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BPP-06-1046Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Date: 07/09/2008 Inspector: Grande, Claudio Owner: PAULSEN, CARL Job Address: 400 101 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: New Block: Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: (305)634 -0958 Building Department Comments NEW SWMMING POOL AND PEVERS DECK 7 Passed Inspector Comments etoz-loen a____ M00(0- I094 .1 o - 10'W CI-- Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Tuesday, July 8, 2008 Page 2 of 2 Miami Shores Village Building Department 1,0; Ai'-' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (Wife It 6.8972 BUILDING R 2 4 1006 Permit No. JP - 1 0143._ PERMIT APPLICATION Y. , n , ,Master Permit No. FBC 2001 Permit Type (circle). Buildin Electrical Plumbing Mechanical Roofmg Owner's Name (Fee She Titleholder) jr`4- (i, % ea1%t,,E,t phone# Owner's Address tiQO City ,ri!` _ /7/1101 State F4.• . Tenant/Lessee Name Zip »? Phone # Job Address (where the work is being done) L 2O City. Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Zip ,/.. -3,17 Contractor's Company Name % cUi . Phone # t % 4 7 - Contractor's Address ,J1„ :1a ,,a/4, ! 4VL • City Midi 7 Qualifier P�t4X0 State g• • Zip 7 State Certificate or Registration No C",1•Licb V CI- Certificate of Competency No. II Architect/Engineer's Name (if applicable) Phone # Value of Work For t i ill O $ h�$ Permit .,hd � 00 Square Footage Of Work: I Type of Work: ❑Addition DAlteration New ❑ Repair/Replace ❑Demolition Describe Work: ,(M' , Pool.. g ' -! iC +F.,_ -7 0 ...... * * * * * *............ ** ***, Fee * * * * * * * * * * * * ** * * * * ** * * ** * ** ** �-y Submittal Fee] - — r; — - Permit Fee $ CCF $ I®- CO /CC , /% Notary $ Training/Education Fee $ Z• Technology Fee $ 13 Scanning $46 tom Radon $� �1 Z -� Zoning Bond $ a . CO Structural Plan Review. $ D Code Enforcement $ Total Fee Now Due $ 1-6, (Continued on opposite side) MAY Q9PAM 1 ai s PERMIT # ,PP- 1 Bonding Company's N CONTRACTOR: 13 WE 11.140S42. pOO)—S SUBMITTAL DATE: AP2-1L 24 Bonding Company's Ad City Mortgage Lender's Nan Mortgage Lender's Addi City RESUBMITAL DATES: Cip PROJECT TYPE:SV.f l M N1 I Niel PC3' Application is hereby m; commenced prior to the construction in this jurisq WELLS, POOLS, FURNi OWNER'S Al+'N'1DAV1' applicable laws regulatin 7 a ZONING FIRE "WARNING TO OWNI PAYING TWICE FOi_ELECTRIC CONSULT WITH COMMENCEMENT. ", STRUCTURAL IMPACT FEES HRS/DERM Zip certify that no work or installation has 4 the standards of all laws regulating rRICAL WORK, PLUMBING, SIGNS, jrc ork will be done in compliance with all EMENT MAY RESULT IN YOUR END TO OBTAIN FINANCING, RDING YOUR NOTICE OF Notice to Applicant: As promise in good faith tha whose property is subject for the first inspection w inspection will not be appr Signature L — ding $2500, the applicant must Owner or Agent The foregoing instrument was acknowledged before me this %,°t day ofArr7- ,20OL by fartA P/g/,,F- // who is person NOTARY PUBLIC: Sign: Print: My Comm e or who has produced As identification and who did take an oath. * * * * * * * * ** Oscar &gra MM' DOW11190 �.a ~ E per a@, ires: APPLICATION APPROVED BY: chc 05/13/03 will be delivered to the person t must be posted at the job site y ce of such posted notice, the Signature Contractor The foregoing instrument was acknowledged before me this Ag day of A -PM , 20 0 by r-A944, r Ev4JJ2 who is pew y rno me or who has produced as identification and who did take an oath. NOTARY PUBL Sign: Print: 'f °4 t v ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 1/2‘ mil' sihZe c Plans Examiner Engineer Zoning SWIMMING POOL OWNER'S CERTIFICATION Date M7(1 t1 ,t Miami Shores Village Building and Zoning Department Attention: Building Official I certify that I am the legal owner of the property described as J 1.h,0K , P.. ow -7 , located at In accordance with Section 33 -12(0, Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until a separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. BUILDING DEPARTMENT 10050 N.E. SECOND AVENUE MIAMI SHORES. FLORIDA 33138-2382 TELEPHONE (3051 795 -2204 FAX (3051 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFTY ACT 6 CP 06 -1,0L4„ I (We) acknowledge that a ew swimming pool, spa or hot tub will be constructed or nstalled at gooe,/%, "a". `'/'° Miami Shores,, Fl., and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statutes. :please initial the method(s) to be used) The pool will be isolated from access from the home by an enclosure that meets the pool barrier requirments of Florida Statute 515.29; The pool will be equipped with an approved safty cover that complies with ASTM F1346 -91; All doors and windows providing direct access from the home to the pool will be equiped with an exit alarm that has a minimum sound pressure rating of 85 decibels at 10 feet; All doors providing direct access from the home to the pool will be equipped with self - closing, self - latching devices with' release mechanisms placed no lower than 54" above the floor or deck; I understand that not having one of the above installed at the time of final inspection, or when pool is completed for contract purposes, will constitute a violation of Chapter 515, F.S. and will be considered as committing a misdemeanor of the second degree, punishable by fines up to $500 and /or up to 60 days in jail as established Chapter 775, F.S. CONTRACTOR'S SIGNATURE & DATE OR'S • IE (PLEASE PRINT) . pi Oscar Small �• My Commission DD357890 OWNER'S SIGN - TURE & DATE. VV OWNER'S NAME ( PLEASE PRINT) oscr Sera ' ssian DD357890 Expires _ NOTf' / • UBLIC r, 4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 atrI040 Inspection Date: 07/09/2008 Inspector: Devaney, Michael Owner: PAULSEN, CARL Job Address: 400 101 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Building Department Comments Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: 305/556 -5759 ELECTRICITY FOR POOL IJUL 10 2000 Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 15662. NEED TO CHECK ID DOOR ALARMS THAT ARE INSTALLED WILL WORK. OWNER DOESN'T WANT TO PUT APPROVED ALARMS IN. HE WANT TO SPEAK TO CLAUDIO. MD 03/02/07 la29 1� T Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid . until Tuesday, July 8, 2008 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FsC zom Permit Type (circle) Building IMCMZYM 191 APR 2 4 2006 B Y: Permit No.-E LC> 1 , Master Permit No.PPb - 1 CD41-ro Plumbing Mechanical Roofmg Owner's Name (Fee Sim le Titleholder) Aar' A +1 4r , pAviblvtione # Owner's Address a h,t/ fai-d-fr Iffdif,G{i City SU` ..4.1n 4 State FL . Tenant/Lessee Name Zip Phone # Job Address (where the work is being done) City Miami Sh res Villa : e Is Building Historically o esignated YES County Miami -Dade Zip **1.-.17 NO Contractor's Company Name SSG (75-'7 Contractor's Address J �fo,L �(%• ,�lL,�. �0�✓& . City %G,Wll iD. State Qualifier Fro• / 11/2 -o I2uf/t -% Zip �i ?�✓ State Certificate or Registration No. fe ®2.g 17 cr Certificate of Competency No. Architect/Engineer's Nan e (if applicable) Phone # $ Value of Wokk For this Permit Type of Work: Describe Work: ❑Ad ition ❑Alteration r New F rriw("ForE2-621.. Square Footage Of Work: ❑ Repair/Replace ❑ Demolition * * * * * * * * * ** * * # ** * *** * * * ** Fees * ** ** * * * * * * * * ** * * * * * ** ** * * *** Submittal Fee $ Permit Fee $ ZZ3 6® Notary $ Training/Education Fee $ CD . Scanning Radon $ Code Enforcement $ Structural Plan Review. $ Zoning CCF $ ° CO /CC. Technology Fee $ Bond $ Total Fee Now Due $ 'C3 o 30 qp1 MAY 09 PAID (Continued on opposite side) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 the 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 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 to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certUied copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved nd a reinspection fee will be charged Signature Signature Owner Agent Contractor The foregoing instrument was acknowledged before me this V The foregoing instrument was acknowledged before me this Alt day of 007014. , 20g4 by C/4 AtRA /7 fr , day of APt7L , 20O/ by Pritil-G//7 0 /7j` ��x who is per to me or who has produced who is person me or who has produced �/ as identification and who did take an oath. As identification and who did take an oath. NOTAR Sign: Print: 4% My Co ' ' sign Expires: ak " ° cer Sew ' MY Commission 130357880 pasraao of Ker Expires September 28, tops NOTARY PUBLIC: / Sign: My Co Print: .0/ iota Expires: N. (Nicer Serreff 26, ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: /V,/ � j ��� �. l�� r� Plans Examiner chc 05/13/03 Engineer Zoning Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Oth1O0. Inspection Date: 02/16/2007 Inspector: Levrack, James Owner: PAULSON, CARL Job Address: 400 101 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Block: Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: (305)634 -0958 Building Department Comments POOL PIPING FEB 2 0 2007 U #i l cLL.L IA, Ly c�rF,G � / Passed In e t omments v Po CL g k 9 qj 5 0 Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Thursday, February 15, 2007 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:Mate 1 ^> Er 756.8972 BUILDING A APR 2 2006 Permit No. PL a) -' 104 7 PERMIT APPLICATION B Y: _' Master Permit No.2 o -- 1 C>Ci—Cm FBC 2001 Permit Type (circle): Building Electrical , Plum Mechanical Roofing Owner's Name '(Fee Simple Titleholder) I/br -4- i (ri. 1 / /t" Phone # '5 7'1rb� t% Owner's Address LO ,(it ..4.4.1-4-7 City /J 411-or J State FL • Tenant/Lessee Name Zip ✓'•�� Phone # Job Address (where the work is being done) ' /Oa ,fly ,10,4/7r. City Miami Shores Village County Miami -Dade Zip 2?J *47 Is Building Historically Designated YES NO Contractor's Company Name n!/ WA Or r P V L Phone # D p i 7 t 7 4g G 7 Contractor's Address ,,2,, /. 2 ,(f . ij /4„J f City 11141.11 State FL . Zip s A 7 Qualifier ,, WA. . pEt.t.frAiv, State Certificate or Registration No.,l -Pe. ..tic/, t/ fJ Certificate of Competency No. Architect/Engineer's Name (if applicable) $ Value of Work For this ermit.a G. Type of Work: ❑Addition ❑Alteration Describe Work: ✓L P /PIi/�, Phone # Square Footage Of Work: ❑ Repair/Replace ❑ Demolition adr * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ 0 Permit Fee $ /ttttt111ll��hhhddd 6' CCF $ 1 • caLJ CO /CC Notary $ Training/Education Fee $ 0 , Technology Fee $ I - Scanning $ co Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ �10t Cip Total Fee Now Due $ MA 0 9 PAID (Continued on opposite si e) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 the 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 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 to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not e approved and a reinspection fee will be charged. Signature Owner or gent The foregoing instrument was acknowledged before me this Agra, ,20a/1 by duArior peetvz 47 own to me or who has produced on and who did take an oath. day of who is NOTARY PUBLI Sign: Print: My Commissio . 'res. Oscar $miff My CO nmiSSIOn DD387890 saptembuf 2e, Ace Signature Contractor ' l The foregoing instrument was acknowledged before me this Zt day of An,. , 20 � t, by F who is pers to me or who has produced NOTARY PUBLIC: *************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03. Sign: Print: My Co as id %atification and who did take an oath. lit xpires: Oscar &waft * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, F Phone: (305)795 -2204 Fax: (305)756 -8972 0b104(p Inspection Number: INS`P -16041 Permit Number: MC -4-06 -1094 Inspection Date: 02/12/2007 Inspector: Perez, JanPierre Owner: PAULSON, CARL Job Address: 400 101 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: BLUE WATER POOLS OF SOUTH FLORIDA Permit Type: Mechanical - Residential Inspection Type: Heat Pump Work Classification: Pool Heater Block: Phone Number (305)754 -9370 Parcel Number 1132060170480 Lot: Phone: (305)634 -0958 Building Department Comments WATER HEATER FEB 14 2007 Passed Inspector Comments ‹.-Kil '1) -7 '4) \ VO Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Friday, February 9, 2007 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1 C1 BUILDING PERMIT APPLICATIO FBC 2004 MOMIEVIE APR 2 7 2006 B Y: Permit No. / \CO o - IQq Master Permit No. ° b ICAkD Permit Type (circle): Building Electrical Plumbing LMechanical Roofing Owner's Name (Fee Simple Titleholder) PCk(,'L C°Y) Own�er's Addres$ �k l E, ( (°) City # o -� , x`■ 1 *1 ` V.4-). State Tenant/Lessee Name Phone# -I 0\370 Zip ?7,3 Phone # Job Address (where the work is being done) City iami Sho es Vill. e FOLIO / PARCEL # County . Miami -Dade Zip %� Is Building Historically D'signated YES NO Contractor's Company Name 1 ?ft Uj4tf/ pa36/ of . • Phone # &c. 4 --7 L!.Z:' Contractor's Address Q A/ City /WI State Fi . Zip`C�+ G Qualifier Name go----AF4 Pe45,AgO Phone # State Certificate or Registration No 6e.t 't li Certificate of Competency No. Architect/Engineer's Nam 4 (if applicable) Phone # Value of Work For this P rmit $ 175-00 • Square / Linear Footage Of Work: Type of Work: PAAddiiion ['Alteration ❑New Describe Work ❑ Repair/Replace ❑ Demolition Notary $ 5,q0 raining/Education Fee $ Scanning $ 3' Radon $ Bond $ Structural Review. $ Code Enforcement $ o•aC DPBR $ CCF $ EfD CO /CC Technology Fee $ Double Fee $ Zoning $ Total Fee Now Due $ II_ 30 MAY 09PAID See Reverse side ---> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 the 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 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 to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection w ot be aaprpved and a reinspection fee will be charged. Signatures °� )J ,) Signature Owner or Agent The fore oing instrument was acknowledged before me this % The day ofi� , 2(4 b iv l'l °� - ig --day Contractor ��II foregoing instrument was acknowledged before me this%�7 of 4 r V' i l , , 200, by,4 L P I rA.WO who is personally known to me or who has produced who is pe As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: T., TT3UC -S1 TE OF r. .' . 01 h m V . v,'' .. . My Commissio Expires: Boll` ed ' "fie Be_ VIII A * * * * * * *4.,* * * ** to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission ; xpires: **************************** * * * * * ** * * * ** * * * * * * * * ** * * * * * ** ** Oscar soma My Commission Do3d7s®0 Es seombor 2e, 2 APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. Job Name Date BUILDING CRITIQUE SHEET St> &-Irr Xe1240/ hc.4_7:6,0 . Q Deci - Z Mzei; S Pecs ,mss z �iv�o e"Xr r ,4l 0f5 �. ri 4' cs it4)/c, ,_eAdc -e 012_ Lo o.v /,4AIs. 7K,) 19460-4, ktt,i/ i ) /ctc&) -D Reviewer: Claudio Grande C.B.O 305 - 795 -2204 Ext 1430 NOTICE OF COMMENCEMENT A RECORDS) COPY MUST SE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO, STATE OF FLORIDA: COUNTY OF MIANII-DADE: TAX FOLIO NO. jibwbvi7on0 THE UNDERSIGNED hereby gives notice that improvements wifl be made to certain real property, and in accordance with Chapter 713, Rorida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: P tr r. f 1 /2 OW .10 gag ifx M m4. 1,14 tarp. CF14 2006Ra:44564 1 9R Bk 24470 Ps 3008; (118) RECORDED 04/28/2006 13:22:0 HARVEY- 1:11V IN 1' 'eft-En -6F etIURT raor-OA r:DUM-P6 Ru-N WI' PAGE 2. Description of improvement 4aut01.114, !WA. 3. Owner(s) name eV: age-st 4441. (iv 11.14:9,* Ft. • Interest in property: Name and address of fee simple iftleholder: 4. Contractor's name and address: fte.X. Orb". aZ2fe 0A7 „aceoror" 5. Surety: (Payment bond required by owner from cordractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by , provided by Section 713.13(1){a)7., Florida Statutes, .‘ Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address:. 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a date is witted) 4,1111r5-4?-4--) • Print Owner's Name ilArLet FladV-vi Sworn to and subscribed before me this day of Aril& Notary Public Print Notary's Name MY comrTIIMIOn -expires 33:81-Y FNE Oscar Micron • My Conimission MINN Prepared by O'Ll;rArr,4.-ff , 20. Addnw.s:Otta2,/,. 0,41.11 Expires SOF81188ei 28, me 1,0414111 &h.Lf,7 KIM, Mid tr. 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