HomeMy WebLinkAbout15-16325 CITY OF ZEPHYRHILLS
�, : 5335—8TH STREET /'
(si3pso-oo20 � 25
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION �,
Permit NumBer: 16325 Address: 6948 GALL BLVD
Permit Type: SIGN ZEPHYRHILLS, FL.
Class of Work: WALL SIGN Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0010-00800-0130
Improv. Cost: 14,800.00 OWNER INFORMATION
Date Issued: 6/01/2015 Name: PMPM INC
Total Fees: 225.00 Address: 7561 49TH ST N
Amount Paid: 225.00 PINELLAS PARK, FL 33781
Date Paid: 6/01/2015 Phone: 817-538-4945
Work Desc: INSTALLATION 2 WALL LED SIGNS 50 X60 FACING NORTH & WEST ONLY W/ELECT
CONTRACTOR S APPLICATION FEES
IGN— TINE SIGN 165.00 ELECTRICAL FEE 60.00
SIGN—STINE
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Ins ecY ns Re uired
F OTER
ELECTRIC cL RO G� (
FINAL 1,
REINSPECTION FEES: Reins ection fees will com I with Florida Statute 553.80 2 c when e r ' i n
p p y ( )( ) xt a inspect o
trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly that
may be found in the public records of this county, and there may be additional permits required from other governmental
� entities such as water management, state agencies or federal agencies.
"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."
Complete ans, Specifications Must Accompany Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONT C OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER '
a�a-�so-oo2o City of Zephyrhills Permit Application Fax-813-780-0021 �
Building Department
' Date Recelved I � �
✓ / ��� Phone Contact for Permittin I �
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Owner's Name ����^� �(6fi Owner Phone Number ��7''S✓. � ��
Owner's Address Owner Phone Number
Fee Slmple Titleholder Nama Owner Phone Numher
Fee Slmple Titleholder Address
JOB ADDRESS '�!I ` �E � `I✓ � �� LOT A �
SUBDIVISION PARCEL IDtf
(OBTAINED FROM PROPERTY TAX NOTICE�
WORK PROPOSED � NEW CONSTR e ADD/ALT 0 SIGN � Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR � COMM � OTHER
TYPE OF CONSTRUCTION � BLOCK F ME 0 STEEL Q
DESCRIP710N OF WORK 1 5��-i� . ��rs 0� ��Q �i ��-�'f E� � �2�
i r� �y r`t `�` ��'° �.,
BUILDING SIZE ��/ !�. v SQ FOOTAGE � vV(S HEIGHT �� n�
Z �� '2
QBUILDING $ �!'f VALUATION OF TOTAL CONSTRUCTION '� ��e �� �
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QELECTRICAL $ AMPSERVICE Q PROGR NERGY Q W.R.E.C. S��
p n� ��,���� ��.5�G�
OPLUMBING $ �JC.'e-V1��'�/�-` `"— lO��
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QMECHANICAL $ VALUATION OF MECHANICAL INSTALIATION �
OGAS � ROOFING Q SPECIALTY � OTHER -�1� � �^ � � e0(,�
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO � �� '�`�Y��� ���
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BUILDER COMPANY �.�(9-�
SIGNATURE REGI3TERED Y/ N FEE CURREA Y/N D
Address ,- Llcense#
ELECTRICIAN O �' COMPANY �(�N���� �/� �
SIGNATURE REGISTERFD Y/ FEE CURRE� Y I N
Address � A'X,L� l `7� License# � ��5� /J�
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISrEREO Y I N F�CuRREn Y/N
Address License#
OTHER COMPANY � `��I 1 � �I r-
SIGNATURE REGISTERED / N FEE CURRE� Y/N
Address �� � k ���i� ��� � LJcense# �J l Z�l� ��j
111111111 111111111111111111111111111111111111111111111111111111111
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ien(10)working days after submittal date. Requlred onsite,Constructlon Plans,Stormwater Plans wJ Silt Fence installed,
Sanitary Facilities 8,1 dumpster;Site Work Permit for subdivislons/large projects
COMMERCIAL Attach(3)compiete sets ot Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new consWctlon.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Siit Fence installetl,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new projects.All commerclal requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directlons:•
Fill out application completely.
Owner&Contrador sign back of applicatlon,notarized
If over 5z500,a Notice of Commencement is requlred. (A/C upgradas over E7500)
•• Agent(for the contractor)or Power of Attomey(for the owner)would be someone wlth notarized letter from owner authorizing same
OVER THE COUNTER PERMITTiNG (Front of ApplicaUon Onty)
� Reroofs if shingtes Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW i
� ' NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what ticensing requirements may apply for the
intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the"contractor Block"of this appllcation for which they will be responsible. If you, as the owner sign as the
contractor,that may be an indication that he is not properiy licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTlUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buiidings,change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands,that such fees,as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a°certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release,the fees must be paid prior to permit issuance. Furthermore, if Pasco County WateNSewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner",I certiy that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owne�'prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be pertormed to meet standards of ali laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I aiso
certity that I understand that the regulations of other government agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not Iimited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WateNWastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Senrices/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted buiiding using stem wall
constniction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certity that use of such fiil will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit application,for lots less than one (1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or
set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building O�cial from thereafter
requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMEtdT MAY RESULT IN YOUR
PAYING 7WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO 08TAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN A ORNEY BEFORE RECORDING YOUR NOTICE OF CO ENCEMENT.
FLORIDA JURAT(F.S.1 3) .-
OWNER OR AGENT CONTRACTOR��
Subscribed and swo to( rmed) ore e this Subscri6ed and swo�rm d) re me thfs
b ' �
Who Is/are ersonalty know to me or has/have produced Who is/are ersonally kno to me or haslFiave produced
as identiflcation. as identificaGon.
�v�"�� Notary Public ���1 Yi� /I �/J!� Notary Public
commiss�on No. FFI� f`1�'SFU commiss�on No.___�F/(�^/9yU
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'�V�Y PU"'..
-��d3rrie �r�6tery tyE! , r t Name of Notary typed, r�s���s��' ed ASH LEY N EVANS
��MY COMMISSION#FF167940 " MY COMMISSION#FF167940
•�'�'oF;�d"'• EXPIRES November 28,2018 �'��d°�� EXPIRES November 28,2018
...�.��� •...Of FL,,•
(ao7)ase-o153 FloridallotaryService.com (a07).398-0153 FloridallotaryService.com
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: � \ \�'� V � s
Date Received: J��[.� (�
Site: � �� ���� �(/�
Permit Type: (� , �r� �� x �Q,�
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Approved w/no comment Ap roved w/the below commen •� Denied w/the below comments:
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This comment s _ et s 11 kept with the pernut and/or plans. '
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' (Required when comments are present)
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Zephyrhills, �L 33542 ��`asi9�atw� pate: SubmitAnotherPraof: �14/30/2015i8�S.SIGN3
Genera! Q Design is in a•c�;rdance with the requirements of the 2010 Elorida Building Code for use within&ouiside the Nigh Velocity Hurticane Zone{�iVtiZ). �This engtneertng certifies only the structural integrity of those systems,camponenu,andtor other construci3on explicitly
Notes: specified herein.t7 Electrtca)�otes,detaits,&specifications are provided by and arethe sole TespanslbiUtyof theelectrical contraaor,No elearica!review has been performed and no certift[ation ef cuch ic iniwndpri CF Alitmloum ovtn min�c c6oii F.n GbI.AS<....in. +...t..+M... •.
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GENER�4L NOTIES:
1. Design is in accordance with the 2010 Florida Building Code for use within
and outside the High Velocity Hurricane Zone(HVHZ).
2. Wind loads have been calculated per the requirements of ASCE 7-10 as
shown herein.
3. These engineering calculations pertain only to the structural integrity of
those systems,components,and/or other construction explicitly specified
herein and/or in accompanying engineering drawings. The existing host Index:
structure(if any)must be capable of supporting the loaded system as pg 1 Cover
verified by building department or architect/engineer of record. No pg 2 Wind Loads
warranty,either expressed or implied, is contained herein.
Pg 3 Anchor Design
4. System components shall be as noted herein. All references to named
components and installation shall conform to manufacturer's or industry
specifications as summarized herein. �
5. Where site conditions deviate from those noted herein, revisions may be Engineer'§signatur.e and seal valid
required or a separate site-specific engineering evaluation performed. - . �.,
for pages-l- through,,�'�
6. Aluminum components in contact with steel or embedded in concrete shall - � , -� - - ,
be protected as prescribed in the 2005 Aluminum Design Manual,Part 1A. _� � ; ; ,-, �
Steel components in contact with,but not encased in,concrete shall be � ,
coated,painted,or otherwise protected against corrosion. - � `
7. Engineer seal affixed hereto validates structural design as shown only. Use M8y 0 5,,: _
of this specification by contractor,et.AI,indemnifies and saves harmless - -
this engineer for all costs&damages including legal fees&apellate fees Ch'ristian Lt ey'�.._ ` PE#67382
resulting from deviation from this design. , E�S�/Se�IS • Ce Auth#29531
1200 N Federal Hwy,#200 ��C�9���1�- COm Page 1
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� Design wind pressure: P= 35.2 psf
� Sign type: Channel Letter `
j Sign size: A= b.0 sqft {per letter, critical}
Wal( rnaterial: Wood CDY,or equiv,thickness to rr�atch Min Embed
Anchor type/size: 1/4"Toggle Balt{r)
Ref: Pawers Toggle 8olt,eatalog
Min Embedment: Q.5"
Min edge dist: 2" Min Spacing: 1.5"
Anchor tensile capacity: Tcap= 87.5 Ib (per anchor)
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Total Reaction: Rt= 211 ib ...=p�a (per letter)
No.of anchars req'd: n= 2.4 anchors per letter ...=Rt/Tcap
Total anchors required: 3 anchors per letter
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CUSTONiERIJOB NAME: PAWNMAX I have carefully reviewed and hereby accept the drawing(s)as shown.
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' PHOPIE: 813-443-4622(MOBILE) 79s1 E.BroadwayAve.
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�^ Rpprovai Signature: Date: Print As Is: vssi s.a�auam�ao> ��„y�
�' �9y�� u,���� ���/�. Print W!Changes: T.mr>.Fn ssexa . .
.�����p�'�I§' �� �,y�A� tanmards�gnature: DBfB: SUbfnitAnolhe[Proof: B13•626rf446�626•3I(iNS
`� "� 4/30J2015
�neral O Design is in accordance with the requiremenis of the 20T0 Flortda 8uiiding Code for vse within&outside ihe High Velocity Nurricane Zone(HVHZ). �This engineeri�g certifies onl the structura!integrliy of thase systems,mmoanenta.=��ln•^*ti�•-^-�--�--`- " "
Jotes: speclfiedherefn.mElectr(calnates,detalls,&spedficationsareptovidedbyandarathesoleresponsibitityaftfieelectritalcontractocNoelettdca(reviewhasbeenoerformrda�ar��=����--�'---`°• '
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GENERAL N�TES:
1. Design is in accordance with the 2010 Florida Building Code for use within
and outside the High Velocity Hurricane Zone(HVNZ}.
2. Wind loads have been calculated per the requirements of ASCE 7-10 as
shown herein.
3. These engineering calculations pertain only to the structural integrity of
those systems,camponents,andfor other constructian explicitly specified
herein andjar in accompanying engineering drawings. The existing host Index:
structure(if any}must be capable of supporting the loaded system as Fg 1 Cover
verified by building department ar architect/engineer of record. No pg 2 Wind Loads
warranty,either expressed or imp(ied,is contained herein.
Pg 3 AncFror Design
4. System campanents shaif be as noted herein. AN references to named
components and instailatian shall conform ta manufacturer's or industry
� specifications as surnrnarized herein.
5. Where site conditions deviate from those noted herein,revisions may be Enginee�'s signature`and seal valid
required or a separate site-specific engineering evaluation performed. .{flr.pages 1 throiagh'- '�
6. Aluminum components in cantact with steel or embedded in cancrete shail � . -� � � �,
be pratected as prescribed in the 2005 Aluminum Design Manual,Part 1A. � ,, - ` �P
Steel components in cantact with,but not encased in,concrete sha!!be �
caated,painted,or otherwise pratected against corrasion. - ,
� 7. Engineer seal affixed hereto vaiidates structura!design as shown only. tJse - � � � ��' ` ,�� < - � ;
! af this specification by cantractor,et.AI,indemnifies and saves harmless y- : :� .� ,
�i this engineer for al(costs&damages including legal fees&apellate fees Christiar,i'-Lang( x_'�, PE�#67382
resulting from deviation from this design. Easy�e�1S � . � ert Auth#29531 '
12Q0 N Federel Hwy,#200 /�
Soca Raton,FL33432 t�������.COt7! Page 1
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V= 140 mph &asic wrnd speed ASD Load Combo Coeff: 0.6
Exposure C
�����A��'�113Ct5
a= 9.5 3-sec gust speed power law exponent Kd= 0.85 Directionality factar
z�= 900' fVamina!ht.af atmas.baundnry layer Kzt= 1.0 i'opographic factor
Gcpi= 0 Internal pressure coeff
A= 10 sq ft Tributary area
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j� A5D WlND PRESSURES �
$ g��� CENTER ; CORNER
; HEIGHT (Zone 4) ; (Zone S) � ;� � qZ � �' � �
; 15 ft � 23.9 psf ; 30.4 psf � 0�s� 36.2 -1 i 0 -i-�0
' 20 ft 25.4 psf � 32.3 psf � 0;0 3$.5 -� �� -1 �i�=,
�; 25 ft 26.6 psf � 33.9 psf � i; �S 40.3 -�.,'1C� -1 4C�
'} 30 ft 27.6 psf ; 35.2 psf � t t�8 41.9 -1 10 -1 40
� 35 ft 28.6 psf ; 36.4 psf i U 7 43.3 -A i.0 -� �o
, 40 ft 29.4 psf ; 37.4 psf � 1 r�a 44.5 -2 lo -1 ac
� 45 ft 30.1 psf � 38.3 psf � �C�i 45.6 -? �.0 -1.�tu
i 50 ft 30.8 psf ; 39.2 psf � 1 Ot.� 46.6 t 10 -1-;'Q
� 55 ft 32.4 psf ; 40.0 psf 1.i2 4T.6 -1 1C) -1 �0
4 }
j 60 ft 32A psf ; 40.7 psf # 7 }=� 48.5 -1 �,G -�. �CI
� 70 ft 27.0 psf � 54.1 psf � 1 17 50.1 -0 9G -1.80
' 80 ft 27.$psf � 55.6 psf i ?1 52.5 C+t�0 -1�Ca
� 90 ft 28.5 psf ; 57.0 psf � 1 7_%� 52.$ -0 �U -i.8G�
� 100 ft 29.1 psf ; 58.3 psf � �7 54.0 -D:�0 -1 8Q
` 110 ft 29,?psf ; 59.5 psf � 1 2�? 55.1 -090 -2.�0
i
� 120 ft 30.3 psf : 60.6 psf � 1 3� 56.1 -�5'0 -1 �0
3 13Q ft � 30.8 psf : 61.6 psf � 1 �� 57.0 -0 9t� -1.�0
� 140 ft 31.3 psf � 62.6 psf g 7. 5�-� 57.9 -0 9G � 30
s
� 1S0 ft 31.7 psf ; 63.5 psf � 1 ;n 58.8 -i�9U -7_ �C1
` 175 ft 32.8 psf � 65.6 psf i : 42 60J v 90 ! SC
�
200 ft 33.y psf � 67.5 psf ; i..t;� 62.5 C;�;0 -=� 80
`' 2SQ ft 35.3 psf 70.7 psf _. `.�� 65.5 -f� ;G -i 3C"
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Design wind pressure: P= 35.2 psf
Sign type: Channel Letter
Sign size: A= 6.0 sqft (per letter, critical)
Wall material: Wood • c�x or equiv,thickness to match Min Embed
Anchor type/size: 1/4"Toggle Bolt(r)
Ref: Powers Toggle Bolt,catalog
' Min Embedment: 0.5"
Min edge dist: 2" Min Spacing: 1.5"
Anchor tensile capacity: Tcap= 87.5 Ib (per anchor)
C�e�� �an����� f�r P�a�6��� I
I
Total Reaction: Rt= 211 IfJ ...=P*A (per letter)
No. of anchors req'd: n = 2.4 anchors per letter ...=Rt/rcap
Total anchors required: 3 anchors per let#er
O�C,criti��l anchor�pt6o�sh�e�r�.
llse min (��p�r 9�t��ro
�i
Page 3
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PO Box 964 Valrico, FL 33595 (813)-626-7446 Fax(813) 626-7440
LETT'ER OF AUTH�RIZATION
Signstine Signs, Inc.
Scott Bernier
State Certified Electrical Sign Contractor#E512000731& ES12000749
I,Scott Bernier, hereby authorize the building department to issue permits to Karen Bernier,who is acting as my agent
to secure permits for me and the company I qualify in the designated construction trade.
I understand that as qualifier, I take full responsibili.ty for work approved under the permit and all work is to be
performed by me and/orthe company I qualify.
This authorization is valid for all permits until it is revoked in writing by the undersigned qualifier.
"�ig ture of Qu ifier
State of Florida
County of_Hillsborough_
The foregoing instrument was acknowledged before me this_20_day of_MAY,2015_,
By_Scott J Bernier ,vuho is personallv known to me or has produced
.as identification.
NOT
rt�s'r'>�8..
:=?� �� ��;:_ ASHLEY N EVANS
."�� s MY COMMISSION#FF167940
�f� EXPIRES November 28,2018
•...o��,.
(ao7)39s-oi53 FloridaNOtaryService.com
PO Box 964 Valrico,FL 33595 (813) 626-7446 Fax(813) 626-7440
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_._____� �.�, _�_.__�_—.��,�,���
� �.-.w.,�%� "Izatelligelat Sez^vice"
IVOTARIZED LETTER OF AUTHORIZATION
I � � N ���l�(� as owner or agent for the owners of the property located
At � � 1U,4 Z � ,��ifs � 3 3,�?¢�Z
grant permission for Signstine Signs, Inc.
(lic#ES12000731),it's agents or subcontractors to apply for and receive signage permits required to
install igns on e property at the above location.
�"rL- /,S'
Signature of Owner/Agent Date
. /G�,�-�/ �v�� � �Z /S' '
Print Name Dat
STATE OF �jaUw e)�
COUNTY OF � � �
The foregoing instrument was acknowledged before me this l�day of���20��by
�c��t'�'a�.� �Q f k . Personally Known�OR Produced
Identification
Type of Identification Produced
i
Nota Seal =�°`�',,��8�: ASHLEY N EVANS
t'y =_ ��-:
;� Q, MY COMMISSION#FF167940
�-•'.,��d�`_ EXPIRES November 28,2018
OF FL„
(ao7)398-0153 FloridallotaryService.com
Not gnature
PO Box 964 Valrico, FL 33595 813-626-7446 ES12000731