HomeMy WebLinkAbout1714 Ridgewood LnJob Address:
Parcel ID:
F y�o
Documented Construction V lue:
IQ—o``. NMI
W �JL °" S Historic District: Yes ❑ No ❑
Residential ❑ Commercial ❑
Type of Work: New ❑ AdditionEl
Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: C`2. r Ulf 1
Plan Review Contact
Phone:
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 1955Lf
Title: Q4
Email: yi)onApLo,COrr�1
Property Owner Information
Name kc><, t o p Phone:
Street: Resident of property?
City, State Zip:
Contractor Information
Name _ W C Phone:
Street: (� Fax:
City, State Zip: 0 I State License No.:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING .YOUR NOTICE OF
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5'h Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
Y
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be
found in the public records of this county, and there may be additional permits required from other governmental entities such as water
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
1�)a� 6t�__ I - a2= ( �
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
O,/, v_), Jd
Signature of Notary -State of Florida
J
ir1 E*,
DEBBIE 81_0:7)N
4 i-F',MAB
MY COMPd13Si0N
E\FIRES: February 25, 2019
Londed 7hru Natarry Pudic linderwrite,,�
Contractor/Agent is Personall Known to Me or
Produced ID Type of ID (I e`IP - 41&lr �_
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas[] Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
# of Heads Fire Alarm Permit: Yes ❑ No ❑
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Revised: June 30, 2015 Permit Application
JDAVIE B. HONVIELIL, JLJUC
210 N. Kirkman Road, Orlando, FL 328 11
Telephone: (407)902-7154 License#: CGC1512863
THIS AGREEMENT made day of 0k;4 � j,� -20tT-by and between, DAVE B.
HOWELL, LLC , , hereinafter called the (Contractor) and; _T
J 0,
hereinafter called the (Owner.)
Witnbsseth, that the Contractor and the Owner for the consideration names as follows:
Article 11. Scope of the Work
The Contractor shall perform all of the work shown on the Drawings and/or described in°the
Specifications entitled EXhl'bitIocaled at �,as n�exed hereto as it pertains to work be Performed on
property _y r
ACCORDING TO FLORIDA'S"CONSTRUCTION LIEN LAW (SECTIONS
713.001-7133-1,.FLORIDA STATUTE S)j, THOSE' WHO WORK ON YOUR
PROPERTY OR PROVIDE MATERIALS AND ARE NOT PAID IN FULL
HAVE A RIGHT TO ENFORCE, THEIR CLAIM FO
R PAYMENT AGAINST
YOUR PROPERTY. IF YOUR CONTRACTOR OR A SUB -CONTRACTOR
FAILS TO `PAY SUB -CONTRACTORS, OR MATERIAL SUPPLIERS, THE
PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY
FOR PAYMENTEVEN IF YOU HAVE ALREADY PAID YOUR
CONTRACTOR. YOUR CONTRACTOR M E MAY ALSO HAVES ALIEN ON
YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY
COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR,
MATERIALS, OR OTHER SERVICE'S THAT YOUR CONTRACTOR OR A,
SUBCONTRACTOR MAY HAVE FAILED To PAY. TO PROTECT
YOURSELF, YOU'SHOULD STIPULATE IN THIS CONTRACT THAT
BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS
REQUIRED TO PROVIDE YOU WITH AWRITTEN RELEASE OF LIEN
FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A
"NOTICE TO OWNER."`FLORIDA'S CONSTRUCTION LIEN 'LAW IS
COMPLEX AND IT IS RECOMMENDED THAT YOU CONSULT AN
ATTORNEY.
Article 2. Limitations and General Conditions
Non -Structural Matters: Contractor shall not be responsible or liable for stress or settlement
cracks in any material supplied by contractor where same does not threaten structural integrity.
Thngible Personal Property: Contractor shall have no responsibility or liability for damage or
loss to owner's tangible property on the premises, except for Contractor's intentional:negligent
acts.
Patching and Matching: The color, texture and planes between existing and new materials may
not match exactly, but contractor will use diligence to obtain such matching as close as
reasonably possible, Owner acknowledges that patching maybe detectable.
Article 3. Plans and Specifications: The plaits and specification have been provided by
Owner, and any loss, cost, damage of expense incurred by the other party as the result of any
defects in such plans and specification shall be borne by the party;providing the,plans and
.specifications. In the event of a conflict between the plans and specification, the specifications
shall control.
Article 4. Definitions: the term 'cost"Means all costs and amounts paid or incurred to third
persons by :Contractor or by the Owner for labor; services, material, licenses, permits and
impact fees directly reiated to this Contract. This term, except as it relates to "time and
materials", shall also include 100% of the gross payments to all employees of Contractor for
preparation of the plans and specification referred herein, (including the incomes taxes and
F.I.C.A. taxes withheld thereon). The terms "days" means calendar days, including weekends.
and holidays, unless otherwise noted business days means week days Monday through
Fridays which are not state holidays. "Substantial completion" occurs when the Certificate of
Occupancy or its equivalent has been issued or has been delayed solely by act or omission of
the Owner, when the owner occupies any part of the remodeled property, or when the Building
Authority releases the building permit based upon completion of final inspections.
"Consequential damages" consists off costs or expenses which may arise from the special
circumstances of either party hereto, including, but not limited to, such things as increases in
living expenses, additional storage or interest costs, adverse or aggravated medical conditions
or longer travel times and distances, which may be incurred or suffered as a result of, or arising
from, a delay in any performances hereunder by either party. "Time" shall be a flat rate per hour
change,. or prorated amount thereof, for the actual time spent in the performance of this
agreement, whether for the Contractor's employees, agents or subcontractors.
J Z-
� `)' `�. VV` A A,; L it' �� L FV S L �}� 1L JF v
Article 5. The Contract Price
The Owner shall pay the Contractor for the material and labor to be performed under the
Contract the sum of Dollars ($ ), subject to additions
and deductions pursuant to authorized change order.
Article 6. Progress Payments
Payments of the Contract Price shall be paid in the manner following:
contract date (Non-refundable Deposit) j
after days of contract date
_ 'ti upon completion of job :..�
Article 7. Time of Completion
The work to be performed under this Contract shall be commenced with /_ days (30 if left
blank) of the issuance of all building permits, recordation of 'Notice of ComrtSe,ncement, and
written verification from the ;Owner that all funds necessary for payment of the Contract Price
are available, whichever shall last occur_ The Contractor shall diligently pursue and
substantially complete all work to be performed under this contractwithin>a reasonable period of
time, taking into consideration delays that beyond the control of the contractor,including but not
limited,io, Weather conditions, delays in selection or delivery of materials,; change order requests
by Owner and delays in obtaining all necessary permits, licensing or certificate of occupancy.
Use of Contractor's Employees, Agents, Sub -Contractors or'Material`Suppliers. Owner
and Owner's family members or agents shall not in any manner utilize, unreasonably interfere,
communicate, or contact with Contractor's employees, subcontractors, subcontractor's
employees or agents, or material. suppliers, nor perform or permit any work on the subject
property, without the prior written, approval of the Contractor, which approval maybe withheld in
the Contractors unrestricted discretion; provided, however,, that if such consent is given, then
the owner shall be solely responsible for the payment, shipment, delivery, insurance,
installation, and damages for delay.,
Article 8. Right to Cure: CHAPTER,558 NOTICE OF CLAIM: CHAPTER 558,`FLORIDA
STATUTES CONTAINS IMPORTANT REQUIREMENTS YOU MUST FOLLOW BEFORE YOU
CAN BRING ANY LEGALACTION FOR AN ALEDGED DEFECTIVE CONSTRUCTION IN
YOUR HOME. SIXTY DAYS BEFORE YOU BRING ANY LEGAL ACTION,, YOU MUST
DELIVER TO THE OTHER PARTY TO THISCONTRACT A WRITTEN NOTICE REFERRING
TO CHAPTER 558 PF ANY CONSTRUCTION CONDITIONS YOU ALLEDGE ARE DEFECTIVE
AND PROVIDE SUCH PERSON THE OPPORTUNITY TO INSPECT THE ALLEGED
CONSTRUCTION DEFECTS AND TO CONSIDER'MAKINGAN OFFER TO REPAIR OR PAY
FOR THE ALLEGED CONSTRUCTION DEFECTS. YOUARENOT OBLIGATED TO ACCEPT
ANY OFFER WHICH MAY BE MADE. THERE ARE STRICT DEADLINES AND PROCEDURES
UNDER THIS FLORIDA;LAW WHICH MUST BE METAND FOLLOWED TO PROTECT YOUR
INTEREST.
Article 9. Default/ Notice of Default. Other than for claims of defective construction, which
are governed solely by the "right to cure" law disclosed in article 8,,Contractor shall be in default
under this contract if contractor abandons work on the structure or otherwise refuses to carry out
contractor's obligations under this contract (unless such abandonment or refusal .is based upon
prior default by Owner which Owner has failed to cure after written notice thereof). Contractor
shall deemed to Have abandoned work if contractor shall fail to perform or cause any work to be
performed on the subject property for twenty-one (21) consecutive days, unless such failure.is
the result of any event beyond the control of, the contractor. Owner shalf be n default under this
contract if owner refused topennit contractor to complete performance, fails to pay any amounts
when,due, or otherwise refuses to carry out the obligations of owner under this contract (unless
such refusal or nonpayment is based upon a prior default by the contractor which contractor
failed to cure after written notice thereof),. In the event of default, the defaulting party shall be
entitled to receive written notice, by certified mail return receipt or by hand delivery to the
address shown below, which specifies the,event(s) of default.
Article 10. ARBITRATION. Except for claims by the Owner of defective construction, which
are governed solely by the "right to cure" law, the parties agree that any other action to enforce
this Contract shall be exclusively by arbitration proceedings as described herein, to be held in
the county in which the real property described herein is located, and both parties agree to be
bound by the decision rendered in such proceedings. Within thirty (30) days of 8 written request
for arbitration, each party shall select an arbitrator. If either party fails to Select an arbitrator
within this timeframe, the first arbitrator selected may select the second arbitrator. Within ten
(10) days thereafter the two arbitrators shall select,a third arbitrator. All arbitrators shall be
persons with experience or knowledge in the construction industry. The arbitration shall be
conducted in accordance with the Florida Arbitration Code (Chapter 682, Florida Statutes);
provided, however, the final hearing shall be held not more than ninety (90) days after the
receipt of the request for,arbitration and the final decision shall be rendered not more than thirty
(30) days after the conclusion of the final hearing.
Article 11. General Provisions
Any alteration or deviation from the above specifications, including but not limited to any such
alterations of deviation involving additional material and/or labor costs, will be executed only
upon written order for same, signed by Owner and Contractor, and if there is any charge for
such alteration or deviation, the -additional charge will be added to the contract price of . this
contract. If payment is not made when due, Contractor may suspend work on the job until such
!T s all payments due have been made. A failure to make payments fora period in excess of
days from the due date of the payment shall be deemed a Material breach of this
contract.
In addition, the following general provisions apply:
1. All work shall be completed, in a workman I -like manner and in compliance with all building
codes and'offier'applicable laws.
2.1 the contractor shall furnish a plan and scale drawing showing, the shape, size
dimensions, and construction and equipment specifications for home improvements, a
description, of the work to be, done and description of, materials to be used and the
equipment to be used or installed, and the agreed consideration for the work.
3. To the extent required by law all work shall be performed by individuals duly licensed
and authorized by law to perform said work.
4. Contractor may at its discretion engage sub -contractors to perform work hereunder,
provided Contractor shall fully pay said sub -contractor and in all instances remain
responsible for the proper completion of this Contract.
5. Contractor shall furnish Owner appropriate releases or waivers of lien for all work
performed or materials provided at the time the next periodic payment shall be due.
6. All change orders shall be in writing and signed both by Owner and Contractor, and shall
be incorporated in, and become part of the contract.
7. Contractor warrant ' s it is adequately insured for injury to its employees and others
incurring loss or injury as a result of the acts of Contractor or its employees or sub-
contractors.
8. Contractor shall at its own expense obtain all permits necessary for the work to be
performed.
9. Contractor agrees to remove all debris and leave the premises in broom clean condition.
10. In the event Owner shall fail to pay any periodic or installment payment due hereunder,
Contractor may cease work without breach pending payment or resolution of any
dispute.
11. Contractor shall not be liable for any delay due to circumstances beyond its control
including strikes, casualty or general unavailab'lity of materials.
12. Contractor warrants all work for a period of months following completion.
Article '12. GOVERNINGLAW, ASSIGNMENT AND RECORDING. This contract shall be
construed and enforced in accordance with the laws of the State of Florida, and may not be
assigned or recorded except with the prior approval of both parties, which approval may be
withheld for anv reason whatsoever.
Article 13. INTEGRATION CLAUSE. This; contract and the additional contractdocuments
attached hereto constitute the complete agreement between the parties and may not be modified
except in writing signed by all parties hereto.
Article 14. CONSTRUCTION RECOVERY FUND. PAYMENT MAY BE AVAILABLE
FROM THE FLORIDA HOMEOWNERS CONSTRUCTION RECOVERY FUND IF YOU
LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS
RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY STATE -LICENSED
CONTRACTOR. FOR INFORMATION'ABOUT THE RECOVERY FUNDAND FILING A
CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT
THE FOLLOWING TELEPHONE NUMBER AND ADDRESS:
Construction Industry Licensing Board
1940`N. Monroe Street
Tallahassee, FL 32399-0784
Telephone: 850-487-1395
Article IS. Breach of Contract. If either Owner or Contractor is in breach of this contract the
breaching party shall pay as liquidating damages twenty percent (20%) of the total contract price
plus court costs and fees of the damaged party.
Name and Registration No. of any Salesperson who solicited or negotiated this contract:
Signed this day of , 20
Signed in the presence of:
Witness
Witness
Name of Owner:
By (Signature):
Name of Contractor:,
DAVE B HOWE4L LLC
By
(Signature).,
Street Address:
210 N KIRKMAN ROAD
City/State/Zip;
ORLANDO, FL 32811
Telephone, No.:
407-902-7154
Contractor's Licenser No.:
CGC1512863
"Exhibit A"
A�
74� T. M, R11-T-1, M-Ult.- T-1 r U-A
Dear Property Manager or Whom It May Concern:
We are JJ&N Development tasked to perform work on the below address
In an effort to provide property preservation, secure permits and any other designations
required by our clients
Property Address: 1714 Ridgewood Lane Sanford FL 32773
Bank of America, N.A. is currently servicing the loan on the aforementioned
property in which we have legal right to inspect or conduct routine maintenance.
Along with this letter of authority, our representative(s) will have a work order that
outlines the level of work they are required to perform within a specified time
frame.
Please allow our representative (Dorothy Harris) access so Safeguard
Properties, LLC may take any action necessary in order to preserve and protect
the property from potential damage.
Your cooperation is appreciated.
Sincerely,
Mike Mulica
High Risk Manager
r sa.' ,ramCITY OF
Building & Fire Prevention Division
RESIDENTIAL RE=ROOF POLICY &PROCEDURES
FIRE DEPARTMENT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
"PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
• COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
• COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
• ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
(PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
• DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
• SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNERIBUILDER) SIGNATURE: DATE: ���
CITY ..
ZANFORD
FIRE DEPARTMENT
JOB ADDRESS: nN � I
1 ? - 5 S `(
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
A-w �-e SAiK�
STRUCTURE TYPE: O JINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: PLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF
DECK TYPE (PLEASE SPECIFY: ` W V V
* *PLEASE NOTE: ONL Y 100 SQUARE AE7kOF THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: O OFF -RIDGE RIDGE O SOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES &NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
-----------------------------------------------------------------------
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 C)"2:12 -4:12
O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
G4INGLE
FL# v �l
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
0 OTHER:
FL#
1111111111111111111111111111111111111111
SE' INOLE COUFfi�i�'i`
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1% Ur C:Ji F'?'F:OLL
;;1- ._n
THIS INSTRUME�1T PR OARED BY:
Name:.i. ;rY i1c k':•t-,`f
Address: �_1cu- } 'r •n 'L.
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
Parcel ID Number:
CLERK"i x 2018008837
o
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
GENERAL DESCRIPTION OF IMPROVEMENT:
OWNER INFORMATION:
Address:
Fee Simple Title Holder (if other than owner)
CONTRACTOR: Name:., D a 1i ?. T� )^ye0
y
Address: ;415A", Pr",> r-
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates
of
To receive a copy of the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date is 1 year from date of recording unless a
different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under nal *es of perju ; I declare that I have read the foregoing and that the facts stated in it are true
to th¢' est of know dge and belief.
er s Signature er's Printed Name
Florida Statyt 13.13(1)(g): " The owner must sign the notice of commencement and no one else may be permitted to sign in his or her stead."
State of / t County of SP✓x�.
��� v
The fo omg in tr ment was a knowI dged before me this day of 201 v
by r '' li Who is personally I�oo to me ❑
UUU me of person making statement
OR who has produced identificatiorCM type of Identification produced
CERTIFIED CO Y ORANT MALOY
CLE F TH . CIRCUIT COURT Fv .,
A ' PT _ 4 Rfi t E
COi v� .� a� ik�� ; ��� r FJr}t i1LFa
SE INO: .°' .,�� r �'�V" r10t,.(, t'UIiI1C .ri1"t, Jf t'io 1L�a t?
UN F 41D�1 t 4�'
l t> at: Cvmriissior , FF 191870i a
BY ?r pIly Comm E � r� yap 2 i '0 i 9 b.
D C�B
Date 1