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<br /> <br />f'C.J;" <br /> <br />a P[)F f:!,l-"in forrn af8 on the /8SJ p.3GlH-~~' <br /> <br />11111111111111I111111111111111111111111111111I11111111111111 <br />2004012754 <br /> <br />Rept: 750171 <br />OS: 0.00 <br />01/26/04 <br /> <br />Ree: 6.00 <br />IT: 0.00 <br />Dpty Clerk <br /> <br />Permit No. <br /> <br />~~92~~n"'g: ft:~O fOUNToYf' C'iERK <br />OR BK 5703 PG 307 <br /> <br />Key No. <br /> <br />2. General Description of Improvement <br /> <br /> <br />a~"'f <br />. . <br />.... - - > <br /> <br />State of FLORIDA <br /> <br />e} <br /> <br />3. <br /> <br />ate rl' <br />J <br /> <br />4. <br /> <br />5. <br /> <br />Surety: Name <br />Address - <br />Amount ot Bond: :Ii <br /> <br />Lender: Name <br />Address <br />Phone No. <br /> <br />State <br />/-ax No, <br /> <br />k ' C'ty <br />Phone No.~ <br /> <br />" , <br /> <br />6. <br /> <br />city <br />Fax No. <br /> <br />State <br /> <br />7. <br /> <br />Persons within the State of Florida designated by Owner upon whom notices or other documents may <br />be servest a p,r,o,v iejed y Sectio~ 713.13(1} S7) Florida'~,tatu tes.: ~ ~ ,I J r:.: <br />Namee-, -/...:/C-'L/:?,eE Address " ./. .', /~:; City" ~., 'olE. State rL_ <br />Phone o. ".r, . ' ~. ~x::;/ ax o~ .~- - fr4'y- . <br />In addition to himself, Owner designates of <br />to receive a copy of the lienor's Notice as prOVIded In ~ectlon f 13.13(1 )(b ), FloOda Statutes. <br />9. Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording <br />unle.. a different data is specifled.) . J <br />Signature of Owner: /d.. e u~ ~ 'i:. ( f6.(.A 1..J-u.1\..~ II jS01 <br />State of h~""4-/ .c?/P County of ~8"::'O . <br />Sworn to and subscribed before me this ~ .g 't-e/ day gi~~-<.4';;;fc , 20 (J //, by <br />iPil,I-"~ -r /.<,Lfl-fl. ~ _. ' who IS L'1'"Pi onarry know 0 me or C produced <br />,. . as I entrflcat!on. /J <br />Notary Public: ~~./.A.A.. P ,~~-L-::;2 <br />?' t7 <br /> <br />8. <br /> <br />E:\wpdata\permits\sfrapp, wpd <br /> <br />R":J\. Sandra J PoIIeg <br />o...i My CommieIion ~78 <br />'\ OF ~ Expires July 08, 2007 <br /> <br />Rev, 09/03/02 <br /> <br />" <br />