1290 Hibsicus St ROOF21-0055 NOCDoc # 2021206267, OR BK 19856 Page 94, Number Pages: 1,
Recorded 08/10/2021 04:05 PM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
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F drtrdt No. _ -_ lax Folia o. (�
9W0 d Ft r o�rrty oi�w
Ta where k mayooeto�t
TM isri ed hetVby it iorM You &ei lrapr nf� villi 9e blade to certain anal properrty, and in
scoordenes Wth Sadden 743 of the Fiodde t . the foilmwW information Is stated to Us N*Tjcg OF
c®ase+lt�tce�i�ari. _
Address of Property baing hptoved:
Ganwal doscrlptton or bjprevementX 00,
Owren
Adch
4WWO tiftresf in site of the w.plovev sw
F8e Slrnpie TtdLlder (d Wh-,r then owner)
Nams
address --
Contractor MMAN0ROf3PII INC -----
Aditn r'O BOX 330337 AILANLt[C BRkM ?3.32299 _ —
Phone No. eta $* Fa, -I—
No.--2?6-4810 - -
6urejr
Address V�
-' Amount of bond _
Phone Mo. Fox No.
Name and address of at1Y Dersnn tn9tdilD a ioen or the construcYon of !hs improvements.
Name
Address --
Phone No. F@X No.
Name of person whin+4 83ate of fgxtdo. o rar sen V, 4&elt, deslgna�d bar owner upon Fri ho
dom rtotioes or other
cuments ntay be sawed: •
Mm m DAi W ROMANO
F Address 155 IEWId` Ar c UH- F L3033 — --� ---w
Phone No. soy sto oats - -..............
- --
Fsx
ksaddition in hknssif, owner desIgnatos the tbllM VIng p YO receive 6 capN of tle U®riofs Nance as
in
8ectim 773.06 (2) (b), F1o,9ds 8tatrdee, (M in at ov wa omen)• provided
Nam
address - -
Phone No. Fax No.
btdeffommmdeutete 01 Nnnoe or ;omman`Mww (� 0)wbatlon date Is one (1) Year irom ft dei of l�oortling unless a
Is 8�0d):
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