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RECEP.70 FEB O B 2(}4vi'10E.OF COMMENCEMENT SCANNED
TO BE COMPLETED WHEN CONSTRUCTION VALUE EXCEEDS $2,500.00 BY
OR WHEN HEATING OR AIR CONDITIONING REPAIR OR REPLACEMENT EXCEEDS $7,500.00
St. Lucie
PERMIT#: 16& TAX FOLIO#:%50%-(obJ'-T7yS:K- 1>60 CountL'
State of Florida, County of Indian River, the undersigned herebygivesnotice 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. LEGAL DESCRI\PT(IO'�N OF PROPERTY (AND STREET ADDRESS IF AVAILABLE):
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2. GENERAL DESCRIPTION OF IMPROVEMENT:
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3. OWNER INFORMA Nor ❑LESSEE INFORMATION (If Lessee contracted for the improvement)
a. Name: Dr A . C
Address t-1 O i S C ` rye 7��
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b. Interest in property: 0v +ti r
c. Name and addressq of fee simple title holder (if other than owner):
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4. CONTRACTOR:
a. Name:
Address:
b. Phone number. �f6S �13SS
5. SURETY COMPANY (IF Applicable, a fopy of the payment bond Is attached):
a. Name & Address• 1
b. Phone number: Bond amount:
6. LENDER/MORTGAGE COMPANY: WAa.
Name & Address:
b. Phone number:
7. PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MI
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SERVED AS PROVIDED BY SECTION 713.13 (1) (a) 7., FLORIDA STATUTES:
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a. Name & Address: -( a
b. Phone number: fax number:
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B. IN ADDITION TO HIMSELF OR HERSELF,
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a. Owner designates of r,
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a copy of the lienor's notice as provided in section 713.13(1)(b), Florida statues.
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b. Phone number. �
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9. EXPIRATION DATE OF NOTICE OF COMMENCEMENT:
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(THE EXPIRATION DATE IS ONE (1) YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). -
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WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAP
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PART 1, SECTION 713.13. FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMEN
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MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
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ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS IN IT ARE TRUE TO THE BEST OF MY
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KNOWLEDGE AND BELIEF (SECTION 92.525, FLORIDA STATUTES
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SIGNATURE OF OWNER or LESSEE or OWNER'S AUTHORIZED OFFICER/DIRECTOR/PARTNER/MANAGERSIGNATORY'S
TITLE/OFFICE ��11
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS %y DAY OF ✓ ��'L' , 2Co/_T BY:
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AS FOR Q2C7T /9 - U�'WM6
-. NAME OF PERSON TYPE OF AUTHORITY NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED
P OR ❑PRODUCED, IDENTIFICATION TYPE F IDENTIFICATION PRODUCED
�N-A-L�LY�KN�OW�N
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NOTARY SIGNATURE NOTARY PRINTED NAME NOTARY SEAL 3'' PATRICIA Ji SfiANT�N
MY COMMISSION fi FF112242
y, a A EXPLttES:Iwe03, 2018