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15-15921
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15-15921
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Last modified
11/16/2015 11:21:52 AM
Creation date
11/16/2015 11:21:51 AM
Metadata
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Template:
Building Department
Company Name
ADVENTIST HEALTH SYSTEM
Building Department - Doc Type
Permit
Permit #
15-15921
Building Department - Name
ADVENTIST HEALTH SYSTEM
Address
38233 DAUGHTERY RD
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I I I IIII lllli IIIII IIIII Illli IIIII iliii IIIII11111111 <br /> � 2015009485 <br /> n. ' a <br /> " � Rcpt:i655083 Rec: 10.@0 <br /> DS: 0.00 IT: 0.00 <br /> Pd�'i`I ���tC'tDMI4�lEN��16��NT 01/21/2015 D. B. , Dpty Clerk <br /> Pezmit I�o. <br /> Praperty Identi�cation No. ' ,,� ° L�_���pZ��� ''00�'"r'O <br /> T�E i3NDERSIGN'FjD her�by gives nofice that impro�r ments will be made to certain z�l property,and in accardance e��ith Section <br /> 7I�,13 of the�lorida Statcttes,the following inft�rmatio is pravided iss EIZe?�CD����4}���Dil�f��Ei°d���EN1'. <br /> I. Descriptian of property(te arl�SCP'PyL1 'an:� <br /> a} ;'J�t'�E�f�if�{�L�Sb`: c s <br /> Z. tie�descAption ofimp ovemen#s � <br /> 3. Ou>ner infarmatio� C� l'`�R1.,�,,. <br /> a) Name and address� � � <br /> b} �iame and address of fee simple titleholder�if er than otvner} <br /> c) Interest in progerly <br /> ..t 4. Coanactor Informataon �"'.:�� � �=,�,�/,� ,q�l�> <br /> i33 �<1123�1i2d�t�t�TTASS: r .��:J e)/ <br /> b) Telephone No_: -� �ax I'�To.(Op�) •�6 <br /> �;: . SitI�3}+�I1f42XT1s3f3O?I <br /> �� �c"tIYIO ai]CT 3�C�2SS: <br /> b) Arnount af�ond: <br /> c} Teleph�rne Na.: Fa�Na.{flp�.) <br /> 6. I.en�er /. � <br /> a) Name and adciress' � o�� <br /> �Nv <br /> 7. Tdenzity af persan withzn the State of�lorida desi at�d by a�mer upon whom narices or other documents may be served; I oo�o <br /> a} ?�Tame and address: �m Z <br /> b) Telephone No_: F�Nt�.(�pt.) ,�u�� <br /> 8. In additzon to hitnself,owner desig;�ates the fallow ng person to r�ceive a copy oF the Lienc�r's R?otice as gravided in Secton �a J <br /> 713.13(1){b},�larid�.Statu#es: <br /> a) Name and atidress: `���,N� <br /> . b) fielep�one No.: �ax I�a.(f�pt.} � � � <br /> 9. Expiration date of Notice of Commencement(the xpiratian date is one year from Lhe date nf recc�rding unless a different date is -p ° <br /> specified): � �r� <br /> � <br /> � <br /> �,$'.�l,�t��'ds�'��9�'P+��$a�'�1�°.�.�fio'5�,1�''�'�1���� k$��`�+ C}�T��a�,��'�$$.'I'��+ �+:�Y�.�'�Ot�T��'+�'��+ 3��'I'I�:�CDF �"��ao <br /> ��I�14��iTC�..+'��:NN�������I�?�+:�+I�II�'°�n�D ��tF�����I`C�"S IJI�iF���S.".���'�+$2.73�,���`Is 5�+��`��I`�'7�3.13s �+�o <br /> �+'�tAIt��3A.�'i`�'�"$J'��S�z"d$9��I�I�;�u�J$.,�'�+I�'E�I.�i�a't�l?'�iG�'����+`t��$7[Y'I�;}�`a��+i+#"€'S T�B�OFJ�T'T��D�'�+I2'Y'�'.A i� � <br /> id�"i'�`�C�C3�'��.3PviTv�NNC:�1�JiEP�t'I'I���.T�'�'��,,"+ �� RTI���'�3�'"�}�Ti'�+�D f�Pd'I'�J�3��I`�'�I3E�+CD m + 'T'��+3�'� �� o <br /> �T�'���."€`�{�?�T.�£+`�'�#T��,'+��`I$'$'��9�g��ZiT� $�IC�'�'x.�{�I4iSUI,'��'��JI3$.,��8��{9��d Pa�'T{$�2.I��'�E+$`�.i�+ , m <br /> ��l'�I�i'd�k�x 1C;`F�'�3������+C��1dP�7��"��T P ��IC�����l�il�`�+P�T�'�•1�?�'. � � <br /> C����i'f'Y{D�'��LtiD �l/f`s'����,e��i� <br /> Si�nature OF Q��ser ar C}v,ner's Auchc�rized OffiwerlBirectorlParEaer,'149�g� <br /> ����.s /��til�crr� <br /> �t N� <br /> The foregoin�instrmnent uas acknowCedged befare me this i day of ����a�y 20 i'r'.,.�' ,by k�+i.All� t�A E'H L Oa Q i',N <br /> as F��i�l DA taGS a Tp{. ��'PH FcNli� (ty�a�of authority,e.g,officar,4rustee,attomey in fact)for <br /> Di K3ECTi3 C�+ �r- ��..,a�r a tSPC�iA'tiG4F�i a e of party an behalf 4f who�ins#r€iment was executed}. <br /> Personally Knnwn �/ OR Produced Tdentiiication htotary Signattare �+"'R�"-�-1--��' ' P't`"A'.� <br /> K�M Ea�{;b 3�0 4�f 1 LL <br /> Type of Identi�cation Produced Na,-ne(print} �l <br /> Ve�ific�ation pttrsuant 10 Sectian 92_525,FIori@a Sfafutes.Un er penaities af gerjetry,I declar�that I fiave read the fnrcgning and that ihe facts stated <br /> in it are true ta the best of my kttowledge and belie£ <br /> F4X3�tS1NOC.rsd2�7 1�� �'����tGi'1+ <br /> Si{7tanseafNariaat PtiaanSign3ngAbovc <br /> ,,�i�F�.�_ ItIMBEFiLY J.HI�{. <br /> k: :r_ MY COMM1SSIdN ii EE 198821 <br /> ���„R���°��` 8ondedxThruRNotary P Wk Und1envrite <br />
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