HomeMy WebLinkAbout115 E 21 St (4)Permi
,eJob-A-A
Description of Work: / f f.o�✓PL-C E EX! ST% M G W) ►1 p tr,� s ! N ST-AII I �'I.t", W 1 n Cl 0 W t mvw p�vtr-��-0
Historic District: Zoning: Value of_Workr$ 1 d
GPermit Type: Building ►/ Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool.
&lectr I: New Service — # of AMPS Addition/Alteration V Change of Service Temporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Epergy CalF. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
CQcKgpancy Type: Residential Y" Commercial Industrial Total Square Footage
Construction Tyne: 'F(OAV- # of Stories: L # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 3G- ( 9 ` 30 - 3 W - 0 b q N - 00 0 (3 (Attach Proof of Ownership & Legal Description)
tOrLners Name_&Address: — 3l7 D Aeen F—Z
CP.n��SV07—.322-GQ 9
Contractor Name &""Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Contact Person:
State License Number:
Architect/Engineer: Phone:
Address: Fax:
hone:
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.
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 la\�,s rgnilating
construction and zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA. TNG
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 maybe a 'tional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit i fication that I ui tify the owner of the property of the requirements of Florida Lien Law, FS 713.
CD
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$ Stb. mre-of er/Agent CDate=7 Signature of Contractor/Agent Date
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$ Prin. Owner/ g nt's N me
IY� AIA
336.03
U LD Signature of Notary -State of F orida Date
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Tye Mar O\kner/Agent is Personally �,nowntlVle Co—
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APPLICA I ION APPROVED BY: Bldg: �—: Zoning:
:Initial & Date)
S'PCCla! Conditions:
Print Contractor Agent's Name
Signature of Notary -State of Florida Date
Contractor/A2,--: is Personaiiv Known to Me or
Produce" :D
(Initial & Date)
Lt.::ies: _ FD:
(Initial & Date) (IrHtial & Dat:
CITY OF SANFORD BUILDING ]fDIVISION
OWNER/BUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, onsite supervision
themselves of all work not performed by licensed contractors, when building or improving farm
outbuildings or one -family or two-family residences on such property for the occupancy or use of such
owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to
exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease, of any such
structure by the owner -builder within 1 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other person
unless that person is registered or certified under this part and the work being performed is within the
scope of that person's license. For the purposes of this subsection, the term "owners of property"
includes the owner of a mobile home situated on a leased lot. To qualify for exemption under this
subsection, an owner must personally appear and sign the building permit application.
State law requires construction to be done by licensed contractors. You have applied for a permit under
an exemption to that law. The exemption allows you, as the owner of your property, to act as your own
contractor with certain restrictions even though you do not have a license. You must provide direct,
onsite supervision of the construction yourself. You may build or improve a one -family or two-family
residence or a farm outbuilding. You may also build or improve a commercial building, provided your
costs do not exceed $25,000. The building or residence must be for your own use or occupancy. It may
not be built or substantially improved for sale or lease. If you sell or lease a building you have built or
substantially improved yourself within 1 year after the construction is complete, the law will presuixie tbat
you built or substantially improved it for sale or lease, which is a violation of this exemption. You gray
not hire an unlicensed person to act as your contractor or to supervise people working on your hui.I itag. A
is your responsibility to make sure that people employed by you have licenses required by state law and
by county or municipal licensing ordinances. You may not delegate the responsibility for supervising
work to a licensed contractor who is not licensed to perform the work being done. Any person working
on your building who is not licensed must work under your direct supervision and must be employed by
you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation
for that employee, all as prescribed by law. Your construction must comply with all applicable laws,
ordinances, b' g codes, and zoning regulations.
do hereby state that I am qualified and capable of performing the
requested co ction involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed b aw on the permitted structure.
04
0 ; 7 n e r /-P Wilder SignatureDate,
GEORGE e—KRRI
P,ri_p_-0�w'n. eTfflni•1der, Naine
r r DD.043740
gcBCiU25
Signature of Notary—State of Florida Date
Owner is Personally Known to Memr has
Produced ID ,Dr i L)f r5 L. 10 0, IOU's -e
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL
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1101 K. First St.
Lanford fl.32771
.
407-AAi-7 SI►A
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2003 WORKING VALUE SUMMARY
Value Method: Market
GENERAL
Number of Buildings: 1
Parcel Id: 36-19-30-300-064A-0000 Tax District: S1-SANFORD
Depreciated Bldg Value: $26,348
Owner: CURRIE GEORGE w Exemptions:
Depreciated EXFT Value: $0
Address: 830 DOE DR
Land Value (Market): $12,152
City,State,ZipCode: OSTEEN FL 32764
Land Value Ag: $0
Property Address: 115 21ST ST E
Just/Market Value: $38,500
Subdivision Name:
Assessed Value (SOH): $38,500
Dor: 01 -SINGLE FAMILY
Exempt Value: $0
Taxable Value: $38,500
SALES
Deed Date Book Page Amount Vac/Imp
WARRANTY DEED 03/1992 02532 1025 $34,000 Improved
WARRANTY DEED 10/1986 01801 0676 $35,000 Improved
2002 VALUE SUMMARY
QUIT CLAIM DEED 12/1984 01603 0394 $100 Improved
2002 Tax Bill Amount: $764
WARRANTY DEED 08/1983 01479 0570 $29,000 Improved
2002 Taxable Value: $36,087
WARRANTY DEED 03/1980 01270 1197 $25,000 Improved
WARRANTY DEED 06/1973 01245 1825 $100 Improved
Find Comparable Sales within this Subdivision
LAND
LEGAL DESCRIPTION
Land Assess Method Frontage Depth Land Unit Land
Units Price Value
LEG SEC 36 TWP 19S RGE 30E E 100 FT OF N
78.35 FT OF S 300 FT OF NW 1/4 OF NE
FRONT FOOT & 78 100 .000 190.00 $12,152
1/4 OF SE 1/4 (LESS R/W)
DEPTH
BUILDING INFORMATION
Bid Num Bid Type Year Bit Fixtures Gross SF Heated SF Ext Wall Bid Value Est. Cost New
1 SINGLE FAMILY 1920 6 1,390 1,255 SIDING AVG $26,348 $63,874
Appendage / Sgft SCREEN PORCH -FINISHED / 105
Appendage / Sgft OPEN PORCH FINISHED / 30
NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem
tax purposes.
"' If you recently purchased a homesteaded property our next ear's property tax will be based on Just/Market value.
../re web.seminole_county_title?parcel=361930300064A0000&cpad=21st&cpad_num=115&4/30/2003
CITY OF SANFORD;BUILDING DIVISION
OWNER/BUILDER AFFIDAVIT
ELECTRICAL & FIRE ALARM SYSTEMS
An owner of property making application for permit, supervising, and doing the work in connection with
the construction, maintenance, repair, and alteration of and addition to a single-family or duplex residence
for his or her own use and occupancy and not intended for sale or an owner of property when acting as his
or her own electrical contractor and providing all material supervision himself or herself, when building
or improving a farm outbuilding or a single-family or duplex residence on such property for the
occupancy or use of such owner and not offered for sale or lease, or building or improving a commercial
building with aggregate construction costs of under $25,000 on such property for the occupancy or use of
such owner and not offered for sale or lease. In an action brought under this subsection, proof of the sale
or lease, or offering for sale or lease, of more than one such structure by the owner -builder within 1 year
after completion of same is prima facie evidence that the construction was undertaken for purposes of sale
or lease. This subsection does not exempt any person who is employed by such owner and who acts in
the capacity of a contractor. For the purpose of this subsection, the term "owner of property" includes the
owner of a mobile home situated on a leased lot. To qualify for exemption under this subsection, an
owner shall personally appear and sign the building permit application.
State law requires electrical contracting to be done by licensed electrical contractors. You have applied
for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to
act as your own electrical contractor even though you do not have a license. You may install electrical
wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical ,,viring in
a commercial building the aggregate construction cots of which are under $25,000. The home or
building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or
lease more than one building you have wired yourself within 1 year after the construction is complete, the
lav will presume that you built it for sale or lease, which is a violation of this exemption. You may not
hire, an unlicensed person as your electrical contractor. Your construction shall be done according to
building codes and zoning regulations. It is your responsibility to make sure that people employed by you
have411censesred by state lawand by county or municipal licensing ordinances.
do hereby state that I am qualified and capable of performing the
requeion involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
� 3
owner -B ' dei Signature CDate---,
GEO,EGG Cyt I?oDs
Print own erBui der Name
th
Signature of Notary—State of Florida Date
Owner is Personally Knmvn to Me ori_
Produced ID Dr c u e r!j L, n r?,ftjs �
patrias P
+• my commission DD043740
yip Expires October 30 2005
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Figure 1. Wall And Partition Framing Members
WALLAND CEILING FRAMING —TRAINEE TASK MODULE 27105
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WALL AND CEILING FRAMING —TRAINEE TASK MODULE 27105
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THIS FENESTRATION PRODUCT COMPLIES * WITH THE
NEW FLORIDA BUILDING CODE
FOR RESIDENTIAL BUILDINGS WITH A MEAN ROOF
HEIGHT OF 30 FT. OR LESS, EXPOSURE "B" (WHICH IS
INLAND OF A LINE THAT IS 1500 FT. FROM THE COAST),
AND WALL ZONE "5" (INSTALLED NEAR THE CORNER OF
THE BUILDING).
PER ASTM E1300, THE CORRECT GLASS THICKNESS,
BASED ON THE NEGATIVE DESIGN PRESSURE (DP)
LISTED BELOW, HAS BEEN INSTALLED IN THIS UNIT.
THE GLASS THICKNESS IS BASED ON IT'S WIDTH,
HEIGHT, AND ASPECT RATIO.
WIND ZONE: 140 MPH OR LESS
DESIGN PRESSURE (DP): + 35.3 /
THIS PRODUCT MEETS THE REQUIREMENTS FOR
STRUCTURAL LOADS, WATER AND AIR INFILTRATION
PER ATTACHED AAMA PERFORMANCE LABEL. BE
ADVISED THAT IF LOADS ARE PLACED UP TO OR
EXCEEDING THE TESTED LEVELS, THIS PRODUCT MAY
BE ALTERED IN SUCH A WAY THAT FUTURE PERFOR-
MANCE WILL BE REDUCED.
* COMPLIANCE MUST INCLUDE INSTALLATION
ACCORDING TO MANUFACTURER'S INSTRUCTIONS
I
AND FLORIDA CODE REQUIREMENTS.
MIP -466
j
PRODUCT CONTROL NOTICE OF ACCEPTANCE
Premdor Entry Systems
911 E. Jeferson, P.O. Box 76
Pittsburgh ,KS 66762
MIAMI-DADE COUNTY, FLORIDA
METRO-DADE FLAGLER BUILDING
BUILDING CODE COMPLIANCE OFFICE
METRO-DADE FLAGLER BUILDING
140 WEST FLAGLER STREET, SUITE 1603
MIAMI. FLORIDA 33130-1563
(305) 375-2901 PAX (305) 373-2908
CON•rRAc'rolt LICENSING SVC ION
(305) 375-2527 rAX (305) 375-2558
CONTRACTOR 1•: NIf0RCEtN11`NT DI%'ISI0N
(3U5) 375-2966 fAX (305) 375-2908
PRODUCI' CONTRO1. DIVISION
(305) 375-29U2 FAX (305) 372-6339Your application for Notice of Acceptance (NOA) of:
Entergy Series Single Flush(Embossed) Outswing/Inswing Residential Insulated Steel Door -Impact
under Chapter 8 of the Code of Miami -Dade County governing the use of Alternate Materials and Types of
Construction, and completely described herein, has been recommended for acceptance by the Miami -Dade
County Building Code Compliance Office (BCCO) under the conditions specified herein.
This NOA shall not be valid after the expiration date stated below. BCCO reserves the right to secure this
product or material at any time from a jobsite or manufacturer's plant for quality control testing. If this
product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the
use of such product or material immediately. BCCO reserves the right to revoke this approval, if it is
determined by BCCO that this product or material fails to meet the requirements of the South Florida
Building Code.
The expense of such testing will be incurred by the manufacturer.
ACCEPTANCE NO.: 00=0720.05
EXPIRES: 08/25/2003 Raul Rodriguez
Chiel Product Control Division
THIS IS THE COVERSHEET, SEE ADDITIONAL PAGES FOR SPECIFIC AND GENERAL
CONDITIONS
BUILDING CODE S PRODUCT REVIEW COMMITTEE
This application for Product Approval has been reviewed by the BCCO and approved by the Building
Code and Product Review Committee to be used in Miami -Dade County, Florida under the conditions set
forth above.
APPROVED: 09/14/2000
Francisco J. Quintana, R.A.
Director
Miami -Dade County
Building Code Compliance Office
\\s045000I\pc2000\\temp1ates\n0tice acceptance cover page.doc
Internet mail address: postmaster@buildingcodeonline.com a Homepage: littp://%vww.buildingcodeoniiiie.coni
Premdor Entry Systems
ACCEPTANCE NO.: 00-0720.0
APPROVED SEP 14 2000
EXPIRES August 25, 2003
NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS
I. SCOPE
1.1 This renews the Notice of Acceptance No. 97-0204.08, which was issued on August 25`x, 1997. It
approves an outswing / inswing residential insulated steel door, as described in Section 2 of this
Notice of Acceptance, designed to comply with the South Florida Building Code (SFBC), 1994
Edition for Miami -Dade County, for the locations where the pressure requirements, as determined
by SFBC Chapter 23, do not exceed the Design Pressure Rating values indicated in the approved
drawings.
2. PRODUCT DESCRIPTION
2.1 The "Entergy" Series Single Flush (Embossed) Outswing / Inswing Residential Insulated Steel
Doors — Large Missile Impact Resistant and its components shall be constructed in strict
compliance with the following documents: Drawing No 31 -1015 -EW, titled "Entergy Wood Edge
Steel door," Sheets 1 through 6 of 6, prepared by manufacturer, dated 2/18/97 and latest revised on
08-21-00, bearing the Miami -Dade County Product Control approval stamp with the Notice of
Acceptance number and approval date by the Miami -Dade County Product Control Division. These
documents shall hereinafter be referred to as the approved drawings.
3. LIMITATIONS
3.1 This approval applies to single unit applications of a single outswing / or inswing door, as shown in
approved drawings.
3.2 Refer to corresponding design pressure table, for water infiltration requirements.
4. INSTALLATION
4.1 The outswing / or inswing residential insulated steel door and its components shall be installed in
strict compliance with the approved drawings.
4.2 Hurricane protection system (shutters): the installation of this unit will not rcquirc a hurricane
protection system.
5. LABELING
5.1 Each unit shall bear a permanent label with the manufacturer's name or logo, city, state and
following statement: "Miami -Dade County Product Control Approved".
5.2 The door slab itself shall also bear a permanent label, at the door inside edge, with the
manufacturer's name or logo, city and state.
6. BUILDING PERMIT REQUIREMENTS
6.1 Application for building permit shall be accompanied by copies of the following:
6.1.1 This Notice of Acceptance
6.1.2 Duplicate copies of the approved drawings, as identified in Section 2 of this Notice of
Acceptance, clearly marked to show the components selected for the proposed installation.
6.1.3 Any other documents required by the Building Official or the South Florida Building Code
(SFBC) in order to properly evaluate the installation of this system.
I Sl�tig 1. L !ti �.�•-�-.
Ishaq I. Chanda, P.E., Product Control Examiner
Product Control Division
2 of 3
Premdor Entry Systems
ACCEPTANCE NO.: 00-0720.05
APPROVED SEP 14 2000
EXPIRES : Auzust 25, 2003
NOTICE OF ACCEPTANCE: STANDARD CONDITIONS
1. Renewal of this Acceptance (approval) shall be considered after a renewal application has been filed and the
original submitted documentation, including test supporting data, engineering documents, are no older than
eight (8) years.
2. Any and all approved products shall be permanently labeled with the manufacturer's name, city, state, and the
following statement: "Miami -Dade County Product Control Approved", or as specifically stated in the specific
conditions of this Acceptance.
3. Renewals of Acceptance will not be considered if:
a) There has been a change in the South Florida Building Code affecting the evaluation of this product and the
product is not in compliance with the code changes;
b) The product is no longer the same product (identical) as the one originally approved;
c) If the Acceptance holder has not complied with all the requirements of this acceptance, including the
correct installation of the product;
d) The engineer who originally prepared, signed and sealed the required documentation initially submitted is
no longer practicing the engineering profession.
•
4. Any revision or change in the materials, use, and/or manufacture of the product or process shall automatically
be cause for termination of this Acceptance, unless prior written approval has been requested (through the filing
of a revision application with appropriate fee) and granted by this office.
5. Any of the following shall also be grounds for removal of this Acceptance:
a) Unsatisfactory performance of this product or process.
b) Misuse of this Acceptance as an endorsement of any product, for sales, advertising or any other
purpose.
6. The Notice of Acceptance number preceded by the words Miami -Dade County, Florida, and followed by the
expiration date may be displayed in advertising literature. If any portion of the Notice of Acceptance is
displayed, then it shall be done in its entirety.
7. A copy of this Acceptance as well as approved drawings and other documents, where it applies, shall be
provided to the user by the manufacturer or its distributors and shall be available for inspection at the job site at
all time. The engineer need not reseal the copies.
8. Failure to comply with any section of this Acceptance shall be cause for termination and removal of
Acceptance.
9. This Notice of Acceptance consists of pages 1, 2 and this last page 3.
sXo-1 1. LU4Ktl"
Ishaq I. Chanda, P.E., Product Control Examiner
Product Control Division
END OF THIS ACCEPTANCE
3 of 3
r-
�REMDOR (ENTERGY BRAND ODD EDGE) i
3'-0 x 6'-8 STEEL DOOR WITH BUMPER THRESHOLD
IN A WOOD FRAME
OUTS�/ING/INSWING DOORS
37 1/2"
M A X
7/16' x 1 3/4' Ig. STAPLES
c3> PER SIDE _4
a' \
TOP OF ODOR To g 7(l
[_ OF HfNGE
17 1/2'
CTYP.>
TYR. ON F-IIN=
#10 x 1 1/4' MINIMUM EMBEDMENT A
(S> PER SIDES
ALTERNATE: 3/16' PFH TAPCONS -•
w/1 1/2' MINIMUM EMBEDMENT 31 3/16'
#8 x 1 3/4' SCREWS -�
JAMBS TO THRESHOLD '
C2> PER SIDE —
4'
R.H. INSWING
L.H. INSWING
R.H. OUTSW ING
L.H. OUTSWING
B
#10 x 2' SCREWS
C2> PER HINGE
KWIKSET
660 DEADLOCK
KWIKSET -
200 L❑CKSET
4-
S 1/2'
2
43 11/16"
TOP OF DOOR
T CL OC LOCK
81 1i/lE S
M i X
— - - #8 x 2" F.H.W.S.
#10 x 1 1/4' MINIMUM EMBEDMENT
ALTERNATE= 3/16' PFH TAPCONS
w/1 1/2' MINIMUM EMBEDMENT
C2> 2 THRESHOLD
C2> 2 HEADER
B '
4"
❑UTS\41NG CVIE\./ FROM EXTERIOR)
1.> WOOD BUCKS BY OTHERS. MUST BE ANCHORED
PROPERLY TO TRANSFER LOADS TO THE STRUCTURE.
2.> THE PRECEDING DRAWINGS ARE INTENDED TO
QUALIFY THE FOLLOWING INSTALLATIONS.
A. WOOD FRAME CONSTRUCTION WHERE DOOR
SYSTEM IS ANCHORED TO A MINIMUM TWO BY WOOD
OPENING.
B. MASONRY OR CONCRETE CONSTRUCTION WHERE
APPROVEO AS GOM PI'IWG WITH THE DOOR SYSTEM IS ANCHORED TO A MINIMUM TWO BY
soon+rFLn 0 Bulgy ING CODE STRUCTURAL WOOD BUCK.
C. MASONRY OR CONCRETE CONSTRUCTI❑N WHERE
sv_1s4 0 I_ i`-1%nSIO - DOOR SYSTEM IS ANCHORED DIRECTLY TO CONCRETE
PRODUCT ODEdOMPLIA CE OR MASONRY WITH OR WITHOUT A NON—STRUCTURAL
HUILOING CEr4o.�OMPLI/WCEOFT+TCE ONE BY WOOD BUCK.
ACCEPTANCE NO. b!�-O'72n•oS' 3. ALL ANCHORING SCREWS TO BE #10 WITH
MINIMUM 1 1/4' EMBEDMENT INTO WOOD SUBSTRATE.
31-1015-E W
SHEET 1 OF 6
REVISION LETTER (_
Permit No.
State of Florida
County of Seminole
NOTICE OF COMMENCEMENT
Tax Folio No.
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.
1. Description of property: (legal description
2. General description o.F�i�' ems
3. Ow6r information
'•�ya. Name and address 6'6-o)
b. Interest in property
c. Name and address of fee sunt
'the property and street address if available) M57
0� Al'7g, 3s !' a 5. 300 i ivw
c. e 5S #'? w '�-c s77 -
titleholder (if other than Owner)
cr�xiFlFn COPY
4. Contractor n
a. Name and address ,4 1W�IRYAN.NE MORSE
/V pERI- OF CIRCUIT COURT
rteetunl r (: UNTY. FLORIDA
b. Phone number
5. Surety
a. Name and address
C.
Phone number
Amount of bond
6. Lender
a. Name and address
b. Phone number
Fax number
Fax number
Fax number
i7r
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.130)(a)7., Florida Statutes:
a. Name and address G EoR G S' Lo je,Plb 230 T)oe 1�z 03)e io F -Z,
7.Z 7 6 V I
b. Phone number Lj 0 7 3 Z Z- G a 9
In addition to himself or herself, Owner designates
Fax number
of
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
a. Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from the date ecording unless a different
date is specified)
l/'
S ature of Owner
L) Cit rr�
Sworn to (or affirmed) and subscribed before me this I Y� day of 20 by
Personally Known OR Produced Identification
NOLE
Type of Identification Produced L (200 31' 7 X19 YW 5 Wal C M t�tA1TYVOF OMIT 1 tT
Signature of Notary Public, State of Florida
Commission Expires:
CLERK OF SEMI
BK 04821 PG 1802
FILE NUM 2003081020
Melissa leu85/13/2883 83:16:52 PIA
Commission#DDWim
6 FEES 6.88
a. -3, Expires: Dec 20 &VJVMMDED BY M 401dan
"/' OF Fl.O01 Bonded Thru
" Atlantic Bonding Co., Inc.
NIa101NININaiIIN91 NIaIoil I