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Permit Windows &Shutters 1839 Ocean Grove 2011 CITY OF ATLANTIC BEACH i o 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 . ° INSPECTION PHONE LINE 247 -5814 4 0.11 Application Number 11- 00003025 Date 12/21/11 Property Address 1839 OCEAN GROVE DR Application type description WINDOW AND /OR DOOR Property Zoning TO BE UPDATED Application valuation . . . 18020 Application desc WINDOWS AND SHUTTERS Owner Contractor ANDERSON- NEVILLE PELLA WINDOW AND DOOR 1839 OCEAN GROVE DR. 8174 BAYMEADOWS WAY W ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256 (904) 731 -8330 Permit WINDOW AND /OR DOOR PERMIT Additional desc . Permit Fee . . . 145.00 Plan Check Fee 72.50 Issue Date . . . Valuation . . . . 18020 Expiration Date . 6/18/12 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONA1 ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS Other Fees STATE DCA SURCHARGE 2.18 STATE DBPR SURCHARGE 2.18 Fee summary Charged Paid Credited Due Permit Fee Total 145.00 145.00 .00 .00 Plan Check Total 72.50 72.50 .00 .00 Other Fee Total 4.36 4.36 .00 .00 Grand Total 221.86 221.86 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t 4 BUILDING PERMIT APPLICATION Y • CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: )33q ( FQ -, ( 7)v e a f . Permit Number: > //— 363 5-- Le Description ,V)-0,20 t 0 - ?- 25` ie ?EJ� (rsvf lin 5 - P arcel # / &I l oor ea of Sq.kt• ��" D��fJ Valuation of Work $ / 4.90 , Proposed Work heated /cooled n non- heated /cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa vindow /doo� Use of existing/proposed structure(s) (circle one): Commercial If an existing structure, is a fire nkler yst n 'n tailed? (Circle one): • e No N /A Florida Product Approval # For multiple products use pro uct approve orm ��]n Describe in detail the type of work to be performed: 1P f2'l CP , 2 j W is . i � 0 (A/C. a.d lac - l/ , 27 Sjvrl,l. Prri-edjjr. Pa t S la An�tl� rs > o�. s � P I S - ' 04UP Ala Property Owner ' I J nformation: Name: C �" Tf"YI 11 /v U 1 1 � P Address: 1 (3 C & ''1 ' YS Ca�rvP_ �r E-Maill oor # Optional) G Sta te FLZi p 3��3 Phone i a Contractor Information: Company Name: PWD- Orlando, Inc . Address: 350 W. State Rd. 434 Qualifying Agent: James Rowland Office Address: 407- r� Job City Longwood State FL Zip 32750 State Certification/Regin# B /ContadNumber 407-463-4106 Fax # 407- 41�gw -(# Architect Name & Phone # Engineer's Name & Phone # n C Fee Simple Title Holder Name and Address N I A Bonding Company Name and Address AI jet Mortgage Lender Name and Address Al Ii Application is hereby made to obtain a permit to do the work and installations as indicated. I certf that no work or installation has commenced prior to the issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters, Tanks and Air Conditioners, etc. 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. I hereby certf that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type o/ work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the iC . provisions of any other federal, state, or local law re: lacing construction or the performance of construction. Signature of Owne ± A 0 1 Signature of Contractor ' C nt Name (� a /� ... a. ..._ • % • �,.,� Print Name e... �., i ini.i.e.,k u) I l Q a Sworn to and subs 'b -• before me Sworn to and sub « ibed before me this . ay of ._ L •. , i , . : 21 ! this IS Day • ' ' . 201( 7 t �Ot• ' PU 11C 1 /� Vi , - i f. _ . � 4 4 ■ Ot. , " iI C Revised 01.26.10 KELLY JULIAN KISOR f t NOTARY PUBLIC 0 � KELLY JULIAN KISOR � �t„i.� STATE OF FLORIDA ,, .. NOTARYPUSUC .�...,.. DD0962 93 STATE OFFFLORIDA • Expires 3 /10/2012 -- . `, .y - = Comm# 00O REVIEWED FOR CODE COMPLIANCE 3/1012012 CITY OF ATLANTIC SEE PERMITS FOR BEACH ADDITIONAL ° ° =4 - r w,...., REQUIREMENTS AND CONDITIONS. REVIEWED �: DATE: /2_ COP . ..}: '..*arandiagagatialahMiUgladaki4/0=j Doc # 2 011266094, OR BK 15792 Page 1959, Number Pages: 1, Recorded 12/09/2011 at 03:07 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT Permit No. 1/— 365025- Tax Folio No. L97 `1 - ri0a 3 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal desert hart): r n ~. Uc C' a) Street (job) Address: f 9 Qr<t / « �ln, ��o �. 2.Gereral description of improvementsc (P�n r GV� /fi 14- , l < o� r F(3 a X33 ._.,,.. ' �__ r�21ci c � v�, •Pn f "� S '1 r14 er.i7 _ 9 3.Owner Information a) Name and address: (✓ ("`f �j r t � b 1.3� , CiGy� ��r. AEI t� N b) Namc and address offc simple titleholder (if other than th �, .- an owner) � c) Interest in property j �)� l �� r 2 r(— a� S op 4 . Co rtractor Tnformat OI![t Mildews & Door* a) Name and address: 3 State Rn�' w b) Telephone No.: v ' 5.Surety Information Longwood, FL 32750 Fax No, (Opt.) a) Name and address: 4()7 1 4160i? off 407 - 339••7742 fax Amount of Bond: 4 t //i - -- • -- c Telephone No.: _ 1 Fax No. (Opt.) 6.Lender a) Name and address: Phone 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: b) Telephone No.: &I Fax No. n addition to himself, owner designates the following person to receive a copy of the I, (pt.) Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No.: 9.1 date of Notice of Commencement (the expiration date is one year x tYorn the date of recording unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIR&TION 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 TIIE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND 'f0 OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA c / rl / ' e\ couvey OF PLNELLAS 10 .. . ! J� 1 i - /j am / Signgt ofOwner orr Owner's Authorized Ot er /Dir cto a¢ — Nr rintNamc �Y h Ll/t6 (�L.....y The foregoing instrument was acknowledged before me this '7 day of -.r_ , 20 by C ... n-71-/ 1 I 1 F as ('', C Y_l '0'Y (type of authority, e.g. officer, trustee, attorney in fact) for (name of party p r•ty on belt 114whom instrument was exe atcd). Personally Known OR Produced Identification Notaty. Signature Type of Identification Produced Li pp Name (print) (�/ f / / i f - Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, T declare that l have read the fore oin and that the facts stated in it are true to the bb offt a and belief. g g KELLY JU roxnts.�toc�.�xoio NOTARY PUBLIC ��( A STATE OF FLOR*DA AL_ � , Cornr Sie . ture of Natural Person Signing (in 1, 0. bo _xphes 3I1OI2012 \ N e K 407- 469 -5599 office ' 407- 469 -3499 Fax brian.kirby@expeditepermit.com Ilkifelazweizt i98f ij 10X9 TRANSMITTAL SHEET TO: PROM: Building Department Kelley COMPANY: DA`I'I?: City of Atlantic Beach 12/19/2011 RE: RE: Permit Application Cynthia Neville 1839 Ocean Grove Dr. Atlantic Beach, FL 32233 Hi Debbie, Per our cone tion yesterday,- have attached o !owing in or. - submit our plans for review. 1. Building Permit Application 2. Product approval form 3. Property appraiser RE #169599 -0000 4. Copy of Recorded NOC 5. Drawing identifying window replacement and storm panel installati. (2 sets) 6. Product approval FL12600.4, .8, .11 (2 sets) 7. Product approval FL12604.5 (2 sets) 8. Product approval FL11291.1 (2 sets) t As we mentions, Hom- • - 's anxious to b - . _ - •vednesday in order to complete job before Christmas. Thank you • dvance for your assistance, e ey so Permitting .n Team K5 Construction & Development Coordination, LLC 407 - 469 -5599 office 407 - 469 -3499 fax MAILING & SHIPPING ADDRESS: 205 WEST WASHINGTON ST. SUITE. 13 MINNEOLA, 01, 34715 Property Appraiser - Property Details Page 1 of 2 NEVILLE CYNTHIA E & MARK B ANDERSON Primary Site Address Official Record Book /Pace Illel 1839 OCEAN GROVE DR 1839 OCEAN GROVE DR 07483 -00223 ATLANTIC BEACH, FL 32233 Atlantic Beach FL 32233 9 1839 OCEAN GROVE DR Property Detail Value Summa RE # 169599 -0000 Tax rrtct USD3 Dts Value Method CAMA CAMA ProoerUse 0800 MULTI- FAMILY UNITS 2 -9 Total Building $1499A1 7.00 Value $151,615.00 mmm MY # of Buildings 1 °----- ._... �--- - °_.__ ,41 Extra Feature Value $2,082.00 $1,943.00 Legal Desa 20- 020 09- 2S-29E _ f Land Value (Market) $261,900.00 $261,900.00 OCEAN GROVE UNIT NO 2 • _ _ ___......___..._.___.. _- ....._....__ _. ..........._ land Value (parka $0.00 $0.00 Subdivision 03097 OCEAN GROVE UNIT 02 4 — _.._._._.._..... ._..__.___....._ _.._._.._._ ............._.._._.____._.. The sale of this Just (Market) Value $415,597.00 property- __..._..._........_...... ...___..._._�__......__._..____ $413,260.00 p perty may result in higher property taxes. For more information go Assessed Value $415,597.00 $413,260.00 to Save Our Homes and our Property Tax Estimator . Property values, exemptions and bill ..._. other Information listed as 'In Progress' are subject to change. These numbers are Cap Diff /Portaility Amt $0.00 / $0.00 $0.00 / $0.00 part of the 2012 working tax roll and will not be certified until October. Learn how the EXemotions $50,000.00 See below Property Appraiser's Office values property, L Taxable Value $365,597.00 ' See below Taxable Values and Exemptions — In Progress If there are no exemptions applicable to a taxing authority, the Taxable Value is the same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value SJRWMD /FIND Taxable Value School Taxable Value Assessed Value $413,260.00 Assessed Value $413,260.00 Assessed Value Homestead Exemption (HX) - $25,000.00 Homestead Exemption (HX) $$5,000.00 P ( ) - $25,000.00 Homestead Exemption (HX) - $25,000.00 Amend 1 Homestead (HB) - $25,000.00 Amend 1 Homestead (HB) - $25,000.00 Taxable Value $388,260.00 Taxable Value $363,260.00 Taxable Value $363,260.00 Sales History 1 Book /Page sale Date I Sale Price Deed Instrument Tvoe Code Oualifled /Unaual(fl u,. ...... , .. ....... . .... ...... ed Vacant /Improved 1 $80,000.00 WD - Warranty Deed 07483 -00223 12/16/1992 ( a i ed' � Qualified 1 Improved 04246 -00427 1 9/22/1976 $100.00 QC - Quit aaim I Unqualified I Improved Extra Features LN 1 Fe .tore Code I Feature Description 1 Bldg. Length . Width Total Units Value 1 FPPR7 Fireplace Prefab °° 1 0 0 1.00 $1,525.00 II� 2 i DKWR2 , Deck Wooden 1 1 8 112 96.00 , $418.00 Land & Legal Land Leal LN Code Use Description Zoning Front Depth 1 Category Land Units Land Value LN '" UNITS OR LESS ARG -1 60.00 125.00 Common 60.00 ` Legal Description 1 ---- 1 0801 APTS 10 o 9 '" I I $261,900.00 1 � 20-020 2 1 OCEAN GROVE UNIT NO 2 3 I LOT 3 Buildings Building 1 Building 1 Site Address 1839 OCEAN GROVE DR Element Code Detail Atlantic Beach FL 32233" 1 " a , Exterior Wall 11 16 Tile /Frame Stucco Roofing Structure 13 13 Gable or Hip i r------ -- r--1 Building Type 0801 - DUPLEX SOH Roofing Cover „ o, I j r` 1 i 9 3 3 Asph /Comp Shingle � r F L Year Built 1999 Interior Wall i 5 5 Drywall T s Fua I ' u ti r. Int Flooring € 12 12 Hardwood �, �i Fe" J � E ,✓ �--rt Int Flooring " "` 7atRe , Gross Area Pleated Area g it 11Ceramic Clay Tile 1------- Finished Open Porch 513 0 Heating Fuel 4 1 4 Electric 1 Finished upper story 1 1367 1367 l Heating Type 1 4 4 Forced -Ducted Finished upper story 1 672 672 1 Air Conditioning 3 1 3 Central Finished Open Porch 144 0 Base Area 1037 1037 1 Element 1 Code I Finished Open Porch 531 0 Stories I . i 3.000 1 1 Finished Open Porch 136 0 Bedrooms 1 3.000 Finished Garage 456 1 0 Baths j 3.000 http: / /apps.coj. net/ pao_propertySearchBasic /Detail.aspx ?RE= 1695990000 11/14/2011 Doc # 20 11266094, OR BK 15792 Page 1959, Number Pages: 1, Recorded 1 2/09/2011 at 03.07 PM, JIM FULLER CLERK CIRCUIT COURT DUVAI, COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT Permit No. 1/ 30 Tax Folio No. -- l THE UNDERSIGNED hereby gives notice that improvements will be made to certain real ro e 713.]3 of the Florida Statutes, the following information is provided in this NOTICE OF COM ENCEMENT, once with Section I.Description of property (legal tion): descri r v •- e2�„ 9G- al 6 ( /1 / � ' � p �Qr9{) � � r�v� f /�.�� .:2 a) Street (job) Address: —`� ` _ 4.r - 1 C d R,____ aa3 --- 2.Gencral description of improvements: � � � � Nf � p � � P p � , c,_l c'� r 1� r„ ant �. S Yiw r .- — 9. Y ri - 3.0wner Information - �— a) Name and address: �y n f �, ' j /C-f.43 N b) Name and address offed simple t lehold � foth th n owner) �� -4 'fG -U'Q 6r • /Q--{ GJv1.f � c) Interest in property ) — ! �( � a �� p P Y films / l l''' KM 4.Cornractor Information P° likt `flild ,y g ` � �tyill? _ �� a) Name and address: __ `_ 0 $lat Rn r! 43 b) Telephone No.: ___ _ - S.Surety Information Longwood, ax : •. • • , a) Name and address: ` off 407- 339••774 ?. b) Amount of Bond: ' may D_FOR co �L c) Telephone No.: _ LANCE 6.Lender 1 Fax No. ( U a) Name and address: Q UIREMENT ��N� S 7. Identity of person within the State of Florida designated by owner upo I '� 11 7 ` AND CO – D • so a) Name and address: p L "" 3Y be s b) Telephone No.: — 1 &In addition to himself, owner designates the following person to receive a opy Nt1 1 �.t e a . •. e e . 7 13.13(1)(b), Florida Statutes: - �' . • a) Name and address: tn 9.h iratbon date of No tice of Commencement (the expiration date is on vea • ') • P p F is specified): r fro d to . A iQ g �# .•te a. . r .. WARNING TO OWNER; ANY PAYMENTS MADE BY'1'liE OW `ER T ;It Tu •1 . _el COI 1 MENCEMENT ARE CONSIDERED IMPROPER PAYMEN S U� Ol' FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING ' • E I I' 1, ] 1 U A NOTICE OF COMMENCEMENT' MUST BE RECORDED AND POSTE 1 L � RI Y• INSPECTION. IF YOU INTEND - 1'O OBTAIN FINANCING, CONSULT YOUR LENDER 0 • . C kt OMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. 1- . i SPATE OF FLORIDA _ COUNTY OF PCVEL ELLA S �/ = , / / 1 5i n ofO�t'ncr nr (hvncr's �; Anthotized OtTieer /Dir, ctor,�Partncr ae �., i � lint Name - The foregoing instrument was acknowledged before me this n/ � 7 day or dJ2.c___ , 20 . hy t n� "h�. �1�1.!i I l e as �� � _ ( :' Y\ 'Y- (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on beh If of whom instrument was exe - Wed). Personally Known OR Produced Identification Notary Signature ( Type of Identification Produced� C . �.�f 2 __ Name (print) / Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury i declare that 1 have read the foregoing and that facts stated in it are true to the beiof t S g at KELLY J il���e and belief. ✓ 4_� 1 As ror.MS n NOTARY P�U r \ W -- STATE OF FLORIDA v V �► � '- / Sig .turc of Natural Person Signing (in li 0. Above - Explms 3/10/2012 Gd n o p b rd • p �o 0o v o� !-A A w N.) �i rn v, w iv m c . © V • g _ 4 o > d ( o cA z O> 7c/ v' „1 o r o c- . o r co ° v' v a " °° � n �i v n CL o co w Po r* A- C _ O f O pv t '7 , = c z " w z I 14 a- g 0 O m o d o XI . r C o 5 O .t 0 n 0 CA , 0 17-4. ." y • �. o c' `o 0 9.. F C n o c ° o C CD O 1 y 0 CD ill ®M� wa.,.... , _ - _......,....rte \ `D oPi (xi o m� . . ',,, ' ! , n EA ■ , 1 err Y ham+ — — F-. _ /1 5:N tli :P W N .. p Pc v c Cn '--� 1 W N ■�- /b -- p • �° 00 � 1 Q� Vi W N b , r-- °, w o 0 o o o o o, o o 0 0 ( 4 4 C) () c cn cn 4 o N �. ° c o �h �h Ua cs. ° Q. _ ,.,1 cc � ° o a trJ O en C Cr iij ' O O. OrQ .- d O cn " ° * 7 0 q ran O cn 1 r. C n a K A r r _ ' b O 0. O n .•r d H et b K /E = _. K o rM 0 ►.r 41 et ut At A C" 0 et At to t,,, N o pc, • �7 n �•' + d I-0 � F n n • ] c• 0 " • - : P W N `-- : A • `G r N AD CD AD to O O O G /ro n Cd O a . o a eD g Z to m cn CD CT cn c n 0 4 3 ro D m a II L b c' 0 C. C et vi d n c .. "d tb 0 @. A 0 0 0 .n to A Z c N r .. O et to C• H ( 4 n , J { • 0 5 § A .� o . E. b N' A 6 . ,, ,....„ „,•.crq — ...._. s_., , „.., c_. .c, 0 4_,_ _ Z cr 'as .1 c '_t _- 0 .4. a . w = p a EP 0- O ... I..1., , ■ 1 air .'3 .1 0 c3 cm 0 ic ,t1 lio (/) li, o o co on � • 0 5 iv cr CD o 0 E. e ' O 0 ..- '+ 0 Cl, C ° y :. b cm 0 p- .s 'rs () '•--.., ' ° , cv M. n as n < SI n Po ‘..si.3)) \ ---... & w 4 5 \ a; .t N 0 0 C➢ e ' n AD a AD cn 0 o a —• .1 O u sy�w City of Atlantic Beach APPLICATION NUMBER (To be assigned by the Building Department.) 800 Buildin Seminole 9 De Road P artment _ s • Atlantic Beach, Florida 32233 -5445 2 Phone (904) 247 -5826 • Fax (904) 247 -5845 / / •��j�% E -mail: building- dept @coab.us Date routed: / // City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /�3� �� � j , De •,.1•4 = nt review required Yes No ?u-'O �� -�-t� (71/8,) � Idi Applicant: - Planning & Zoning Tree Administrator Project: �r�1— 5 7 Ty Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By _ Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco — Other: APPLICATION STATUS Reviewing Department First Review: 1 Approved. ❑Denied. (Circle one.) Comments: B • G PLANNING & ZONING Reviewed by: Date: a--.20 !/ TREE ADMIN. Second Review: A roved as revised. ❑ pp ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. (Denied. Comments: Reviewed by: Date: Revised 05/14/09 RErORDED ELECTRONICALLY ;rft ` LiCo„ty 1 Vi e NOTICE OF COMMENCEMENT Gat 1 Z - e `$ `B i T p slmplifile www.simplifile.com 800,460.5657 Permit No. Tax Folio No. 07 './' 3 - 6.70„2. 3 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal descri tion): O -C7c90 C) � - a ,A24 C 2(Ie -\ C r ~ r -Je �/n,'t ,&/ 2.. a) Street (job) Address: /9?",-3 4 G�"e, -- 0 ,. -el /4' /,fir, f I, fi C e eJ. f7 3 'a--33 2.General description of improvements: IA} l' E0 LLy re p) e o yy, .pi,,, -t - `%° S Ur 1,A, ,r- .e. f�, 3.Owner Information � � q a) Name and address: C r1 1 l: N V ( , P1,/ i 1 f I .� 1 (3 eQ,, a ft,v,Q 6l . / fi r AOWN b) Name and address of fee simple titleholder (if other than owner) Al( A- , g� (Q FL- c) Interest in property , �'� LL)), f 4.Contractor Information FEW IC1Mow* poor* �t a) Name and address: 350 'State Rnad 434 West � b) Telephone No.: Longwood, FL 32750 Fax No. (Opt.) ✓` 5.Surety Information 4074M-0600 off 407_339 - 7742 fax a) Name and address: b) Amount of Bond: c) Telephone No.: ( ' � Fax No. (Opt.) 6.Lender a) Name and address: A Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: b) Telephone No.: Fax No. (Opt.) 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No.: Fax No. (Opt.) 9.Expiration date of Notice of Commencement (the expiration date is one year from the 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. /� STATE OF FLORIDA / {) < 55. 1 COUNTY OF PINELLAS ill L'�-- , \,1�i J Signtyr• of Owner or 0 er's Authorized Offic /Dir cto . ' artner 4 ag P Name The foregoing instrument was acknowledged before me this 7 day of ne- , 20__, by qj'}---/"/J, , 1\(e U i c ( ( P as (') L .4, n -0 'y- (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on beh '6f whom instrument was exe ted). Personally Known OR Produced Identification ,-------/ Notary Signature - �,, L ; /,/ ° /( ' Type of Identification Produced ". (4'.(/y) (' Name (print) Kg/1 / 7 / , 4, 'Sly OR Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best o '�r t l Io,�e and belief. — \ i l k FORMS/NOC,rvsd2010 'I STATE PUOUC k 1 , `. , - STATE OF FLORIDA ,* . ture of Natural Person Signing (in - 1"... 7- 0. . Bove ' "i 4 • a Commit � Expires 3/10/2012