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HomeMy WebLinkAbout107 Prince Pl (2)CITY OF SANFORD PERMIT APPLICATION Permit No.: + ' % 33 r' _ Date: Job Address: 7 e'4' Parcel No.: 3 3/ 9 3 0 r/ 3 0 0 C, 0 Q 9 70 (Attach Proof of Ownersh Description of Work: 60'- Type of Construction: v.0Hi" &4-.% Legal Description) cam-/^- S Flood Zone: Valuation of Work: S % 0 .-0 Occupancy Type: Residential Commercial Industrial Number of Stories: Number of Dwelling Units: Zoning: Total Square Footage: Owner: A,q 4L Address: / l 7 ' •' ! /, City: . e'1 State: Zip: Jo 721 Phone No.: V O7 3 3 O -J A3J—Fax No.: .ram Contractor: r Address: y/ City: c•/ Phone No.: y 0 7 a3 Contact Person: ` 4 Title Holder (if other than Owner): Address: Bonding Company: Address: Mortgage Lender:_ Address: Architect: Address: J / n-ic. w 9+-ram State: '09/ Zip: 127 7' i State License No.: cR 9 c a Fax No.: Phone No.: YO 7 , ?a; I V % 91 60 Phone No.: Fax No.: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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. dffi mnu Owner/Agent is _ Produced ID hLnA2. Signaturre o C tractor/Agent Date Print Contractor/A is Name Signature of Notary -State of Florida Date Melissa Cameron 2° a om :Cmission # DD079918 Expires Dec. 20, 2005 Bonded Tbru N1111``` Arlanric Bonding Cc., Inc. Contractor/Agent is Personally Known to Me or Produced I D F 2(OS / 6 (o 3 q " d APPLICATION APPROVED BY: 06 /'S' f Personally Known to Me or Date: :Z — L 5-7 O Z Special Conditions: BOONDAKY SURVEY FOR/CERTIFIED TO: Kyle M. Weststrate and ALiher Wes t9trav& .., --- Commonwealth Land Tltle Insurance Company,"'"- Universal Land Title, Inc..- r „ Pinnacle Financial. Corporation DESCRIPTION AS FURNISM. Lot 97, MAYFAIR OAKS, as recorded in Plat Book 50, Pages 38, 39, 40 and 41, Public Records of Seminole County, Florida. L-a-T Icy`} d.E.1 !j• °Ia Dili 14•• . iU.O jl etc I .e. it ti^ c1 •T 4 4 aj $ t.o T R •7 I l_ G T 9 E- le,i n 0 r SANFORD BUILDING DEPT. C] L.JR! !S Tz:1 { r THESE'", LANS ARE REVIEWED AND CONDITIONALCA-- 4..LC- . e--LjnC r-j ACCEF . EL) FOR PERMIT. A PERMIT ISSUED SMALLStbE sC_ J 4;CC-NSTRUED TO BE A LICENSW TO PROCEED W114; w t TF'E V-DIRK AND NOT AS AUTHORITY TO VIOLAT C di C' l cI ALTER, OR SET ASIDE ANY OF TF 16 P V .ON' OF THE TECHNICAL CODES. NOR SHALl Si • OF A PERMIT PREVENT THE BUILDINa1 J T A THEREAFTER REQUIRING A CORRE< 04 J I: 7 FIRORS ON THE PLANS. CONSTRUCTIO A — 9f R '10LATIONS OF THE CODES V a 12o Sv Q s r b a 2o G wALX I 0 Me _ ' r —1 4 a Ica 1 t..o ! ..i,. 3GT pA.c 1._ L u : V Lag + Z 3 Io' .. > m OFFICE COPYwT. 1r' 77 l'f. y ae''`• y a4s4 i..1. b Il SC. 1j 1,r" C RI/ Isr-s. oG' .Bi PE M IT9.•,,It'M7113 roT er,.x rL[V.C?')ft 'C' . ZL•• • d'Z ' #o-z s3 ar rlrr 1001Ib K 1-... nrr.ou rr.ra7'}e.NH_ - 4 1.3 ,• D f v 4 -T141 *;, L-o -r e. Q " 7-1" 1 " ri ?.' fi f71A • FT ' GRUSENMEYER - SCOTT & ASSOC., INC. - LAND SURVEYORS uuw l ARL L(lMf.•M IN wMCM I..Vi a., L VR UILATW aIA U.(1rIlm.'rocnnu-w 6 C!WWAWAI C.l K. CNYI. Ul(R.I-t fKt cce CMITDC"O ft G TstoC. C(lK TI'rRO3 C. M a.R lgaR'R7}(MWIAMfI.( asrnPrlo. o1NN iVVTOR.IMAC4 tARWMI' l I. I 1,0~0PLIM" /(1WC.. 01ow MR A NO- Ke M4D k ACK IAA liollI IMt I.. M ww"PI' ..T",(!(NCI-11"OW M( 0. 0 It Pan.( O, w<wn(K ac C.L IDfla( O, CC-Ame CIWM P0, 1l P(AfAO(q I(CVA`.AIlm 0 POW CP CVRMTW AC. Cola( O/ R VM CUR.P.709 fT. Panal D/ lm*akw? Pot. POW a(UM FAD. RAOW PAC" Inwruaw TTV rn K w Vr I'Ma0K1- Illa( JD 1(NC[ CERTIFICATE OF AUTHORIZATION / L94596 OTC l THR VS DVRVCJ4M DOCI I" MY CIRTRY THAT "S SURVEY MFM ". A,-NVALAM TF0"ICAL ITAArOARDS fR 7001I17 VY TMI PLORI7A VOAAD OP TROD 'W" AI SVRVLYOFd AND MA" M IN CKA)"TIR HG74 FLORIDA ADMNKTRATN CON PLIMANT TO CKA."M 4" =I. nORIDA T'A" 61TI L 2. JIIIMI IT K.W THI 004ATURI AND THI ORKJNAL RAISED SIAL OF A RCIRMA UCINAD NRVIYOR AND MAMIL THIS MAP,7t(Ill n POR a*oa. MATKSNAL FLSIVORf ONLY AND If W W VAUD, I. THH fURM WAi PRIPAAM FROM TTTU (AI M)A4TION p-MIlIr tlD To THE SVRVIYOR. THIN WFy"OTHfl1 RHTRK.TKj OR LASIMWTI V4004 APMCI THIS FROMM. NO UND[ RC&OUND LMPROMIM7MS HAVI KIN LOCATED Vv:ISI OT *WVAP 04CYA". NORTH I. TM SURVEY p P"I"A"D POR TIM SOAR Rd IM OF TTSOSI C[R'7M TO AND SHOULD NOT M MUM Vro.+ IY Am QTIQR DVTRY. I • "'WAY' 10Nf SHOWN KM THI IOCATSON OR "OMAINTf ff MON W OMI) NOT N VELD TO MCONf MUCT POL Ill UNK 7, IIA I"'A, h WOWN. ARI EAStD ON AM)MED CATUM AND ON TM LII4I SHOWN Af RAtI RIAjWr, A.R.} 1. RIVATIONt V uJ 2A a u.* , ---- .,+-.. — ..- . .—, • —....- .. ..... 74C1D L COLAMAL OR ORLANDO, t1729M ND'7f 277JM PAN "MI 43144M CIlTRI(DN , Sqg ILLL Na 411bo TOM X R.L.L /aa 4714 00"S W. 7COTT, ILL S. PA. 4" 1COTT O. xL,L Na IS47 THnmm tNriPRoevtTY DOES NOT Lllxmxw TER tf ARU1H6 iROAI fYU00 KALVID A<fA R -MM4' SON' X 1( PANE10 120294 0040E 4-17-95} RRD DATI OGuuow4>tY f .r Ect ORDI1 Nq t- kau- Q, j I<C V. IZ-24-94 F'(O u T-1 GAT Low,! Fet-C. In:(a.ay S ZS- LI 52kfl mA*-. Mi "A, cmf"rO EY, z1 =- v u R fzzs SECTION 3 SCREEN, VINYL 6 GLASS ROOMS SPANS PER TABLES COMIMMITE PANEL OR PAN w UPRIGHT HEIGHTS TYPICAL SLOPED SOLID ROOF ENCLOSURE USE SEAM To WALL DETAJL L: TYPICAL GABLE SOLID ROOF ENCLOSURE Lawrence E. Bennett, P.E. CMENG am.OEVELO/NNNfcommTANT O. 9M AM. EOIftM OAYTONA R 3VV Tum"am (")TW ATT4 FAX (pO R74 M DEAL PAGE Q CDOPYIYGFTT Z000 I NOT TO EE IN AOOUM N WHOLE OR N PA11T WR140VT INS WIOTTEN P9FM88M Of IAWMNM E. W M ". .E. SECTION 3 SCREEN, VINYL & GLASS ROOMS ALTERNATE CONNECTION DETAIL 1' x r WITH 3) 010 x 1.1/r B.M.S. INTO SCREW BOSS 2) B10 x 1 1R' S. M. 8. INTO SCREW BOSS ANCHOR 1' x r PLATE TO CONCRETE W/ 1/4' x 21/r CONCRETE ANCHORS WITHIN S' OF EACH 810E OF EACH POST AND 24' O.C. MAX. MIN. 3-1/r SLAB 2500 PSI CONC. e x e -10 x 10 W.W.M. — OR FIBER MESH VAPOR BARRIER UNDER CONCRETE BEAM/HEADER ANGLE CLIPS MAY BE SUBSTITUTED FOR INTERNAL SCREW SYSTEMS MIN. (3) #NO x 1 1/r S.M.S. INTO SCREW BOSS 1 • x r EXTRUSION 1-1/8' MIN. IN CONCRETE ALTERNATE HOLLOW UPRIGHT TO BASE AND HOLLOW UPRIGHT TO BEAM DETAIL rxrORrxrORrSMB POST ANCHOR 1' x r CkV4NEL TO CONCRETE WITH 1K' x 2-1/4'CONCRETE ANCHORS WITHIN e' OF EACH 810E OF EACH POST AT 24' O.C. MAX. OR THROUGH ANGLE AT 24' O.C. MAX. MIN. 3-1/r SLAB 2500 PSI CONC. exe-10x10 W.W.M. OR FIBER MESH VAPOR BARRIER UNDER CONCRETE 4) 010 x 1/r S.M.S. EACH SIDE OF POST HEADER BEAM HEAR OR GUSSET PLATE i MIN. (4) 010 x 1/r S.M.& Q EACH POST 1' x r EXTRUSION IAA MIN. IN CONCRETE Lawrence E. Sennett, P.E. P.O. WX UK •OUIW DAVTCK% K W11 me"am lo) TIT-om iNc Na) TrT+eu s9AL PArOi O COPYIegMT 7000 3-8 NOT TO M MW=UMD M W ME OR W PART Wm10UT TW WPIrMN Pgft=*N OF 1AWRIWA E. KNNETT, P.E. Is a SCREEN, VINYL & GLASS ROOMS SECTION 3 PAN ROOF, COMPOSITE PANEL OR HOST STRUCTURAL FRAMING 4) 08 x 1/2" S.1M.S. EACH SIDE OF POST 1 x 2 TOP RAIL FOR SIDE WALLS ONLY OR MIN. FRONT WALL 2 x 2 ATTACHED TO POSTWI lax V x 2" ANGLE CLIPS EACH SIDE OF POST V x 21 TOP RAILS FOR SIDE WALLS i MAX &V LOAD WIDTH SHALL VE A MAXIMUM UPRIGHT. SPACING AS FOLLOWS . WIND ZONE mAx UPRIGHT, SPACING .. 102 r-w 110 6-7- 120 6'-3- 130 1 s-8- 140 5'-1• 150 INTERNAL OR EXTERNAL L' CLIP OR'U' CHANNEL CHAIR RAIL ATTACHED TO POST W/ MIN. ( 4) #10 S.M.S. . GIRT OR CHAIR RAIL AND KICK PLATE 20 x 2• x 0.0320 MIN.' HOLLOW RAIL ANCHOR 1 x 2 PLATE TO CONCRETE WITH 1/4• x Z-1/2" 1• x 2 OR 2 x 2 ATTACHED TO'' CONCRETE ANCHORS WITHIN BOTTOM-W/ V x 1• x 2' x 1/18• 6" OF EACH SIDE OF -EACH 0.045' ANGLE CUPS EACH POST AT 24" O.C. MAX. OR SIDE AND MIN. (4) i 10 x 1l2- THROUGH ANGLE AT 24" O.C. S.M.S., MAX• 1 • x i x 0.032• MIN. OPEN BACK EXTRUSION MIN. 3-1/2" SLAB 2500 PSI CONC. 6 x 6 -10 x 10 W.W.M. a 1-11W MIN. IN CONCRETE OR FIBER MESH VAPOR BARRIER UNDER • CONCRETE POST TO BASE, GIRT AND POST TO BEAM DETAIL SCALE: 3' w V-0- Lawrence E. Bennett, P.E. • CM&# WNWR.oFMQ%4ffNrcaWXTANr ' P. O. BOX 4399, SOUTH OAYTONA, FL 32121 TELEPHONE ( 904) M41"4 FAX ( 904) TV45M BEAL COPYRIGHT 2001 PAGE NOT TO BE REPRODUCED IN WHOLE OR IN PART WITHOUT THE WRITTEN PERMISSION OF LAWRENCE E. BENNETT, P.E. 3.7A SOLID ROOF PANEL PRODUCTS SECTION 7 COMPOSITE ROOF ANCHORING DETAILS 010 x 1.11r $. M. S. OR WOOD WOOD SCREW (1) PER RAFTER OR TRUSS TAIL 010 X 3/4' S. M. S. OR WOOD SCREW SPACED • 12.0. C. ROOF PANEL TO FASCIA DETAIL FOR MASONRY USE 1/4' x 1-1/4' TAPCON ANCHOR OR EQUAL ® 24.O.C. FOR WOOD USE 010 x 1-11r S.M.S. OR WOOD SCREWS a 12.O.C. EXISTING TRUSS OR RAFTER 06 x Ur S.M.S. SPACED 0 r O.C. BOTH SIDES ROOF PANEL S x 1/Y S.M.S. SPACED Q r O.C. BOTH SIDES EXISTING FASCIA CIS x 1/2' S.M.S. SPACED 9' O.C. BOTH SIDES ROOF PANEL EXISTING HOST STRUCTURE 88 x Ur S.M.S. SPACED WOOD FRAME. MASONRY OR Q r O.C. BOTH SIDES OTHER CONSTRUCTION ROOF PANEL TO WALL DETAIL NOTES: WOOD STRUCTURES SHOULD CONNECT TO TRUSS BUTTS OR THE SUB -FASCIA FRAMING WHERE POSSIBLE ONLY 15% OF SCREWS CAN BE OUTSIDE THE TRUSS BUTTS. SUB -FASCIA AND THOSE AREAS SHALL HAVE DOUBLE ANCHORS. ALL SCREWS INTO THE HOST STRUCTURE SHALL HAVE MINIMUM 1-1/4' WASHERS OR SHALL BE WASHER HEADED SCREWS. HEADER INSIDE DIMENSION SHALL BE EQUAL TO PANEL OR PANSY. THE WALL THICKNESS SHALL BE THE THICKNESS OF THE ALUMINUM PAN OR COMPOSITE PANEL WALL THICKNESS. HEADERS SHALL BE ANCHORED TO THE HOST STRUCTURE WITH ANCHORS APPROPRIATE FOR THE MATERIAL CONNECTED TO, THE ANCHORS DETAILED ABOVE ARE BASED ON A LOAD FROM 120 M.P.H. FOR SBC SECTION 1604 FOR A MAXIMUM POSSIBLE SPAN OF THE ROOF PANEL FROM THE HOST STRUCTURE. Lawrence E. Sennett, P.E. awmown -otvuorlllwoomarmT RQ Olc sM. SOUTH OAYTOII a will TttErlglE ttal 1rTri11 FAX MIS) 7074 M MAIL 1 0 NOT TO K REPRODUCED IN WHOLE OR IN PART WITHOUT THE WRITTEN PERMISSION OF tAWRENCE E. BE NrETT, P.E. 1 PACE 7- 3 Ql ..a jl l.: tt i•1 ' I ;l ii:I;1 J i C l: _. J f i=1_..: tY i t1t;i t flili tY i i tft <fCSi tY' i tSCSi ir EY !• i`i f dili t tY l iii EJQ i EJL i E Yj !' 41i t C ISC- t GS <1Qiji tf€S E l:i iltri tY = MOL"M tali NOW i = ECG on&,"= LM f_ <1GSi tf ii Yli Y-Si EYE .ili MEL-MM M Li a2ri di i L i MM-t- tAL-Ai C,i <Y ,i t ili tYid t i tfQli SECTION 3 nmn-' LA; 7. 7 71 t___ M ILLS = 3 iA K-LL _ 1AM UI L r3.! U-1 1 .: 1,0 [l Ll. 3i! 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Y 1 [ti St Lt-iQii [ LSG [L7CSi [l i <f : l :. !: ti [[di•, [iY i [ii/ [f GSI UAL. ir" [ l k-A [Ci'd ou t ` M [L'LA [Lt,i U. A [IK A LL' 1 iL1:. I_ LilQii [t Y [Y.1 `L' ! : It : J• l [C i [i ali iilQ.il 1 fiCidit/ E Gr 1:..:: fl[./itAlt,d f_ii ]_! 1:_1 E:1• [liE l [L: Y / [t 6Y [tZ:id tiil ! :! E ' 1• [ Y Y.1 [t QiL [LfQli ii[Lt`- A al, 1:-!2:%NEI=[iYAklial-,UZAIkI,&Ii ou : 1: 12:.% f-1• fil" [Ls&il [L1G A Uff-A ME' l.'1:9 W, m LL•Qi.. i1-IIii [it A v ii L_ l:. lad E 1• [i fi J 1 [G i [L1 11 <L 1_!: t: [1 L [ice [i L f LiC I tl:. ! I. Ett r/ r1' / F ill t.l Y S 1: I _!! 1: E : ) [I G i ll [i flit [Li WE l 1: % f;:'M IL Y A iL flL. [lfl+d [LY A ti11 '.!AKW!' ! [LEGS/ SLY A iLa" Iu-Y if ti : I: 1l.!: !i 1• it -flit [L Y I [i C5,1 tl : L' 1:'t_ l [YY''> [ri,i [tom [if i E i m ETA iLflL. [L-&ii U-)A" all &W-Si Ef AAk [YaAf I i. I :. . tt r `i Si r_ Y ice- i t rflN tL_ 1-! 1: E : )• U dil [tAW [Lc A [L:crA f > r : Y,1 r_: z ri1QH r ic ll 1_- 1:'. E [L c ,+ it:dii [i ,= f'_i• it ia" [LAW [L" kI A" iF I<I= U C d [L" [i-f-lid [L" tt: l ': J E ]• [!G i [L r il fL [LJCJi Sl : L' ! 1i t f• [tfl5i [t iG it il i1 [LII l __!1i 1 E l• [L i ii [I iC11 [LAC. [iiCfd <L:1_' 1:J t : ]• [1 Y [Y 1 [f L•Ii [l i i I L! 21- 9 E AM [l-kid [LYE/ I-IIA [L"KI :1 ! 1: J t _1• [ilCrl fiJ [t i <L SECTION 3 511WO GALVANIZED'ALL THREAD' OR IWREAD ALL' EMBEDDED IN CONCRETE OR FASTENED TO CONCRETE W/ APPROVED CONCRETE ANCHOR • 24' O.C. MAX. AND WITHIN 6.OF EACH UPRIGHT OR APPROVED ALTERNATE ALTERNATE IW x 6' CONCRETE SCREW THROUGH 1' x r AND ROWLOCK INTO FIRST COURSE OF BRICKS 1) 05 0 BARS WI 3' COVER MYP IC SCREEN, VINYL & GLASS ROOMS ALUMINUM FRAME SCREEN WALL ROWLOCK BRICK KNEEWALL TYPES' MORTAR REQUIRED FOR LOAD BEARING BRICK WALL ALTERNATE CONNECTION OF SCREENED ENCLOSURE FOR BRICK OR OTHER NON- STRUCTURAL KNEE WALL. 1' WIDE x 0.063' STRAP Q EACH POST FROM POST TO FOOTING Wl (2) 010 x 31C - S. M. e. STRAP TO POST AND 1)1/4' x 144' TAPCON TO SLAB OR FOOTING 4' (NOMINAL) PATIO CONCRETE SLAB W/ 6 x 6 -10 x 10 WELDED WIRE MESH OR FIBER MESH CONCRETE BRICK KNEEWALL AND FOUNDATION FOR SCREEN WALLS r-W MIN. BEFORE SLOPE N TYPE FLAT SLOPE / NO FOOTING 0-r 1120 1) 050 BAR CONT. 1) NO BAR CONT. TYPE 11 TYPE III MODERATE SLOPE FOOTING STEEP SLOPE FOOTING r / 1r-1'-10' > 1'-1(' NOTES: 1. NO FOOTING REQUIRED EXCEPT WHEN ADDRESSING EROSION UNTIL ENCLOSURE EXCEEDS IW-V FROM HOST STRUCTURE THEN A TYPE 11 F TING IS REQUIRED.OZO JGREATERTWIN40080. FT. REQUIRE TYPE III FOOTIN03 , '# 7 SIL jv 2. MONOLITHIC SLABS AND FOOTINGS SHALL. BE MINIMUM 2,500 PSI CONCRETE WITH 6 x 6 -10 x 10 WELDED WIRE MESH OR FIBER MESH MAY BE USED IN LIEU OF MESH. 3. IF LOCAL BUILDING CODES REQUIRE A MINIMUM FOOTING USE TYPE 11 FOOTING OR FOOTING SECTION REQUIRED BY LOCAL CODE. LOCAL CODE GOVERNS. SLAB -FOOTING DETAILS Lawrence E. Bennett, P.E. all a% . De>§aaNn C0AMTAW PA. vm4EE. mim DAV TOPA R M21 T$ lJ ma oft) 707-4"4 FAx poy 7S74m l6AL PAGE OOP' YMsW am 3- 1 Q VNOT TO EE INPRODUM Mu WHME OR 04 PART MTHOUT THE WIU? U PIMMUMN OF IAVMMW f E. ITT. P.E. 0 11 f 01 Sanford, Fjo • Building Department d P.O. Bo)(1788 - 32 772-1788 f ' Telephone ( 407) 330-5656 Fax (407) 330-5677 February 14, 2002 t Mr. & Mrs..Weststrate 107 Prince Place Sanford, FL 32771 RE: 107 Prince Place Dear Mr. & Mrs. Weststrate: On January 24, 2002, the Board of Adjustment considered your request for a variance to construct a screen room on your property located at 107 Prince Place. The Board of Adjustment approved a 5.2-ft. rear yard variance to allow a 14.8 rear yard setback for a screen room. Sincerely, i Jo - Ann Johnson Acting Secretary to the Board of Adjustment The Friendly City" SEMINOLE COUNTY FLORIDA'S WATVRAL CHOICE NOTICE OF COMMENCEMENT CERTIFIED COPS MARYANNE MORSE CLERK OF CIRCUIT CDURT SEM N LE COUN F OR 6 p C ERI t jAAe -F. =; -( MAR 1 lUU1 State ofFlorida County of Seminole Permit No. Tax Folio No. (PID) ZE / 9 05 0 .si3 C 00 0 0 971 The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the fulling information is provided in this Notice of Commencement. DESCRIPTION OF PROPERTY (Legal description of the property and street address) Z I- A 9 7 "At i O..- k-i p e s /C s—h GENERAL DESCRIPTION OF r-im OWNER INFORMATION / Name and address k y l -C. GCS ld-?`f- •f 0 Interest in property (Fee Simple, Partnership, etc.) e'r Cr-4 a.y NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER (IF OTHER THAN OWNER) CONTRACTOR Name and 7 7 7 /1 t ti Lt tea--1 ---.. {ter c'' SURETY (Bonding Company) i Name and address i/ 'f c C.+r7/'t c- T llill# q lt If1111 111N1p Amount of Bond LENDER Name and IWRYNK NORBE, CLERK OF CIRCUIT COURT WINOLE COUNTY BK 04339 PG 0530 Persons within the State of Florida designated by Owner upon whom notice or otheA l6QMi&*&yfti8W as provided by Section 713.13(1)(a)7., Florida Statutes: Name and address In addition to himself Owner designates 04 e4 701 of to receive a copy of the Lienor's Notice as provided in Section 713(l)(b), Florida Statutes. Expiration Date of Notice of , Rfneement The expiration date is 1 yt`Bbia 8fitar ecording unless a different date is specifi j' Qp -': Sworn to a ubscir 6is• / Day of iC , 20P G '' :' My Commission Expires: Notary Public ;r:\`•'' r/t.}IlOki,; The foregoing instrument was acknowledged before me this _ day of ,DVG , 20_0L by name of person acknowledged), who is personally known to me or who has produced (type of identification) as inentiScation and who did/did not take an oath.