HomeMy WebLinkAbout15-16865 l
� � CITY OF ZEPHYRHILLS I
: 5335-8TH STREET ii
' (813)780-0020 16865
BUILDING PERMIT
PERMIT INFORMATION � LOCATIO.N INFO.RMATION �
Permit Number: 16865 Address: 38429 COTTONWOOD PL
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: DRIFTWOOD
Est. Value: Parcel Number: 02-26-21-021B-OOG00-0040
Improv. Cost: 1,442.00 OWNER INFORMATION
Date Issued: 12/31/2015 Name: LAWRENCE, JAMES & BRENDA
Total Fees: 67.50 Address: 24 WOODRISE
Amount Paid: 67.50 FALMOUTH MA 02540
Date Paid: 12/31/2015 Phone: (813)783-1452
Work Desc: REPLACE 2 WINDOVIIS S/S
- _ CONTRACTOR S - APPLICATION FEES
, HOMEOWNER BUILDING FEE 67.50
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' Ins ections Re uired
FOOTER 2ND ROUGH PLUMB M C INSULATIO CEILI G
� FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
' REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the
, local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property 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 Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
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CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
� PROTECT CARD FROM WEATHER
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City of Zephyrhills
BUILDING PLAN REVIEW CQMMENTS
Cantractor/Homeowner: ���1-�..vlC� _ ��G'�-✓��
Date Received: � �— .�B�-�s
Site: 3�� Z~°l' �d�"�n �+��G7'{ �'L
PermitType: rcX_,��G�Ce Z � � �'1G�C�S
Approved w/no comments: Approved w/the below camments: ❑ Denied w/the below comments: ❑
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This comment sheet shail be kept with the permit and/or plans. �
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Kal in Swit Plans Examiner Date Contractor and/ox Homeowner
(Required when camments are present)
e��-�so-ooao City of Zephyrhills Permit Application FaX-s�aaeaooz�
Buflding Repartment -
Date Recetyed C�'�ZU'`�� � Phone Contact far.�PerinittEn .��� �7 D '
qwner's Name ..�� vi. Owner Phane N�mber .Sv��Z���l 70
Owner's Address 3 o'�Z Ca TrD V1 0 Owner Phone Number J�G ��-�G/_'��Z� _I
Fee 5lmple Tltleholder'Name � � Owne�Phone Number '�� �
Fee Simple Titleholder Addresa
JOB ADDRESS �� L � W�0 4T �!G +.',. LOT# �_��
SUBDIVtS10N � � P.ARCE�tD# W
. (08TAINED F.R4M.PROPERTYTAX NOTICE)
W4RK PROPOSED �.,NEW CONSTR ADQIAI.T � SIGN C] [� DEMOLISH
-e: INSTAL4. 8 REPAIR
FRQPqSED:USE _ Q� SFR Q COMM Q OTNER �
TYPE OF CONSTRUGTION � Q ' "BLOGK ' [� FRAME ' G� STEEG Q
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DESCitIPT1�N OF WORK v J � �Q c..2 "'�W t�CZ �'��r i G�� Y�O 1+rt �vt Gf O WS
i BtlILDIMG'812E _�� � 3{�FOOTAGE�� H51GHT .C�_____�
��������" � ,� ��lZ VAIUATE0t+1'�CiF`TO'4'PiL COt�STRt1G1'ION
E�ECTRICAR. . -� � AMP SERVICE Q PROt'aRESS ENERGY Q W.R.E.C.
QPLUMBING ' � �y�'� �
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QMEGHANICAL $ VALt)ATtOtV QF MECHANiGAi INSTALlAT10i+1 ���
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�� [,,,�]GAS CJ RQOFING Q SPECIAI.TY [� OTHER - "!'
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FINISHED FLOOR ELEVATIQNS � FLOOD 20NE AREA [�YES NO
�; BUFl.DER ' �� ` COMPANY ����-�Cl{.�Yl i°f--
'� SIGNATURE �"�O�' � REGISTERED Y/ N FEE CURRE� Y/N
Address ` CicEtttse# � �
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� E�EC'CEi1C1AEt , ' �`COMP�WY
SiGNATURE �' REGI3TERED Y/ N F�'cuFtRer. Y/N
Adctress • - _ ' - � , . , Licanse,# � . �
� PLUMBER � „COMP.ANY . .� °� ,
' SIGNATURE �y , REGISTERED . Y:/.-N �FEE CURREP ', Y�/N `
Addre�s � - ' ' License,# � - , '��.
MEC11Al+lIGAE: ` � � C.OMR�WY, � -
SItiNATURE � ' REGISTERED � ... Y/ N ' FeE�cuttt�n Y,/-N
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Addre�s' ' s- � ' ' ticense.# �—� ��
OTHER � - � ' � �;COi111PANY, , � �
SiGNATURE ' � � ' � ` ' � � �REGISTEFtED " � Y/ N... FEE CURREA Y/N
Addre�, � » � ��r � � ' Llcense#�� �
�;;;-,...:: :. .r . . .. .. ;. � .
RESIDENTIAL•:,_.°Attach"(2j P1ofiP,lans;,(2)sets�of::Butliling�Plai►s;(1)sef of-Energjrx�oiin's;R=00.W Perrmiit for new copstruction, .
- Minimumkten�(1.0);wo,rking;days_aiter�"submittai`date.�R'equlred onsite,ConstrucUan:Rians;Stormwater'Plans w/Siit Fenrs installed,
- � ' "���� Sanitary FaclltUe.s,;&;1;dumpste_r,�Site Work,Permlt#onsubdivisio�s/large<pr,ojects ,N,::., � `- � -�: � '
CQMMERCtAL Attach{3)complete�sets af Bu1l�liig Plans plas a Ufe Sa�iy Page;{1}set of Energy Forms.!Z 4 W Pesmtt�os new aanstnsction, - --- -
Minimum ken(10)working days after submittai date. Required onsfte,Construc8an Plane,Stormwater Plans w/Silt Fence lnslalled,
Sanitary Facilitles 8�1 dumpster.Site Wodt Permit�or ali new:proJects:All commercial.requlrements.must meet campllance `
SIGN PERMIT Attac�'{2)sefs of'Englnee,r,ed�1?ians. ..: .<: : , , , ,
""'PROPERTY SURVEY required for all NEW construCUan.
Directlons: .. .:. � . , � �• "
� FIII out applicaUon completely.
Gwner&Contractor slgn back of appllcaUqn,notarized
tf aver�2504,a Nottce of Commencement is required. {/VC apgrades aver ST500) ,
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Agent(far the contractor)or"Pbwer of�Attoriiey'(for tFie owner)would be someone with natarized letter ftom owner authodzfng same
OVER THE COUNTER PERM17'f1HCa.�.,,M•3,:(Fftin#of=1tPP1IcaBon�Onty}��^ �y , " . , _. _.�,_.._ ,.,.. �: '.":-'. -: :
Reroofs(f shinglas Sewers Service}Upgradas,-A/C ._ Fences(Plot/Survay/Footage) r - " � � . .1
Drivswaya-Not aver Caunter.if on�publlc roadways..ii�eds Rt3W<, ` �{, f F . � , ' . '�� �� �...
'„ ... .�M: ... . .. .wN.- .�,-• - _•,.,,, , " .:, ....... .M..<. . ,-. . � ,. �. ,__., , . .
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NQTICE OF DEED.RE8TRICTIONS: The underslgned,under�tands�th�#r#hi�.;.��cmif,maynbe,sub�ect:to:r:deed:_restrictlons r__.;.::,..._,�...
,� :- � ., .. .
which may�be��more.r."esti:tctive'�#h��County-��gr�laflons:��Ttie��underslg'ned assumea�r`esponsibllity�for'compllance'with"any� ' " "
appllcable�deed�reaMctians. .:.... . :. . .: . � . .. ,.. . .._, ._.� �.. ,:,. . : --
UNLICENSED•CCiNTRACTORS �AND CCtNTRACTOR RESPONSIBtttT1ES:: -ff the�ownerLhas��hired'�a'contractvr ar
contractors�#a undertake work, they may:be.;requir:;edRto.�b�;itcensed In accardance.with;state.and_•local:.regulations: �If�the��-� r �
con#rac#or ts nof�llcenseil�as roqulred`�6y law. bath'#he owner�r�'coriVactoT��rnay be�cit$d�for��a:misa��mesnor vtolatEan
under state law. If the awner or Intended:-cantra�tor:are3�unce�taln as to wfiat Ilrensing,requlrements:;;meyt:epply�ior�tFie��� �:_�� � ��
�.r��.,r ., i, . �
intended work�they are advlse�!to�coritact fhe Pasao�Cou�ty Bullding;`Inspe�ctlon;DIvlslgn.-L•tcensing Seatton at 727-847- �
8009. FurtFiermore, if the ovi±ner�iias'hi�d a aori�actor�oT coritractors, tie is advised to have the cantractor(s),.slgn
portions of the °contractar Block"_,of.thfe_application:fo�whlch they,wili..be.>tesponstble.- If.:yau;Y•as.#he owner'sign'a's"''the �
contraotor, thet�may'be an Indtcation that`�ie'Es'rio#:prapeiiy llcensed'and��ls`�ti�t'en�itled�to petmittiitg prEulleges In Pasca
County. - ::�.�_:..�:- .
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TRANSPORTATION-IMFACT/UTILiT1ES�(MPAC'C�ANb-RE$AURCE RECOVERY�PEES;�The undersfgned"understands
that Transpartation impacf Fees:and.Recourse Recovery_Fees,niey�rappty.ito:th�construction of nsw_ba�iidings,rchange�of`="�' `'��� ��
use in existing buiidings,-or:expansl�n•of°�ex�sti�i�:�6uildiags, as specffied.in Pasco County Or'dtnanae number 89-07 and •
90-07, as ame�ded.f:The underslgned afiso;understands, t#��#:�such fees;=,as�m�y:��e��dt�e;,,will>6e Idan��Ied a#thektime�df:� , ..Y',- _
permikting. It is fu"i'the�understood that Tra�sportatlon Impact Fees and�R�source..Reco�ery�'Fees.must be pald prior to
receEving a."cecfERcate-ot occup�ncy"'or flnal powe.r._r.eleese: :}f-the.pro�ect:doe�;ri6t invalve�:a�cert�ica�e of occupancy�o�`::��- ��`; =:
final powec�release; the;fees_mu�t be"patd,pr�or#o.permit issuance. Ft�,�thermore;If.P�sco.C,ounty'°Water/Sewer;lmpact� ,:� -��.���
fees are due,.they must.be;pald.prior�o.permiE':iss.uance�.in,accordancs:witt�.appllai�ble,_Pasco'-.Cvunty�a��llnances. •
COtdSTRUGTtON'CIEN"I.AW tCfiapt�r 713N Elor�da�tstut�a�t�a amendedy: �f valua�on of work is$?,500.00;or.more,.l -:. ���,
certify tFiat I, the �appllcant,_ have�been praylded �wlth-~a=copy-�of. #he��;"Florida ConsUucttoin� Liert ts�uw�-Homeowner`s
Pratection Gutde" preparod by.the Flo�da Qepartmer�t�af Ag�cult�re and C6ns�mer-A{�atrs. If#he applicant Is someone .,...;,
other than th�'owmer", I certify.that I�have.obtained�a'copy;ot#he;above.rles,crlbed docunt�ent�and,pt;amise:tn;gootl:faith_to � ,
deliver It ta:the,'ov�mer":pi9or�:toL4ornmencement:`' ' � , . � . _ ,µ.. � _ . � _ �-
CONTRRCTOR'S/OWNER'S AFFiDAVIT: I.ceiti�'y,;ffisfiatl the�;tnformatlon�:ln�this appltcation is sccurat�s and fhat atl woric
wltl'be done in cumpltance wlth all.appllcable laws regulating canstructlon� xoning and�land developm�nt. Applicatlon fs
heceby made to obt�tn .a.pert»i#:,to.:da,wor�r;,.and=lhstalla�on as indt�a#ed:..,.°:1.-certitjr that no work�r�r tnstalta#ton fias
commenced pi�lor M I'ssuance of-a pemilt'and that':all�work wlll be pertormed�#o meetrstanderds-af �U laws regula�ing�
construatiort, County and Ctty codes, zonlr�g regutatlans� and land devebpm�r�t regislatEor�s�In t#ie Jurlsdtcfton.= l�a4'so
ce�ify that I understand #hat the regulatlons of other goveenment agencles may�apply�ta the.lntended�vork, a�d that it is
my responslbility..to Identlty�what.acttons!must�take:to be,lr�:.cort�pllance:_S,uch:agencles Include but�are�.not Ilmlted to: •
- Depa�t n�LLre�nt aaf Environmental�°Protectfoti=Cypress.8syfiead�, We�and Areas and EnvironmentaNy Sensitive
�ands,''Vli'ater/;Was#ewater Treatment. . ,,�
- Sauthwest Flo�t�a 1�ater Managemen� :t�isUlct 1Ne1ls;` Cyptess. 8ay#�eads; Wetland Are�s, Altering
Watercaurses. �
- Army Corps a1`Englneers-Seawalls}Dooks,IVavtgatile Waterways.
- Depar#ment af,:Hea1tF►;:,b. Ref�abilitaHve,ServicestEnvitonmen#at�Nealth Unit Wells�-Wastewater�Treatment, �
�'aeptic Tanks.. - � - - � .
- US Envlronmental Protectlan Aget�cyAsbestos aba#emen#. � '
- -FederalAvlatlon=AutMorlty=Runways:� -
!understand.that the.tollowing.restrlctlons�apply"to the use of fllf:•
- Use of fill is not allawed 1n.Fiocd,Zone"V"unless expressly permittsd.
- If the.fill ma�terlal ts �to��b:e used-ln �flood Zone. "A", It Is understood that a dratnage p9an addressing a
"compe�sating volume'will be submltted at�me of.petmltting wfitch is prepared by a prof�ssional englneer
qcensed by the�tate of Florlda: � � �
- tf th� i91! materlal�is�to be:used 1n F1ood �one 'A° in�connection�wlth�a��ermltted buflding� using stem waN
� canatnactton� I certify.that fUl:i�rlll:b.e-used only.to.f111 the area withln�the�ste�n-wall.
- If fill m�te�lal�ls to be used-lri any area; I��ceKffy t#�at .uss. of such fll! will not adversely affect ad)acent
propetties. If use�of fill 1s foc�nd;to adversely��ffect adjaiEerit•-prc�perties,.the owner may be cited for vto�a#ing
the cand4ilons..of the bi�llding:permlt ls'sued�under the'at�actied.:permit applicatlon� for._lots-�.�ess:than.one (1)
acre wtitcfi a�elevaterl�6y i�ll,��t englnee�d draln�ge plan Is requl�d. . .
If I am the AQENT FOR.THE�OWNER,,I;pramtse In good.falth#o Inform the awner of-the permltting conclft�ons set forth In
thls affldaYtt�prior to commeracing constniotlon. 1 uriders#iand that a�s�parate�pea7»!t may be requlred f�r electrfcal�work, , __
,�.�.�.t .
plumbtng, signs, we(Is,.paols,.air canditioning,-.gas,�or"othef instaEt�itfons no�•spec�catly induded�in.the application. �A • ,_
permlt Issued shall be coinstrued to`b`i��a�Ilcense`-tp��proceed wlth tFie avo�k and not�as:authoHty.to:vlolate;cancel, alter, ar .
set aslde eny pr+avlsEans of#he teclinfcal cades;,nor shelt Issuance�of a.permlt.prevenf ffi�e Bulldirig t?#fiicla�l from therea(ter
requlring a canecttan Qf ercors In,plans; consftuctlon.or irlolatlons bf�eny codes. Every p�ermtt Issued"siialf become�invalid
unless the wark authorized�by such permlt:#s_commencec��wlthtn_sf�c.months of�perm{t lssuanae� or if wc►rk autharized by
#he permit is suspended�aC.abandoned�for:a::period,of sim f�)monfiis.afte�the tlrrie fhe�wo�k��s commenced,� An eutenslon
may be requested� In wrltlrig� firom the Bullding,Offlclal�for a perlod::not to exceed'nlriety�(90) days ai�d w1A demonstrate
jus#�iabte caeise far.�the extensloa; If work ce�s,es;for nlnety.{9Q)cons.ecuthre:days,..th�job�is.eonsfdered��a�doned:
WARNlNG TQ 01NNEl�: YOUF�.-�AILURE,TQ,R�ECQEtQ,A�NOTICE:QF���CQMMENCEMENT_.MAY�RESULT IN�YOUR
PAYtNG TWICE�FQR IMPROVEIWEN.�'8 TO.YO.Ut�•:PItOPERTY:��IF�:YO.U�Ii�"FEt�D��TO��MBTAIN�FINA�1�tNG,�ON3ULT
. . . .. _ _—_
TWI�T.R9H�����EMD�R�OR AIV°�TTORNE��EFOR�RC�OR�1t�l�ltl"�ll�'l1,�t��'��C�M111�@NC���"-_- _
OWNER OR AOENT ?" ��� . '�"�,r CONTRACiO ; ` � � ,
Subsal6�and swo a�f�ed)6etore me this Subscrlbgd sad'sw� � {ot a�lnnedybe#[ore me�th
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/2�2t��by ccw,�.S w. . ��C /Z 2F�1.�:by� . r"'��€�-�-i�! � .k�r�.v�cQ.
Wh slare personally knawn to.me or haslhave.produced Who.ls/are,p.eraanal�r kn m`Co me or has/have•�roduced • �
_�.�ceh�..:_. as Ider�tlBc�Boti. ,��t�s Ci c�,+� as Iden�iicattan.
� ' -+'�. �-� � Notery Publtc . 1.�. Npfary Publlc
Commiss c. �� Comr7�bs � o, ,
r,�ti ��;, ACQUELINE BQGES
,,••ti�+��Y,�.,, JACQfJELINE BOGES =�; :►'� Co
Name o1 N F�tty e1t=P Name of NotarY tYp ;�' 6�6C�t�bBt 12 20t8
;; •a,� xpres ecem6er92,2018 ��„, ��,rw„ {
'%�,pa��;;`�`� BondW ih�u iroy Fdn In�uronc�800�385.70f9 ���I������°+,�IB
12/23/2015 06:17PM 8139293345 HODA PAGE 01/01
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Quote _ . . http;//sstsrvto�s.comhnz0 b/mediumQ��ote.jsp?projectid�l4...
Nc�t Gla�s:IVo
Gluys CalorTezture:Cleor
G1�vc Type:Anuedled
C Op�ious:None
Glass Thickne��:3/IG in-3/15 ont
Grid Type:NO Gnids
scceer�:so�r► ALL WORK SHALL COMPLY TH ALL
� Fuu o�•(-1ulF 5creen:l-LalPSc4�ee�a PREVAILING CODES,FLORI A BUILDING
Screen Mes1t Type:Fi6ergl�ss Mesh• CODE,NATIONAL ELECTRI CODE AND
cYeen Mesh F;nish.Charcoal Mesh CITY OF ZEPHYRHILLS 0 ANCES
Lnck Type:S►yle Cu�n Lock(s)
iV�unher pf�,qeks:2 Y..ocks
H:i��dwm�e Fini�h-Interior:$lack
C.atch I.pCalioiL Noqe ,
Doey Uni�Meet Eg»es Rcq;N(ee��5.7 sgft Egre�(A�l ' i` /
oors) •���11�PV G�'�1 �y�D��J
Bxte�•iar Frflme Op►iona:None ���
nterior�rame Opiions:None ��PH RHILL�
Prep f�r Mull:N�Mull Prep PLA1�S �XRMI
, •- �Io�tida�A .��val Num6er:�i446?:2 �._....�_--
Lead Tinx:21 bays '
� Iicm Number: J2I679 •
Project 7�aa�: �i,143.78
Salcaperson: pANTEL BEMTEZ(S 1003DB 1)
Accepted by: Ds�le.11/'?7/2U15
Print Detailed Quote I ,
Thi.r Millwork Quote i�vE►lid umil 12/26l2015.7'bis is an estin�qte oialy.This eseim�ue doe,s no�include t;vc qr deliveiy
chorge�,IIelivery o�:aJl matea�iuls contaiqed in tliis e�timdee�re subjec�to ev�tilubiijly Frrnu tbe m.ur.ufuclnreror avpplicr.Ali
lhe:�F,ove quuntieie.r,diz[►casiona.�perific�uions nod iisces�o�ties hnve been vcri[ied and acecptcd.
2of2
11/27l2015 l0-2S A�A
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DISCLOSIIRE STATII�NT FOR OWNFR
CITY OF ZEPHYRHILLS SIIILDING DEPARTMENT
I, have read and fully understand and
agree to the provisioas of this iastrumeat.
The undersigaed states aad affirms that he or she is desirous of constructing,
reaovatiag, adding to or reroofiag his or her own domicile, that he or she
actually occupies, or will occupy by said domicile, aad same is not for
rent, lease or sale. That he or she shall comply with the following conditioas:
1. That the owaer aad he or she alone shall act as the builder for all phases of
constructioa.
2. That the owaer will comply with all provisions of the City of Zephyrhills
ordinances aad codes pertinent to the buildiag.
3. That ia the event various phases of constructioa are subcontracted, he will
engage oaly properly liceased subcoatractors aad will personally supervise
such work.
4. That in the eveat the Buildiag Iaspector ahall require corrections to be made,
the owner will assume full responsibility to iasure they are made, and upon
completion will call for a reiaspection before proceediag with the building.
5. That the owner shall assume full respoasibility for the constructioa aad will
not expect supervision of his work from the City of Zephyrhills Building
Departmeat.
6. That prior to final iaspectioa aay additional fees, iacluding reiaspection
fees, must be paid ia full. A written request from this office shall
coastitute an official notice to pay additional fees.
7. That the owner shall comply with all City, State and Federal laws in regard to
social security, workman's compensation, lien laws, etc. , where applicable.
8. That the owner shall comply with all the safety codes issued by the Florida
Iadustrial Commission.
9. State law requires construction to be done by liceased contractors. You have
applied for a permit under an exemptioa to that law. The exemption allows
you, as the owner of your property, to act as your own contractor with certaia
restrictions evea though you do not have a license. You must provide direct
onsite supervisioa of the constructioa yourself. You may build or improve a
one-family or two-family residence or a farm outbuildiag. You may also build
or improve a commercial buildiag, provided your costs do aot exceed $75,000.
The buildiag or residence must be for your own use or occupancy. It may aot
be built or substantially improved for sale or lease. If you sell or lease a
building you have built or substantially improved yourself within 1 year after
the coastructioa is complete, the law will presume that you built or
aubstaatially improved if for sale or lease, which is a violatioa of this
exemption. You may not hire an unlicensed persoa to act as your coatractor or
to supervise people working on your building. It is your respoasibility to
make sure that people employed by you have licenses required by state law and
by couaty or municipal liceasing ordinances. You may aot delegate the
respoasibility for supervising work to a licensed contractor who is not
licensed to perform the work being done. Any person workiag on your buildiag
who is aot licensed must work under your direct supervision aad must be
employed by you, which meaas that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for that employee, all ae prescribed by law.
Your constructioa must comply with all applicable laws, ordiaaaces, building
codes, and zoning regulations.
OWNER'S SIGNATURE � DATE ' ��?��/��
ADDRESS ?j� � �„9po t� ��-�
PHONE 5 -�('7
Q i
WITNESS PERMIT # �2 � J� ' � S