Request For Notice To Owner
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2PO Box 449
Loxahatchee, FL 33470
Phone: 561.746.4400
Fax: 561.746.6500
REQUEST FOR NOTICE TO OWNER
BASED ON THE INFORMATION WE FURNISHED BELOW, PLEASE ATTEMPT TO PREPARE AND ATTEMPT TO SERVE A NOTICE TO OWNER BY CERTIFIED MAIL. WHERE
YOU ARE ABLE TO DETERMINE THAT ADDITIONAL COPIES OF THE NOTICE TO OWNER SHOULD BE SERVED, PLEASE ATTEMPT TO SERVE THE ADD ITIONAL COPIES. WE
UNDERSTAND THAT ASIDE FROM THE INFORMATION WE HAVE FURNISHED, YOU MAY NOT BE ABLE TO DETERMINE WHO TO SEND COPIES TO. I AUTHORIZED YOUR
PERSONNEL TO SIGN ANY NOTICES THAT RESULT FROM THIS REQUEST. IN THE EVENT THE UNDERSIGNED SUFFERS ANY DAMAGES AS A RESULT OF NEGLIGENCE ON
THE PART OF PBN CONSTRUCTION NOTICES IN RESEARCHING, PREPARING OR ATTEMPTING TO SERVE THE LIMIT OF LIABILITY SHALL NOT EXCEED $500.00. PBN
CONSTRUCTION NOTICES WILL MAIL THE NOTICES HOWEVER IT IS THE RESPONSIBILITY OF THE UNDERSIGNED TO MONITOR THE CERTIFIED RETURN RECEIPTS AND
INSURE THE ACCEPTANCE OF THE NOTICE.
YOUR COMPANY NAME
________________________________________________________________________________________
AUTHORIZING PERSON
____________________________________________________________________________________________
ADDRESS
CITY/STATE
ZIP
__________________________________________________
_______________________________________
__________________
PHONE
FAX
MOBILE
EMAIL
_________________________
_______________________
______________________
____________________________________
REQUIRED INFORMATION – PLEASE PRINT CLEARLY
START DATE
CLIENT’S JOB #(IF ANY)
_________________________________
______________________________
SCOPE OF WORK/MATERIALS
_____________________________________________________________________________________________________
COMPLETE JOB ADDRESS
_________________________________________________________________________________________
CITY
COUNTY
______________________________________________________
________________________________________________
TENANT SPACE
PERMIT #
___________________________________________
_______________________________________________
YOUR CONTRACT IS WITH
__________________________________________________________________________________ ________
ADDRESS
CITY/STATE
ZIP
__________________________________________________
_______________________________________
__________________
PHONE
FAX
MOBILE
EMAIL
_________________________
_______________________
______________________
____________________________________
GENERAL CONTRACTOR
____________________________________________________________________________________ ______
ADDRESS
CITY/STATE
ZIP
__________________________________________________
_______________________________________
__________________
PHONE
FAX
MOBILE
EMAIL
_________________________
_______________________
______________________
____________________________________
OPTIONAL INFORMATION
OWNER
____________________________________________________________________________________________________ _______
ADDRESS
CITY/STATE
ZIP
__________________________________________________
_______________________________________
__________________
NOTICE OF COMMENCEMENT/BOOK & PAGE #
____________________________________________________________________
LEGAL DESCRIPTION
_____________________________________________________________________________________________ __________________
NEW CUSTOMERS ONLY – Please complete the second page to open your account. Account holders have access to our
automated online ordering system, which enables you to track the status of your NTO, print copies, and create and print
releases.
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