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19-21036
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19-21036
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Last modified
1/7/2020 10:00:37 AM
Creation date
1/7/2020 10:00:36 AM
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Building Department
Company Name
ST ELIZABETH'S EPISCOPAL CHURCH
Building Department - Doc Type
Permit
Permit #
19-21036
Building Department - Name
ST ELIZABETH'S EPISCOPAL CHURCH
Address
5855 16TH ST
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INSTR#2019050125OR BK9878 PG3700 Pag. <br /> 03/26/2019 03:47 PM Rcpt*2040093 Rec: 10.00 DS: 0.00 IT:0.00 <br /> Paula S. OWK-PkD, Pasco County Cfierk&COmytroCCer <br /> tqoTICF-OF Comwmixic-M-wr <br /> State or, <br /> Tfir--UNDPRS(GNED hereby gives nq(tcq-that Improvement'All 158 Madelo certain•r--sl property,and in anaordancawBirl CSqplar71.9,Florida Statutes, <br /> the following information fopravided rn ilila Hotias of cornmencarnVill* <br /> I. i�scrjpllon of Piaperly; Pefcat Iderffiloall6a No. I(-a6-C)6jlD- <br /> Slraa1,Addra*s:,5855 1.644 's5i- hill's 335q <br /> 9- General casuripfron of Improvement DD <br /> — <br /> & WTer Information or Lessee Informaffan iftho Leewe con led fhMheimprovement: <br /> • Address ty <br /> interest in Pippirly. <br /> Name of Fee Sfruple 71fleliddal: <br /> (II'dirlier-aril from OftErlfstedabovo) <br /> Addrets City <br /> A. Contractor K14 M- QA ROA09 <br /> StaGV <br /> Address city state <br /> Contractor's Tela,phonaPia: C)l <br /> 6. surety, <br /> Name <br /> Ilk <br /> Address City <br /> Amount of Bond: Telephone Noz <br /> S. Lender:- <br /> Name <br /> Address city <br /> Lendee*T,s1ep1hcne No.: <br /> 7. Persaas vilthin the Slats a,Florida designatad the Owner Upon whom notices Or other documents 1Ina;,bU served ES provided by <br /> SCOW 713.1113(l)(a)(7),Florida Statnies-, <br /> Name <br /> Address city. state <br /> Telephone Number a?114inated Person: f <br /> a. In addition to himself,the okmer designates <br /> Telephone Number of person or Enla DesTqmtEd by 01wriar. <br /> e. Expiration date or Notice or comrnericeinemt(the explrallon dale may not be balara the comple!oncana2I Ticgi an�dt ayment to the <br /> butWIM be one year tram tle data afrecarding unIF-gs a dif,*=renkdata <br /> WARNING M OWNER*. ANY PAYMENTS-MADE BY THE OWNER ME!R-fEiEr--XPIRA-r[CINCF-niEiNdifcEov,co?j"WENCE(VICNT <br /> ARE CONSIDERED IMPROT-ER FAYMEMTS.'UNMR CHAKERAS,PART i BEG1101,4713M, FLOEDA STATUTES, AND CAN <br /> 11,liSULT IN YOUR PAYING.TWICE FOR INIPROVEMEN—M TO YOUR FROPARTY. A,NOTICE OF MwWww MUST En ti <br /> 11EGORDED AND POSTED ONTHE JOB SITESEPOWITHEFIRST INSPECTION.IF YOU 114-YEND TO 08I]AINFINANCIRG CONSULT <br /> W W. <br /> Tji POUF,LENDER OFANXfTRN OFz Y BEFORE Cof&zENCING WORN.OR PECORDIING YOUR No J ICROF COMMENCOk <br /> tinder penalty ofperjury,I declarathat I have readiha foregoing notice Or commenarment and that'1he facts sided therein ere true tolhebest <br /> or My linaviledge and belief. <br /> STATE OF FLORIDA <br /> COUNTY OF PASCO <br /> Big aura M�Wvtnr a a, or Less5ds Aulgarized <br /> .111 ctadPa erl?l nager <br /> [I 69 <br /> pa u107,r <br /> Sig MquWaloffian <br /> The tcregaing In-Arum twas aoRnwAadged betasMetwa57,,v by <br /> CA r <br /> .(type or authority,erg.,o5oor,trustpe,abufftwin fact)for <br /> a i Personally Known 0 OR Produced IdenthIcoilanjj� Nalls <br /> TYPO Of Ider0cation Produced L signature Name(P'slril)-- Ll <br /> ANGELA HAY <br /> WOOD <br /> �ubljv <br /> Florida <br /> Con'n1ISSIO11 r VF 9 1;" <br /> EXPIRM Aug 24 201-9 <br /> oil <br /> dool throllull 1,1,111011,11 tqjoj,L;A*1-M1.n. <br />
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