�L_____ ^_ <br /> 2.C3eneral descriQtion ofimproveme ����,�irdh�t�i <br /> 3 Ou�ner Information / <br /> --- S�tll �-�t i1�'� .� <br /> a)Name and address: �t.�t� ��'t�lra.eJR� ���.�.r���' �.� ,��'��_-- <br /> b)Name and address offee:szmple ritle6oid.er:(if otber than ow�mer)�.__._,,__ <br /> c)Interesf iu FsrapertY.��le_._._..---: ._ _,._,« <br /> 4.Cor.tractor Information p�/� - .•/ /� / <br /> a)Nasne and address: � /� �G tet/eC�dl �`�/Qd'l,B�,��t����g�` �.��.� <br /> h)Teteptione No.: - __'�-�K' Pax No.(Opt} � -+i—�7� ___._ <br /> .. <br /> S.Surety Information <br /> a}Alame a�id address: _ __.__ �__.___________... <br /> b}t�rnoimt of.7�ond: _.__.__ _,__ �� _y <br /> c}'1"e1e�!ione No.: _ Pnx TQo.(Opt.)� <br /> 61,entler <br /> � a)Name and address:�,.__ ___ ,____ �_ <br /> PIIURe NO_ <br /> 7.Identity�of persan witkin the 5txte of F(orida desigiatad by owner upon v�hmm�otices or oYher do�iamnnis znay be se�ved: <br /> al Name and address: <br /> b)Telephone No.: -______.._�_. ___ T Fax No.(OpL)------ � <br /> R.In adci9tion to himseI�ovJner designates ihe follaa�in�person to raceive a copy o£L�e Lienor's Notioe as provided in SecYioil <br /> 7t3.13(4)(b),Floci&a Statutes: <br /> a)Name and address: � _T___� <br /> b)"Felephone No.: � _ Fax Ne}.(Opt.) <br /> 9.Expiration date of I�Totice of Commencement(the expiration date is one year frc�m the'date af record'uxg unless a different date is <br /> speci�ed): <br /> V�IAI2N7NC T��WNE12: F�IlTT.'PAl'M�N�'S t�IAT)F�I3Y'CfIIs�fllxlNF'R.e1Y'TP•.R T.H���'IR.41'I(9Id QF T'�E I4t9TILT ON <br /> CtDM�I�vCENL�N1`ARE C01�ISIDEREF3[MC'&t4}PER PA'YI�TL�NTS IJNLT�;Ft C4IAPTER 713,PA�'C I,SECTIf1N?13.53, <br /> FL(3it7a?A SCATI7fiE8,hieIT)C�'�`IZI:SUI,T 3Fd�'f)iJT2!'�YI1�IG�'iA'IC�I'FSt2 FMPR47'�1:111-1�CtTS 3'O YOTJIt PI8€?�'�R'FX_ <br /> A NO'T3fC�t3T+'C()M2V1�:N4:1?PUI�id'i`i'V1(JST$�ItEC43R�3L�U ANI)1'�STI<;D C3T�7t3���O$3 SIT��EI��RE 1T1iI�FI125T <br /> INSPECTIO\. IF Yd7CJ 1?VT�N7R TO(133'd'A.Ii+I 3±iNAN'Cl?'tG,��AfSULT Y€DfIId LLiNDER C@RA1V AT`a0 T' }2�I�t3RE <br /> CC)IbIM�NCIN�WflI2T�plt It�:�Ob'YDT�G'YOU�t Nd37['ICT E�t�Oi�f -_ ��. �F,.V'I`. <br /> srn•rr o�rc,oar�n ----,- <br /> COi;TYTYOF�O}.�(U�S�� _. _ � <br /> Ss amre of - or Uwnc-'s Au �oilzed Ofi:cul:Iiicdcr/Purfnec(Mausger <br /> .��� �" '�•,-��-a(�;� <br /> Print;�tame ' <br /> The f'oregning instrument was ackn:�a�tc lgct3 bePore me this�day of_��-.�,}2U�,b,:� rl U�2 <br /> _ ss�(��/�1���. _,�_.__.l��of authcriLy,c.g.oflicer;�usce::,ationzey <br /> in tact)for ____ , (name of parfy nn l�ehalf of whom instnunent w exe• {ed). <br /> .J <br /> ?'crsoually I{no�vn___---OR Produced Tdeniifica'ion� Notary 5ignatnre,_^l`^�1�I__�I. -- - - <br /> 'C}�se a£Identificatian Producet��.�����2�� Name(print) �� T``��' L � .� <br /> � �� <br /> Veaificarion pursuant to Sec:tion 92.525,Flarida 5tatutes.Under penatties af perjury,l decltue 8iat T lztive xead ihe fareg�sing and tltat <br /> the facfs stated in it are true to the bsst p#'my lrnowle3ge and bslicf, <br /> .�tPR��'bg� S aNreofNati�ra]I'crsonSip�ingAbove �� <br /> �oehssr��c,�r t==°s .`c': LINDY HENLEY <br /> = + . : Notary Public-State of Florida <br /> z,+ aY;My Comm.Expires f�1ay 21,2017 <br /> �'o;;�f F�q;�� Cammissian#FF 020396 <br /> „������ <br />