Request For Notice To Owner
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1P.O. Box 18095 Sarasota, FL 34276-1095 - Phone: (941) 951-6657 - (800) 780-6657 Fax: (941) 954-0758
REQUEST FOR NOTICE TO OWNER
Please complete this form and Print, Sign, and Fax to: (941) 954-0758
TO: BUILDING SUPPLY NOTICE SERVICES, LLC
(941) 951-6657
P.O BOX 18095
(800) 780-6657
SARASOTA, FL 34276-1095
FAX:
(941) 954-0758
DATE: ____________________
PLEASE PREPARE AND ATTEMPT TO SERVE A NOTICE TO OWNER BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, BASED ON THE
INFORMATION WE HAVE FURNISHED BELOW. WHERE YOU ARE ABLE TO DETERMINE THAT ADDITIONAL COPIES OF THE NOTICE TO
OWNER SHOULD BE SERVED, PLEASE ATTEMPT TO SERVE THE ADDITIONAL COPIES BY CERTIFIED MAIL. WE HEREBY WAIVE ANY CLAIM
AGAINST YOU THAT WE NOW HAVE OR MAY HAVE IN THE FUTURE BECAUSE OF YOUR FAILURE TO ASCERTAIN WHO SHOULD RECEIVE
COPIES OF THE NOTICE TO OWNER.
*1. SPECIFIC JOB ADDRESS: _______________________________________________________________________________________
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CITY: ____________________________________________________________ STATE: ________________ ZIP: _________________
2. JOB NAME: ___________________________________________________ BUILDING PERMIT #:_____________________________
3. LEGAL DESCRIPTION (IF AVAILABLE): __________________________________________________________________________ ___
LOTS: _________________ BLOCKS: __________________________ SUBDIVISION: ______________________________________
SECTION ______________ TOWNSHIP ___________________ RANGE ____________________________________________________
*4. DATE OF FIRST DELIVERY OF MATERIALS OR BEGINNING OF SERVICES AND/OR LABOR FURNISHED:__________________________
*5. GENERAL DESCRIPTION OF MATERIALS, SERVICES, AND/OR LABOR FURNISHED:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
*6. YOUR CUSTOMER NAME AND ADDRESS : __________________________________________ JOB # _________________________
STREET: _____________________________________________ CITY: _____________________ STATE:___ ZIP: ________________
7. GENERAL CONTRACTOR NAME, ADDRESS AND PHONE NUMBER (IF AVAILABLE): ______________________PHONE: _____________
STREET: ________________________________________________ CITY: _____________________ STATE:___ ZIP: _____________
8. SUBCONTRACTOR NAME, ADDRESS, AND PHONE NUMBER: ______________________________________PHONE: _____________
STREET: ________________________________________________ CITY: _____________________ STATE:___ ZIP: _____________
9. OWNER'S NAME AND ADDRESS (IF AVAILABLE): ________________________________________________PHONE: _____________
STREET: ________________________________________________ CITY: _____________________ STATE:___ ZIP: _____________
10. LENDER'S NAME AND ADDRESS (IF AVAILABLE): _______________________________________________PHONE: _____________
STREET: ________________________________________________ CITY: _____________________ STATE:___ ZIP: _____________
YOUR FIRM’s NAME:_______________________ _________________________________________________PHONE: _____________
STREET: ________________________________________________ CITY: _____________________ STATE:___ ZIP: _____________
SIGNED BY: _______________________________________ TITLE: ______________________________________________________
Signature of Authorized Agent:_______________________________________________________ Date:_________________________
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Parent category: Legal