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Home My WebLink About16-17623 : CITY OF ZEPHYRHILLS `" 5335-8TH STREET (813)780-0020 17623 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION � Permit Number: 17623 Address: 5908 FOREST LN Perm�it Type: MECHANICAL • ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Propos�d Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS , Es�. Value: Parcel Rlumber: 10-26-21-0110-00000-0130 ' Impra�v. Cost: 3,400.00 OWNER INFORMATION Date Issued: 8/02/2016 Name: BUSBY LEROY & JOYCE Total Fees: 55.00 Address: 5908 FOREST LN Amo�nt Paid: 55.00 ZEPHYRHILLS, FL. 33542 D �te Paid: 8/02/2016 Phone: 813-395-8193 Woc�k Desc: A/C CHANGE OUT 2.5 TON 15 SEER HP CONTRACTOR S APPLICATION FEES ALL ABOUT AIR FORCENTRAL FLORIDA A/C CHANGEOUT 55.00 �� , �� Ins ections Re uired DUCTS IN TALLED � DUCTSIN$ULATED FINAL I REINS ECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the I local �overnment 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. NOTIC : In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that may b 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. "Wa�ning to owner; Your failure to record a notice of commencement may result in your paying twice for improvements to your properly. 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 pertormed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. I CONTRACTOR IGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR IPISPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-7 0-0020 City of Zephyrhills Permit Application Fax-813-780-0021 .- ' Buitding bepartment Date Received 1 Phone-Contact far PennitEin Owner's Name Owner Phone Number � „��,�� . Owner's Addre s � G L Owner Phone Number r � ' Fee Slmple Tit eholder Name � � Owner Phone Number � � i Fee Simple Tit eholder Address JOB ACIDRES LOT# I� � 1 I, SUBDiViSION �j'(''��,� �f} 11� PARCEL ID# �(�' - —(� ,3 (OBTAINED FROM PROPERTY TAX NQTICE) WORK PROP SED , N£W CO3vSTR � ApDJALT � S1GN Q CJ DEMOLISH e INSTALL 8 REPAIR � PROPOSED U E , Q SFR Q COMM � OTHEft 7YPE pF CON 7RUC'170N Q BI.00K Q FRAME � STEEL Q DESCRIPTIO OF WORK ,� � $' � �� BUtLDING SiZ SQ�OOTAGE�� HEIGHT C�� ' QBUI i}1NG �6 � VALUATION C!F TOTAI.CONSTRUCTION QEi.E RICAI. � AMP SERVIC6 Q PROGRESS ENEi2GY Q W.R.E.C. QPLU 81NG �� ;��''�� 3�� L- QME NANtGAI $ � t,�y VAIUATlON OF MEGHRNtCA[.INSTA�lATIC?IU ��} 1� // ,� OGA [� Ftt70FfNG Q SPECIAI.'fY � OTHER � j �� v FINISHED FL �OR ELEVATIONS FLOOD ZQNE AREA YES NO �� ✓ `@� 0 1� �"�" l� �4Jt�t?�6� -- COMpANY - SIGNA7URE , , REGISTERED Y/ N FEE CURRE� Y/N Addres� Ucense# � � E�ECTRlCI CBMPAt�tY SIGNATURE REGISTERED Y/ N PEE CURRE� Y/N Address � L(cense# r� �� PIUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURREA Y/N Address License# C. ,_,�„_ ,,, MECNANIC � ��j _ 1,,��;,,� COMPANY � {�1{' k-C 0.t �'lo ' �. SIGNA7URE �'"'�"'�"- �'�-�"�"�-�'� REGISTERED Y/ N FEE CURRE� Y/N Address �,�� ,(� �� W�p�^-,�� L. 3S License# � —� OTHER COMPANY i SIGNATURE , Re��s7'EREo Y/ N PEE CURRE� Y/N Ac3dress , License# �� RESiDENT1i41� Attach{2)Piot Plans;..(2}sets af:Btillding`Plans;(1)seE of E�ergy Forms;R-O-W Pemilt i�ar new constnsction, Minimum;ten,(10)working days after submlttal date. Required onsite,Construction Plans;Stormwater Plans w/Sflt Fence installed, Sanitary FaciUUes&1.dumpster Site'Wor6c Permit for subdlvisionsAarge projects COMM�RCI Attach{3)complete sets of Bu3tdirig Plans plus a life Safety Page;{1)set af Energy Fotms.R-0 W Permi#far new canstruc6on. � F Minimum ten(10)working days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w/Silt Fence installed, San(tary Facilides&1 dumpster.Site Work Pertnit for all new proJects.All commercia!requlrements must meet compllance SIGN P�RMt Attach{2}sets of Etiglrieeted Rfans.... ••'•PROPERIY SURVEY required for all NEW construcBon. Dtrectlons: . Kill out a plicatlon completely. Owner 8 Contraotor sign back of appt(caUon,notarized If over� 504,a Nottc�of Cammencement i�requtred. (A!C upgrades over$T500) `" Agent(fo�r the contractor)or Power of Attomey(for the owner)would be someone with natarized le8er fram owner authorizing same OVER TNE C�UNTER PERMITiiNG ��•r;- {Eront of;ApplEcatiomOnly}�_, Reroofs if shi gles Sewers �_Service Upgrades A/C Fences(PIoUSurvey/Footage) ' Drivewa -Not over Counter If on,public roadways..needs ROW ' - .,. _, . ,....F�ri . ._. w...., ,...x.. -..b ... ' ' -- . . � NOTICE OF DEED RESTRICTIONS: The undersigned understands.th�t.this.permit may.be.subject to,"deed"restrictions" � which may be•more=r.estcictive-thart County�regulations:�The undersigned assumes responsibiltty for�compliance witFi any � applicable deed restrictions. • ' UNLICENSED CONTRACTORS -AND CONTRACTOR RESPONSIBILITIES: If the owner�has hired� a contractor or contractors to undertake work, they may_be r�quired.to be._Ilcensed.In.accordance.wtth state:.and:local.regulations. =1f the � contractor is not Ifcensed as required"-by law, both the owner and contractormay be-cited��for-a�misdemeanor violation under state law. If the owner or intended>contractor are;uncertain as to what Iicensing.requlrements;may;apply:for,the intended work, they are advised to contact the Pasco County Bullding Inspectton DlVislon--Licensing Sectton at 727-847- 8009. Furthermore, (f the owner has hired a contractor or contractors, he Is advised to have the contractor(s) sign portions of the "contractor Block° of this application for whtch they will be responsible. If you�.as.the owner�'slgn as the contractor, that may be an indication that he is not.properly Iicensed and is not entitled to permitting privileges In Pasco '� County. � ' � ` � TRANSPORTATION IMPACTIUTILITIES�IMPAC�'�ANb RESOURCE RECOVERY-FEES: The undersigned understands , '� that Transportatlon Impact Fees and.Recourse Recove.ry.Fees may��apply�to:the constructlon of new bulidings,.�change of - , use in existing buildings, or,expansion:of-+existin,g`�buildings� as specifled.in Pasco County Ordinance number 89-07 and � 90-07, as amended. The undersigned also understands, thaE such fees�.as,may�be�..due,.wilL be identified at the�time of � I permitting. It Is iurther understaod that Trensportatlon Impact Fees and°Resource Recovery�Fees must be paid pr(or to � ' receiving a "certificate of occupancy" or flnal power,release. :If the.project�does.not,involve a certfficate of occupancy�or : ' finai power release, the fees must be pald prior to permit Issuance. Ft��thermore,�if:Pasco County�Water/Sewer-lmpact � � fees are due,they�must.be�paid prbr to permit-Issuance-in accordance with applicabie Pasco County ordinances. CONSTRUCTION LIEN LAVY(Chapter 713� Florlda Statutes,as amended); If valuation of work is$2,500.00 or more, I certify that I, #he applicant, have.been provided with a copy of the��Florida� Construction Lien Law=Homeowner's Protection Guide" prepared by the Florida Departmenf of Agrlc.ulture and Consumer Affairs. If the appl(cant is someone other than the°owner", I certify that I have.obtained°a copy;of..the.above..described docuFnent°and.promise in,good faith_to ' deliver it to the°owner�priorto�commencement: � � � CONTRACTOR'S/OWNER'S AFFIDAVIT: I ce�tify.that all the Information (n this application is accurate and that all work will�be done in compliance with all appNcable laws regulating constructlon, zoning and land development. Application is hereby made to obtain .a permit to do work.and Installatlon as indicafed:. 'I certffy that no work or Installation has commenced prior to Issuance of a permtt and that.all work will be pertormed to meet standards of ali laws regulating� construction, County and City codes, zoning regulations, and land development cegulations�in the jurlsdtction. ( al'so certify that I uaderstand that the regulatlons of other government agencies may�apply�to the intended work, and that it is my responsibility to(dentify�what.actions I must take.to besln:.corrlpliance. Such agencies Include but-are..not Ilmtted to: - Department of Ehvlronmental Protection-Cypress. Bayheads, Wetland Areas and Envlronmentaliy Sensitive '° , Lands,WatedWastewater Treatment. ' - Southwest Florida Water Management District-Wells, Cypress. Bayheads� Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. , - Depanment of Health� 8 ReMabilitative Servlces/Environmenfal Health Unit-Welis, Wastevu�ater Treatment, ' Septic Tanks. � . JS-��d!rQ.^.men��!Q��#e�tls�r�.4�e�cy��sbe�tm�-�b�t�rn�r�t,. - -. — ---- � - Federal Aviatton Aulhority-Runways. � I understand that the following:restricNons apply to the use of flIL•� - Use of fill is not allowed in Flood Zone"V"unless expressly permitted. - If the flil materlal is to be used. in �Flood Zone "A", It is understood that a drainage plan addressing a "compensating volume" will be subm(tted at�ime of permitting which (s prepared by a professional engineer Iicensed by the State of Florida. ' - If the fill materlal.is-to be used (n Flood �one °A° in�connection with.a permitted building using stem wall � construction, I certify that fill•:wlll=be used oniy.to.fill the area within the stem wali. - If flil materlal is to be used in any area, I certffy that .use. of such fiil will not adversely affect adjacent properties. If use of flll Is found to adversely.�ffect adJasent�propertfes, the owner may be cited for viofating the condi#ions of the building:permit issued under the.attached�ermit application, for Iots less than one (1) acre which are elevated by flll, an engineered dralnage plan is required. If I am the AGENT FOR THE OWNER, I,;promise In good faith to inform the owner of-the permitting conditlons set forth In this aKdavit prior to commerncing construction. I understand that a:separate permit may be requtred for electrical work, plumbing, signs, wells, pools; alr conditioning, .gas, or other Installations nol,spec�ically included in.the application. .A permit issued shall be construed to be a Itcense to p�oceed with the work and not as.authority to,violate,cancel, alter, or set asfde any provisions of the technical codes; nor shall issuance�of a.permtt.pcevent the Bulldirig O#ficial from thereafter requfring a correction nf enors In.plans, construction or violations of any codes. Every permlt�Issued shail 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(H)months after the time the�work fs commenced. An extenslon may be requested, fn writing, from the Building,Officfal for a perlod not to exceed ninety�(90) days a�d will demonstrate justifiable cause for.the extension. If work ceases for ninety(90)consecutive:day.s�..the)ob is considered abandoned. WARNING TO OWNER: YOUR.FAILURE�TO.REC.ORD A:NOTIGE:OF�COMMENCEMEMT MAY�RESULT IN YOUR PAYING TWICE:FOR IMPROVEMENTS TO.YOUR.PR�OPERTY.-IF°YO.U�INTEND"TO�OBTAIN��FIN�ANEING;'CONSULT W17H YOUR LENDER OR AN ATTORNEY BfFORE=RECORDI G�YOUR'�NDTICE'OF`CQMMENCEIIMENT' ___ _ � �Fi:ORiDA Ji�R�4Y�.S:9.'i 7:09� _�— -- �. --- - . OWNER OR AdENT CONTRACTOR � �5�� pa.� Subscribed and swom to(or affirmed)before me this Subecrlbed and swort),:to(�aflirtned)' efore me ttiis by �by�1r��/5v f,/�.S ,. VYho Is/are personally knovm lo.me or haslhave produced Who.l a e p.e onelly known�me or has/have produced as IdenBflwtlon. �� r.�r� �Pl�as Identlfica0on. � Notery Public . l.� Notary Publlc I Commisslon No. Com is on No. � ,,�ti�Y.:i;��; JAG4UELINE BOGES• - o mission#FF 150422 Name ot Notary typed,printed or stamped Name of Notary typed � � 'bt�rn�i�December 2,2 �!;f' Qp��` Bond�d Thfu Troy Fa�n Inciuonw 800385-7019 �RP�S� � I� �ut i� �� t� 9 ��ri � ��n�. P o. Box 1511 B�shnell,FL. 33513 (�52)5680800 Ilaboutairsandi@hotmail.com I Jesse Gomez, President of all All About Air For Central Florida Inc. hereby give my uthorization for �� •R.�`e� JP_i S to be allowed to obtain permits, and sign all ocuments on my behalf for the City of Zephyrhills, Florida. This will take effect any job sites tarting on 07/25/2016 and ending on 07/25/2016 tate License Number CAC181782 he Foregoing ins ent wa knowledged before me this�day of�2016 � Signature of License Holder Signature of Notary Public—State of Florida ( Print,type, or Stamp Co missioned Name of Notary) �ersonally known J or produced i ntification Type of identification ' roduced `SPaY P�B;��, yANIA C.ELLINGTON ;�=or „�; Notar Public-State ot Florlda * * Commission#FF 910277 :"s,r �:� My Comm.Expires Oct 23,2019 ��'��°;;:°` Bonded through National Notaryr Assn. q}; � r�IIIiIIII IIO III o��Lo�tion:T,�PA Proposa�Pate o�/15/zo16 Job Number 20711163 Sears Home Improvement Products,Inc. Custome Name �/�� ,�� /" P.O.Box 522290 JOYCE BUSBY C 1024 Florida Central Parkway Customer`s Home Phone Customer's Woric Phone LongWood,FL 32750-7579 (813) 395-8193 Home Improvement Products PhOne(800)469-4663 Street Ad'ress ESTIAl9ATE AIdD PROPOSAL Contractor License/Registration Number 5908 �FOREST LN FL(CGC012538,CMC1249510) ' c;ty � s,�,e Zp Code Heating �Cooling ZEPHYRHILLS FL 33542 Is installation within aty limits? Install�tion Address Count�Asco (Yes/No): YEs � Billing Address(if difierent from above) City State Zip Code roject Consuftant Name 8 License No.(if applicable) ' DAVID BRAZEN Description of the.Pro'ect and Descri tion of the Si nificant Materials to be Used and E uipment to be installed SYSTER�INFORMATION: Equipment Bran�ENMORE (Split SystemlPackage/Dual Fuel/Straight CooUHeat Pump/Fumace): SEER:�S•20 CoolingBTU:z8800.00 �: HP AIR HANDLER �R-410A E UIPMENT SPECIFICATIONS: FURNACE FUEL: (Gas/OiI/LP Gas/Electric): Existin New MODEL#OF NEW COMPONENT AFUE(up to): Heating BTU: ❑ � FURNACE/FAN COIL FXM4X3000AL ELECTRICAL: � � CONDENSER UNIT NXH530GK'� ❑ CONNECTTO EXISTING ELECTRICAL ❑ ❑ EVAPORATOR COIL ❑ INSTALL NEW AMP MAIN PANEL ❑ ❑ PACKAGE UNIT ❑ NEW DISCONNECT ❑ FURNACE ❑ CONDENSER ❑ � THERMOSTAT 1F95EZ-0671SE ❑ NEW GFI OUTLET ❑ATTIC LIGHT 8�RECEPTACLE ❑ ❑ HUMIDIFIER Other. ❑ ❑ AIR CLEANER DUCT WORK: ❑ ❑ UV LIGHT � RE-USE EXISTING DUCT SYSTEM � ❑ ❑ EVAP COOLER ❑ INSTALL NEW DUCT SYSTEM WITH#t NEW RUNS MISCELLANEOUS: � REBUILD PLENUM (Supply/Retum): ❑ ❑ LINE SET ' ❑� PAD "x " ❑ NEW TRUNK LINE(S) (Supply/Retum): ❑ ❑ DRAIN LINE ' ❑ CONDENSATE PUMP � NEW RETURiV GRILL(S) X X ❑ ❑ AUXILIARY DRAIN PAN ❑ Other ❑ EXISTING RETURN GRILL SIZE IfdSU TION: ❑ REPLACE REGISTER(S}# � ❑ (Batt/Blown): R-Value ❑ DUCT CLEANING Other. FLUE 1iEPlTI G AND10R CHtMINEY: ❑ Use existing vent or chimney ❑ Install new chimney liner Size: ❑ C Vent Pipe for High-Efficiency Fumace ❑ Horizontal ❑Ve�ical ❑Type-B Vent Pipe ❑ Stainless Steel Vent Pipe ❑ 1�Pipe Installation �2 Pipe Installation ❑ Combustion Air ❑ Existing ❑ Modify SPECI L IPIISTRUCTIONS:KENMORE 2.5 REPLACEMENT All of�he above check boxes and "Special Instructions"section have been reviewed and Customer{s)initials � �f�-- explair{ed to me. SHl-F (Dig.) Rev 6/16/2016 Page i of 3 -- -- — � � ' il�ll IN I lii tli Job Number. za��,11e3 APPRO MATE START DATE and APPROXIMATE COMPLETIQtd DATE: The work will start approximate�7 (Appro�mate Start Date) It will b substantially compl�ted by approximatel� {Approximate Completian Date) � 3tsese da es are subject to change at the t'sme the contrac#is accepted by Sears Home Impravemenf Praducfs,lnc.�°Sears�ar a#any other tisne by mu#uat written ag eement.Custamer understands that the Approximate Start Date is only an estimated date and the Customer will be cantacted prior to this date to schedule e adual stark date. ASBEST�S ASATEMEIdT:This Estimate and Proposal assumes that fhere are no asbesfos carttaining materiafs�"ACMs7 fhat would be disturbed in the performa ce of the installation work.If upan further inspection by the caMractor or others it is leamed tha#ACMs have to be disturhed ta perfortn v�rk,then Custome must arrange and pay far abatemen#of asbestas by a qualifted pe�son prior ta the start ar c�nGnuation of wark.If Customer fails fo acrange far necessary asbestos abatement within thirt�r(30)days,Sears may cancel this contract upan Gusfomer(s�initials � %'!;'� wtitten na�ce to Customer. PLEASE OTE that Sears is not responsible for correcting any existing cade violations or pre-existing conditions of any ductwork,piping,elechical supplies or equip eM not being replaced at this�me.If addi6onal work is required,it will be the Gustomer's responsibility.My additional charges will be qeoted and approved rior to the start of any additional work. {�, � Customer(s)initials Q THE CO TRACT PR10E INCLtIDES: ' P�ice A c�py of the fe�s and cor�i�ons of the Mas#er Protet�ion Agreemgnt or Re- Year Master Protection Agreement ❑� pair Protection Agreement(as applicable have been rovided to Customer. Year Repair Protection Agreement �� . Custamer(s}initials The TO L PRICE including all labor,material,taxes and any applicable discount is$ 5,893.01 Contract Price ��$5,893.01 State sales T�{a.oo °to) $o.o0 Local Sales Tax( o,oo %) $o.o0 Custome Payment is due prior to Sears' lacement of Special Order for products. Total Amount Due�5,893.oi � The farm nd method by which fhe Customer{s}will pay is described in a separats CashlGred'st � � Card Pa ent Addendum made a part of and incorporated into this contract by reference. �ustomer{s)iniGats NQTICE 0 BUYER:YOU,THE BUYER,MAY CANGEl.THtS TRANSACTION AT ANY TIME PRIOR TO MtDMIGHT OF TNE THIRD 8USINESS DAY{FI�TH � BElStNE S DAY iN ALASKA,FIFi'EENTN BUSiWESS DAY IN NORTH UAKOTA tF YOU ARE AGE 65 OR OLDERj AFTER THE DATE OF THIS 7RANSAC- TION.SE THE ATTACHED N0710E pF CANCELLATION FORM FOR AN EXPLANATfON OF THIS RIGHT. ADDCTtONAC PROV#SI�NS Proposal nd A rp oval.Sears affers#o fumish the materials and arrange for their delivery and insfallation as speafied on the first page and/or the attached , sketches�nd specification sheets for the TOFAL.PRICE shown.'t'�is o#fer must be approve�i by the Instatlation L}epartmen�If this is a cdedit saEe ar a payme�t � an compietion sa1e,it musf be approved by the Credit Sales Deparfinent.If this proposal is not approved or ttie installation cannot be made in accordance with the law,th s offe�will be withdrawn and any payments you have made will be refunded to you.My materials left over after the instaUation has been completed are Sears ropert}+and wilE be remaved by Sears. Installa'dn.I understand that Sears will not install the materials but will arrange far the installation.Sea►s is not responsible for materials or installation NOT fumished r arranged by Sears.Sears'installation con#rador(sj will obfain al!building permits required by lo�l lauu.For homes located in historic or lar►dmark zoning dis 'cts,Customer wiii be responsible for obfaining requireti approvais and reiated permifis prior to the cammencement of work on this cantra�. Authoriza�tion.I authorize Sears to:(1)arrange far a conuador(licensed where�equired by law)to make the installation of matenals;(2)issue a work order for this in #aElafian to a contractor,{3}inspec#the installatian;and{4}pay the coiytractor vut�en the installatian is compleEe if 1 have signed a cecfifificate that fhe installatio has been completed#o my setisfaction. Dela s in Installation.I agree that Sears is not responsibfe for delays in delivery or installation due to wea#her,fire,strikes,war,govemment regulatians or any causes b ond Sears'contral. � Oral A reements and Chan es in Cont ct.I understand that there are no oral agreements between Sears and me.Everykhing I expect Sears to do has been included i writing in this contract.Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears_ Responsi�iii of Bu er.l agree that any information or measurements that 1 give to Sears are correct and compiete.(am respansible for any special work described in this contract. Efec#rical&Plumbin Service,t wi11 pravide adequate elecUica(andlor plumbing senrice{s�#o run any newly installed appliances or other fumishings.if the electrical ndlor plumbing service(s)do not meet the standards of the utility company or electrical and/or plumbing codes,I will make the necessary changes at my expen e unless Sea�s has agreed in this contract to make the changes. a ment;l wi(1 pay Sears the cash price#hat cove�s the price o#material and installatian as shown an ttte firsf page. Warran Inform tion.Appropriate product warranty documents will be given to me by Sears.Sears'Warranty on Installation is: SEAl2S'LlR�CfED WARRANTY OTd 1NSTALtAT10N In additio to any manufacturer wrarranty extended to you on the product(s)used(which warranty becomes effective the date the merchandise is installed),if the wo anship(or application}of any Sears'arranged installation proves faulty within one year after the completion of installation,then upon�otice from you Sears wifl cause such fauits to 6e cottected by repair at no additional txist to you:lf Sears determines that repair is naf commeraally pracf'scable ar cannot be timely ma e,then,at Sears'sole discretion,Sears may elect to provide replacement or refund.Service under this Limited Warranty is available by calling 5ears No e Improvemeat Froducts ai 1-800 222�sQ3Q,Optian 4,This warranty g4ves you specific legal rights,and yon may also have other rights that vary from Stat to State. SHi-FL (Dig.) Rev 6J26/2016 Page 2 of 3 . � � - -- -- -— - , � � �r�� Job Number: Zo711163 I� NOTICE TO OWWER 1. DO N�T SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE EF1'BLANK. . 2. YOU RE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT.KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. THIS OME IMPROVEMENT CONTRACT MAY CONTAIN A MORTGAGE OR OTHERIRIISE CREATE A LIEN ON YOUR PROPERTY THAT COULD BE FOR CLOSED ON IF YOU DO NOT PAY.BE SURE YOD UNDERSTAND ALL PROVISIONS OF THIS CONTRACT BEFORE YOU SIGN. 4. YOU AY PAY OFF THE FULL UNPAID BALAIdCE DUE UNDER THE AGREEMENT AT ANY TIME,AND Ifd•SO DOING YOU SHALL BE ENTITLED TO A FU L REBATE OF THE UNEARMED FINANCE AND INSURANCE CHARGES. ' S. YOU AY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY(FIFfH BUSINESS DAY IN AI..ASKA, '� FIFT�ENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER]AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTI�E OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTE FERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS.IF YOU WISH,YOU MAY USE THIS PAGE AS NOTI ICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAIWE AND ADDRESS.A DUPLICATE OF THIS RECEIPT IS PROVIDED BY ' THE ELLER FOR YOUR RECORDS. , 6. IT S LL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO i REP SSESS GOODS PURCHASED UNDER THIS AGREEMENT. ' FLORID/!HOMEOWNERS'CONSTRUCTION RECOVERY FUND I PAYME T MAY BE AVAIIABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND, UP TO A LIMITED�1MOUNT, IF YOU L SE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW B A LICENSED CONTRACTOR. FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONST�1UCTION INDUSTRY LICENSING BOARD AT THE FOLIOWING TELEPHONE NUMBER AND ADDRE55: CONSTRUCTIOW INDUSTRIES I�'� RECOVERY FUND, 1940 NORTH MONROE STREET,TALLAHASSEE,FL 32399;TELEPHONE:(850)921-6593. ACCO DING TO FLORIDA'S CONSTRUCTION LIEN LAW(SECTIOPIS 713.001-713.37, FLORIDA STATUTES),THOSE WIiO WOR � ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO EN ORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. F YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB-SUBCONTRACTORS, , OR M TERIAL SUPPLIERS,THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN° F YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTI CTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY.THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR,MATERIALS,OR OTHER SERVICES THAT YOUR CONTRACTOR OPt � A SUBCONTRACTOR MAY HAVE FAILED TO PAY.TO PROTECT YOURSELF,YOU SHOULD STIPULATE IN THIS CONTRACT THAT IBEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEdSE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A"NOTICE TO OWNER.",FLORIDA'S CONS RUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY. `� � �� 07/15/2016 �fJ r�� 07/15/2016 Customer's signature Date Customer's signature Date Accept d by Sears Home Improvement Products,Inc.("Sears�on 07/15/2016 by; � Date Management Representa6ve SHl-R( ig.) Rev 6/16/2016 Page 3 of 3