HomeMy WebLinkAboutBLDG PERMIT #9512City of Cape Canaveral, Florida
MECHANICAL PERMIT 9512
PHONE: 321 - 868 -1222 INSPECTIONS & FAX: 868 -1247
Mr P_ ERMIT INFORMATION — - - _ -_ _ - -- - LOCATION INFORMATION _
Permit #:9512 Issued: 3/01/2013
Address: 166 CENTER ST
Permit Type: MECHANICAL
CAPE CANAVERAL, FL
Class of Work: 437- Add /Alt/Roof Commercial
Township: 24 Range: 37
Proposed Use: BUSINESS
Lot(s): Block: Section: 23
Sq. Feet: Est. Value:
Book: Page:
Cost: 9,375.00 Total Fees: 177.68
Subdivision: TECH VEST
Amount Paid: Date Paid:
Parcel Number: 24 3723JI E1
_
CONTRACTOR INFORMATION
OWNER INFORMATION
Name: TECH -VEST LLC
Name: FLORIDA MASTERTEMP, INC.
Addr: 3475 N HIGHWAY 1, UNIT 1
Address: 124 ST CROIX AVE
COCOA, FL 32926
COCOA BEACH, FL 32931
Phone: (321)639 -3166 Lic: CAC1816171
Phone: (321)783 -8474
Work Desc: HVAC CHANGE -OUT
APPLICATION FEES
MECHANICAL - REP ALT OVER 21 115.00 PLAN REVIEW OVER 2K 57.50 BUILDING-PERMIT SURCHARGE 5.18
Ins- ections Re uire
Final Mechanical
APPLICATION ACCEPTED BY: Jam-' PLANS CHECKED BY: APPROVED BY-
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORI D IS NOT COMMENCE WITHIN 6 MONTHS, OR
IF CONSTRUCTION OR WORK IS SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER WORK IS STARTED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS DOCUMENT AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING
THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
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 ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT-
Am 0'u t
ISSUED BY /D ORIZ D SI
LLTURT/DATE
PRINTED NAME: �i U��
02128113 01:30PM FLORIDA MASTERTEMP 3216382473 p.02
i .)ate: RECEIVED— CYI`� "'�i�» O CAPE CANAVERAL Tracking �� - a7
FEB 2 8 2013 BUILDING PERMIT APPLICATION
(321)$68.1222
City of Cfapo <:arlavcrai Building De paitment. - 7511) N. Atlantis, Ave, » Cape Conaveml, FL 32920
You may dowrtlottd this appIioatic >rl; www_(ily�i;►t�ecllveriii;c>r You tlttty fax to; (3 2,1)H! >$- 1247. All z3ppeatinns must include die
backside of'thi form. ImpolullL PIOQ,;e Wffll)Iete the Checklist on this back of tliis fbrtn and provide other documentation as indicated OTI
the checklist. A copy of contract. tray be regWred, Application packages will not be accepted ilrtless coniplete;.
APPLICANT WILL BE CAC „I...ED WHEN PERMIT IS READY
(Contractor /Owner- hildrr is required to 91911 for 1110 building pennit, unless indicated otherwise by affidavit, 1_i ?, may be required)
1lddtcss of�'ob Site: %,( •_D v�'.,,,skif . )Zoning classification: Flood lane:
Legal description of Property: TWN:._.�._. R.NC+, _..,....�... st' =< "; .,..,.,.�_._. st113D, _ 131.tc �.1,� —° �� rl�, pc�.,..,
.......ry _..., »1 1111....,..
ProPetl:y Owner Name: "..t,.•. its..... 1�! 5_.. .1���- „_._.._._...._.,,.,»,.�, ...,_,.._... _Phone:
Address: _ _. ._.... �-., ,...,..�_ ............... _ ,
} ter„ Simple Titleholder's Name (entim. ouln vwlwr):
Bonding, Company.- _.._...,,,u,.�..., 1111_ — _._..,�_..._. _.._....,..,..._.._. A.._.....,.._._.... 1 Addres1s11' 1_.. .»..... .
.,. M,_—...,,.. ...........__...........__....
Mortgage andar: ddres Address:
”" --
Type of
Square,
,1111..»
t::onst.
111_1, »..,...w
Oteu.
—. _ _ .
HIL tines
City $ewer
,....,.,...w.._........ _......
# of
,w
# of
# Of
# of
rK of
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y
Building
r"O
'I” ¢
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1 Y
currently
av,ltlable
C:oucr¢tG
stories
dw¢t.
be0•
wettr
V*1v*dvn'of work
(ptutac
u,rdcr
(lid
A,
Lhlssiflcn
uvniiuhl¢ lu
to serve
A•9 Matt
p
ling
room$
closets
(Copy ofl;nntrncJ ttYyulrcd)
indicant as
roof
VD,
.11..411
serve this
this
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ultits
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ato)
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property?
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02/28/13 01:30PM FLORIDA MASTERTEMP 3216382473
p.03
Application is hereby nude to obtain a permit to do the work and installations as indicated, I certify that no work or
installation has cots inenc:ed Prior to the issuance of a petlnit and that all work will be performed to lnneet the standards of all
laws regulating construction in this jurisdiction. The Building Code in effect at the tit'tze of this application is the 14lotida
Build tl ..C:c .de ,; ,%jj l &jgtj. I understi�rac3 that. all laertYlits require itlsl >c!utinns as indicated and that, it is the responsibility of
the pertrtit holder to notify the building department when ready for inspection(s). ']'his permit application is valid for six
months fro,tn date of submission, BY s41,111-119, applicant. affirms that all above, is true and correct and that rte /she is an
authorized almit. of the Contractor /Owner and has the authority to iplaly for this }permit.
*ALL OTII E R AIIPl,,I(',A I,E s7wm oR vr>;):J RA1. Ptw>ixMI'M MU6T DE 0DTA1NV,,D Flxl,caR T() cr'OmMEN •r.. TNT*
Al7I >licant's Name: µ, + I�. , " � c Applicant's Signature:
Site Address; rt',.:xu
For Notary use only: State of Florida, County of" Drevard
Sworn and subscribed before me. this ...,,9841, cloy of " 2� j� ll �
_.. ,,........_ .... , y m...r.,,. '
- Printed raante of nyplieyni
whet produced identification: or
is Pei'
�'�• Y� HOPE M. PERRY
Seal; » ,
Notary Public •State of Finrida
My Contra. Expires Aiap 26, 2QIS
Cptrintl1100n 0 Ef 90423
.... tiitnaturc • Nnta�y P,ibilc A . r ..' '�'
'111is forlri tiny be duplimtv1.
Address: / �, ( -e,-i_
BUILDING PERMIT FEES:
Building Permit per square footage: ..........
Total Sq. Ft. (Living Area):
Total Sq. Ft. (Enclosed Area):
Building Permit based on valuation: ................... .. 5..
.... ...............................
Total Sq. Ft. (Living Area):
Total Sq. Ft. (Enclosed Area):
Building Permit miscellaneous:. ..................................... ...............................
Total Sq. Ft. (fiving Area):
Total Sq. Ft. (Enclosed Area):
Electrical............ ............................... .. ............................... ..........................
Plumbing.............................................................................. ...............................
9512
Mechanical................................................... ,. .......... ,.,.............................. :............
Building Permit Plan Check Fee .................... .............. ............................... S S? 5-
FireDept. Plan Check Fee ....... z ......................................... ...............................
Radon Trust Fund: sq. footage ...............................
Concurrency Management Fee .......................................... .................:.............
t �, ('s ,
CapitalExpansion Fee ......................................................... ...............................
Total Building Permit Fees:...... 7 ��
SEWER PERMIT FEES:
SewerImpact Fee ...................................................... ...............................
SewerTap Fee .......................................................... ......I........................
Total Sewer Permit Fees .............
By: Date:
, z2 (Zc 13
04/26/13 08:52AM FLORIDA MASTERTEMP 3216382473
STATE OF r?-,
CovNTY or A y
NoTU',I 4 car CQ M 11,NC1 N0j
TAX FOLIO NO,
p.02
TTTTcs UNMRSTONEA hereby gives notice that iinprovernent will lie inaade to certain real property, and, in accordance with Chapter
713, Florida Statates, the following inks >rmation is provided in this Notice of CoMmoncemont,
1. Description of property: (legal description of the property and street address if avatilable)„ f ,(, i�
2, () elieral (lescriptionofimprovement:� 'a,`' Z,;.�1... ._t_ x;a.. »...•..... I!h .-- ............_ ..... . ........ _.� , .
3. Owner b1forrmatiow a) Name and address: Js:� .�,,.:� �'�..•...... .L,�.r •....._�,J 1... <:' t. X. C c',:,I:: ,i ,• ;'�, c !:, Ri „':, I
b) Interest in property ,.........................,, _ . _, .......� ,� .,,...., „,„„, „, ..
c) Narne and address of fee simple titl6older (if other than owner)!., ......
4,
.,..
„CAntrlGtnr (Naztie tend d:.......�1:!x;:at. 1.,.....,•...__....
.... ..,, ........
S, Barely: ._ ............. _.............
a) Name and address: ......................... ...... ... ........ �,. — .........__...... ... ......................
..
b) Amount otbond : ... .............. �.. .................... _........_....,.,,,,.,,�._��. ,� ,....,.,..,,w . �.,,. .....».,.,,,,,....��,.•....w� „.,... .,,. .......
6, Lender (Name and address) . ,,,,,.,,.,,.».,.,., .............._...,........—_.............,,•.,.... ,.T,— .........
7. Persons within 11-11-1
tho State of Florida designated by Owner upon whom notices or other documents �ro -
............... may be staved as provided by
Section 713.13 (1) (a) (7),, Florida Statutes (Name anti ad<Iross):
-.,�,, ,,,,, ,,,,,,,,,,,,� .� ,,M...,.... ........ - --
copy himself, C•)wner desipriataYt�t �,_.. iW ;I,., 1 �,
a..' .., •.” �� "
to receive a
8, Irt t3dditton to !t �, ., . (I..._— of `::�,..:.iw,.��, � „.�'
cc',> of the Lienor Notice as provided in Section 713.13 (1) (b), Florida Statutes,
9, Fxpiration of date of notice on oommenceaaraortt (the expiration date is I year from the date of recording unless a difftrent date is
specified): �...., .,
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER ftl TERT11E.EXPIRATION OF 11'1r'r NOTICE OF COMMI NCEMi:W ARE
CONSIDERED IMPROPER PAYMENTS IINDER CRAPTER 713, PART I, SlsxmON 713.13, FLOW DA ST'KIU'rEs, AND CAN RESULT IN
YOUR PAYING TWICE FOR IM.PROVE'MENTS'1O YOUR PROPER'T'Y, A NOTICE OF COMMI:NCE.MI,NT MUST BE R:EZOR13ED AND
POSTED ON'TI-IE JOB SITS BE'FOIZE'r'IIE F7IIS'I' INSIIE(:TION, IF YOU WEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN NT.rORNFY BEFORE COMMENCINC; WORK OR RECORDING'YOtJR NOTICE OF COMMENCEMENT.
,n a� t4 O OR : i � Or C ;. 24, : - i . - `
R` (brt ,`a r1 t , at O�,O t pM. S ignature t wncr or U l.n.
e" r: u`
tlorized
COU ts, reverd County 'Cott Cierk
of (�f TiccrlUirectorlPartnc rltnanager
# f'!1s:1
,,.,,A J..'
Si ato 's Title /of oe
STATE OF FLORIDA
COUN"T"Y OF DREVAIW , a r.
J .Y:1 .,.....,,,,._, wlc dgui before of authority e day of ., officer, it isteee, attome in fact) for f °IbY •�s��a� name of
pe s foregoing a. �trtstavfnent was acknowledged ,...,..... , (YEa Y f(' A Y -j'74
(natal; ofparty'on khalf ofwhotn instiurrient was exeouted)
�M���M�AAAi11AAl1� ,A�AIAAMIwwN' A� I�_.��
a� ^ HOPE M, PERRY
Nolify Pubilo • Stine of Florida
My Comm, Exparas Aug 26, 20115
Cantmisslon # Ef 011423
'•.' l .�•” u.. l.. ...... I. W.nnww�+ly�uJ.y.wvdlYixi4rww...
�•Signattar n # "Ngtaty
Print,'rype or Stamp Commissioned Name of Notary Public
Commission Number
,
Personally ICntawn ,��'_ or Produced Identification
Y., �f3cnticiri.! ?ucsaiant.; tc�.• cti�a..�1,�2S.F'lacida..5luut�s
Under penalties of perjury, l declare that I have read the foregoing and that the f icts stattxi in it aro true to the best of my knowle4ge and believe,
J'
Signntt,rn of Nhtural t'ersan Sil nine Akrtyves
i'
02/28/13 01:30PM FLORIDA MASTERTEMP 3216382473 p.04
norida ASTERTEMP PROPOSAL
3475 N. HIGHWAY I
ST E # I
C;0C',0A, F.L. 32926
Phone (321) 639 -3166 DKIT: Feb. 4, 2013
Fax (321) 638 -2473
To: Tech Vest
RE: A/C Est. ,• N.E. Downstairs
We hereby submit specifications and estimates for;
Y Disconnect and remove. split 24 ton alc system from Downstairs 'N.I'is. Unit:,
}�- Install one new 10 ton A/H into room and connect to existing ductwork.
> Install now 10 ton C;'du onto roof
Flush freon line's and reconnect to new system.
Y Connect and finish all electrical.
Y Start and run system to cornpletion.
Goodman 10 ton S.C. 248/230 -3 edit
+ Goodman 10 ton S.C. AN
ip Goodman heat kit- 15kw
Price for units, and labor,
1) $9375.00
Y Florida MasterTornp warrants its labor and material for I year with the cxccption of filters, fuses, and
general ntaintenarice.
WE PROPOSE" hereby to furnish material -- complete in accordance with these specifications, for the Sum of:
1) $9375.00
l ayable its i'ol lows; 1) N inc Thousand Three Seventy -Five w.w� a w.µ�_-C — ....,..,,.. w w _ ......... _
....... .......
' e I')ollars and'Nt, Cents
Proposal may be withdrawn if not accepted
Within 30 days.
Authorized signature
ACCEPTANCE, OF PROPOSAL
........— .................... ..................- ............ _ .........
Signature .....w..,..,,....,
Date
02/28/13 01:56PM FLORIDA MASTERTEMP 3216382473
� - CE1 TIFIEWTM
Certificate of Product Ratings
vdww.lthridirt;chlry.erg
p.02
AHRI Certified Reference Number: 5561993 Date: 2/28/2013 ^Status: Active
Product: Split System; Air - Cooled Condensing Unit, Coll with Blower
Model Number: CAS121(H,L,S)A*
Indoor Model Number: FAS120(M,S)A *AO*
Manufacturer: TEMPSTAR
Trade/Brand name: TEMPSTAR
Rated as follows In accordance with AHRI Standard 340/360.2007, Commercial and industry Unitary
Air-Condition Ing and Heat Pump Equipment and subject to verification of rating accuracy by AHRI - sponsored,
Independent, third party testing:
Cooling Capacity (Stuh): 117000/117000
EER Hating (Cooling): 11,20/11,20 co
IEER: 1 2,0/12.0
Heating Capacity at 47F (Stuh):
CQP'at 47F: City of Cape Canaveral
PERMITTED FOR CONSPXT�� (( )
Heating Capacity at 11F (Btuh): PERMITNo,, u+
�3COP at 17F: Rye �w� Ebs-�Tsn s.liut a .t it ce vloiatloa o'i•``�
Any fecal, state or fedenw± :� ;, >r sane, or stattrtf
OFFICE COPY
T Modolu with qn 'Active' :uatua uro those !hilt nrnf currently in prnduollon. Modol , wilh a'UisQOntinuod' status sire e, lh0i(+ that the monufaolurer has Nklrtod to stop producing, yet stock
is ,011 evaNahle. M00018 with eh ,000lnte' status We those that the manufacturer ix Me Wood to plop mArnilasluring due to nn AHRI cee iticmion program 171st fnNuro,
libfiilps foftnwart Ily V1 ealerlsk (') inQitale a volunlery feraiei of phlviAUaly t>Ulttished data , un1088 AAOOrnpanlyd with a WAtil, wili011 IntiloalAY, an invoillnlAry rM1lfillti
DISCLA1MFR
ANRI0009 not 81100MO the products) listed oil this Certificate slid makes no roproaontations, warranties or guarantees as to, and assumes no respoilAfbility for,
tho producl(s) littod on this Certificate. AHRi expressly 0I$Claint9 all liability for damages of any kind arising out of the use or performance of the produCt(s), or the
unauthorized aft,aration of data listed on this Certificate. Certified ratI119% am valid only for models and configurations listed In the directory at Www,ehridirectory.orn,
TERMS AND CONDITIONS
This Co Ok ste and Its contents are proprietary products of AHRI. Thl9 Cortificate $hall only be used for Individual, personal and confidential reference purposes,
The contents of this Certificate itlby not, In whole or in pan, be mproducod; copied; dissotninated; entarod into a computer database; or otherwise uillirod, in any
form or manner or by ally swans, except for the user's Individual, peraollat and confidential reference.
CERTIFICATE V" (CATIDN
The Information for the �
model cited on this cortificalo can be verified at vrww.ahrisiirectWy,o'tl' Ait'�GOridilioning, Heating,
click on "Vrirlfy Ceti {ricote° link and enter the ANRt Certified Referonce Number slid the date 'o" illi� ��
wllieh tho ovrti9cato Web 10*UG0. which is Hated above, and 010 Certitleate No„ Which is listed below. and f20frigercallQn lnstitute
0 2012 Air-Conditioning, Heating, and Refrigeration institute CERTIFICATE NO.: 13006.546939416307'2
' CITY OF CAPE CANAVERAL
AUTHORIZATION FORM
City of Cape Canaveral Building Department 105 Polk Ave. Cape Canaveral, FL 32920
(321) 868 -1222
(You may download this authorization: www.myflorida.com/cape. You may fax to: (321) 868 -1247.
Date: 3- 1 O — � j
Permit #: " I (j 1
CONTRACTORS AND SUBCONTRACTORS - PLEASE HAVE YOUR SIGNATURE
NOTARIZED AND SUBMIT THIS FORM WITH THE PERMIT APPLICATION.
Company Name: -�- (0 '� C a-
rQ
I,' &WIGS �- 'ke(k�,„d ,hereby authorize `ctiu Eb {svc�-CcQ�—
(State License Holder's Name— PLEASE PRINT) (Authorized Person— PLEASE PRINT)
to obtain a permit on my behalf under my state license as issued by the Department of
Business and Professional Regulation, Construction Industry Licensing Board C 0, C � � I (p �- 1 ,
(State License Number)
for the job site described below.
* For blanket authorization, do not complete.
Name of Property Owner
Address of Job Site
SigrCaii e of License Holder
For Notary use only: State of Florida, County of Brevard p l
Sworn and subscribed before me this � day of yylar C, L_ , 20 13 , by () Yl�l �S �� �1nct v'o11
Name of Applicant
F1who produced identification: or
is personally known to me.
4!1.01 DIV Pg ;, ��
ro .� HOPE M. PERRY
Seal: _ Notary Public - State of Florida
=N " +, My Comm . Expires Aug 26, 2015
%f oF d;.•• Commission #f EE 90423
G :\B1dg.Dept.Fonns\Authorization Form
Signature - Notary Public At La
This form may be duplicated.
Type of Permit
Building
Plumbing
Electrical
Mechanical
Roofing
Swimming Pool
Specialty Structure
Other — Specify:
Name of Property Owner
Address of Job Site
SigrCaii e of License Holder
For Notary use only: State of Florida, County of Brevard p l
Sworn and subscribed before me this � day of yylar C, L_ , 20 13 , by () Yl�l �S �� �1nct v'o11
Name of Applicant
F1who produced identification: or
is personally known to me.
4!1.01 DIV Pg ;, ��
ro .� HOPE M. PERRY
Seal: _ Notary Public - State of Florida
=N " +, My Comm . Expires Aug 26, 2015
%f oF d;.•• Commission #f EE 90423
G :\B1dg.Dept.Fonns\Authorization Form
Signature - Notary Public At La
This form may be duplicated.
03/21/13 01:25pM FLORIDA MASTERTEMP 3216382473 p.01
PE- RM•1'r NO, {':�.'` .. ._ .,�..,...,..., .�� TALC F0L1O NO. ,-.. - ..._.......w_,�
STATE OF fjOlt QA,
COUNTY OF 1t v IiTa
TI':1E UN'DE.'RSiGNTI) hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter
713, Florida Stat'utom die; following information is provided in this Notice: of Commencement,
1. Description of property: (legal description of the property and street address if available) (
2. General description of
3. Uwtter urfonnation: a Name and atic9ross:' ,
b) Tnteroat in propeYty:w
c) Name and address of fee simple titleholder (if other than owttCr):
Q.~ MCotatractor ame Kncf address ) "-"'...,.,L.i,.,........,....1 `... _r ,,,.,,,.,.• .................. „,,., i .,._................_._._ .� - -- - �............. -- ............... ..... ... ...
......_......
lam _: ?::......,�._ \.._......... .. .%i.1t.. , .................. r.,,.f., r�u .....,./:.L�_...,.....�_,: —_�
5. Surety: - ....... . _�_� -- ...,, .,. — ,....,,- ..,......,..,,......,., •..,,., .._ .....,.,..,....,,.. ,,.,.,, .. .ww,..,
a) Name and address :....................,.... �....,_.,.:,., ...._..... ,...,...,......._.._ .......................................... .— . ..... _ ... .... ....
........._ . _..... ... ..... ..,..,....,...... ,._ ,...,..,..... ....,.............,..,,,.,,,,.,
„. ........... .
b) Amount of bond:, ..... ..,, .� W.. ..,.,:.. - - -- — ........... - ......
.. ._,...........,....._.__.,..,,. �,. ,.,_,,.:,,,..,, ,�..,, .,, w. ..,...,.,,� ..................,.
6, I.,ender (Narne anal address):
7, Persons within the ,State of Florida designated by Owner upott 'whom notices or other documents may be served as provided by
Sootion 713.13 (1) (a) (7)., Florida Statutes (Wane and address):.,,„, ,,,,_„ ,, _,.
R.
in addition to himself, owner designates L I.z.,:� ka�,�,.ti 1........_, of ��1 �_ t b i s M..1 , / Y' � � , to receive a
copy of the Lienor Notice as provided in Section 713.13 (1) (b) Florida Statutes,
9. Expiration of" date of notice on corranencement (the expiration date is I year from the date of recording unless a different (late, is
specified). .,.,..,,, . , �_.._..................., „, „�,�
WARNIN(;'1 0 OWNER: ANY PAYMENTS MADE BY TIM OWNT?R AFI'IsR'IIET>, EXPIRATION OF TfIENOTICT;Of COMMENCEMENT ARE,
CONSIDERED IMPROPER PAYMENTS UNDER CI•IAP'I'Elt 713, PART I, -qra ON 71.3.13, FLORIDA S'I m'UTES, AND CAN R.I:.SiJL,T IN
YOUR PAYING TWICE FOR IMPROVEMENT 'S "I'O YOUR PROPERTY, A :N01 "It: E OF COMMENCEMENT M'US'T' BE RECORDED AND
POSTED ON THE JOTS SITE REI ORk3'I kfrIs V IRST INSPEX' T'ION, IT; YOU IN'T'END'T'O OBTAIN MNANCINU, CONSt,JI.,t' WI'jTl YOUR I.):•?NDER
OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENt'.EmEN'T',
.:.....,.1..: . /; .
Signature of Owner or Owner's, 6thorized
)
t fcer /Director/Partner /manager
Signatory's Tit1c /Office
STA'I"I? OF I' X)RIDA
COUNTY OF BREVART)
The I , . , .b
pe �oo) rgei Y a �u[rt► YW''� as a�ktaowledgc d before e of aotY of ity cg: ofcer, trustee, attorney in filet) for} l �) �nittr►c of
(name of party on behalf of whom instrument was cxccutod)
HOPE M, PEARY Signature of Notary
NMnry PubtiC • State at F OMA Print, Type w Stwnp Ccxtnt�issianed Nainc of Notary Pubtiu
• My Comm. Explaes Aug 26, 2015 Commission Number
Cpttltttikklort * EE 9012 ,
Personally Known,,, or Produced Identification
V�AatiAn„ 1'. pusut> zl Cl al�tiou92�,C,1Rt''lcl6 „S1AtutCS
Under penalties of petjwy, I declare that I have rend the foregoing and that the facts stated in it are true to the beat of my knowfodgo W boliovc.
StgnAturu UPNatUR1) ('pion Sigrxing Above