HomeMy WebLinkAbout17-18966 CITY OF ZEPHYRHILLS
' � 5335-8TH STREET
(813)7so-oo20 18966
BUILDING PERMIT
� PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 18966 Address: 37519 SERENITY AVE
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: VALLEYDALE RO ASSOCIATION
Est. Value: Parcel Number: 03-26-21-0170-00000-0090
Improv. Cost: 3,359.00 OWNER INFORMATION
Date Issued: 10/23/2017 Name: VAN YORX VICTOR& BETTY LIVING TR
Total Fees: 55.00 Address: 37519 SERENITY AVE
Amount Paid: 55.00 ZEPHYRHILLS FL 33542-4837
Date Paid: 10/23/2017 Phone: 813-779-2130
Work Desc: A/C CHANGEOUT 3 TON
CONTRACTOR S APPLICATION FEES
BAHR'S PROPANE GAS &A/C, INC. A/C CHANGEOUT 55.00
�
Ins ections Re uired
D CTS INSTALLED
DUCTSINSULATE
FINAL i
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 pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRAC O SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
o�y�Qw���� City of Zephyrhills Permit Applica#ion Fax 813-7saoo2�
' " '�� 8utiding Depattmant
� , .
Date Recelved Phone Contact for Parntit#in !� �� ��
Owner's Name �� /Q �r!C � `��E'' L. Owner Phane Number gj����f ����
Ownefs Address ���f� J� r� ����2�� Owrner Phone Fiumber �— � �
Fee 8tmple Titleholder Name Owner phone Number � �
Fae Slmple Titleholder Address
.tOB ADDRE3S �7•�?�� q"��er�*jvp �lfi� LOT# ��
susoivisioN �A'��G�L°.- �J�J�� pARCEL ID# �� � �l 1.�17,� DDC'� dD`,it�
(OeTAINED FROM PROPER7YTAX NOTICE)
WORK PROPOSED , e NEW CONSTR� ADD/ALT [,� SlGN Q Q DEMQLtSH
INSTALL REPAIR
PROPQSED USE Q SFR �] COMM [� OTHER
TYPE OF CONSTRUC'170N Q BLOCK ' Q FRAME [„] STEEL C] �
QE3CRIPTION flF WORK ltC-".Sp Af� ��tR�l e-pc.� /' ��rm a,�jE;,� „� �o/�IJ�' ��G
BUILDING SIZE � � S6!FOOTAGE�� HElGH'C �_,_`�
OBUILDING � � VALUATlON�OF T(?TAL CONSTFtUCTiOtV
QEI.ECTRICAI i$ i � AMP SERVICE Q PROGRESS ENERGY CJ W.R.E.C.
��_
QPLUMBING �� - �
�MECHANICAL $ —f�� .�,�—� � VALUATICYN OF MECHANICAI.INSTALi.AT10N
C_.___�`.��
QGAS Q ROOFING .Q SPEClAITY �] OTHER
FlNt$HED FLOOR ELEVATiONS �'� FL04D ZQNE AREA QYES NO
BU!l,DER COMPANY
SlGNATURE REGISTERED Y/ N FEE CURREP Y/N
Address License# � ��
ELECTRICtAN __� COMRANY '
SIGNATURE � REGISTERED Y! N FEE GURREt� Y/1V
Address Ucense# ( ��
PLUMSER �� COMPANY
51GNATURE REGtSTERED Y/ N FEE CURRE� - Y/N
Address Ucense# �` ` ��
SIGNA�RE � �� `
,��
` COMPAfi1Y �1�R'✓��ht�G''L���t--' ��L°'
REGIS7ERED Y/ W FEE CURRE� Y/�N
Addr�ss '�f'��'� I T���11� �l�f/�L,GS'/�'�.. Ucense# �!�'Cb tt'�✓��'�7�'��
OTHER ,COMPANY
SIGNATURE REGISTERED Y/ N FEE CUftREI� Y/N
Address I.icense# ! i'�
RESIQENTIAL Attach'(2)..Plot Pians;(2)sets.of�Bi]i(iJiiig`Plans;(1)set of-Eriergy�Forms;R-O-W Permit for new constru�tion,
Mlnlmum:ten(1.0).worktng;days,after.submlttal date. Fteyulred onsite,Constr'ucNon-Plans;Storrnwater Pians wi Sitt Fence instatled,
Sanitary Facill8es.&.1,dumpster-•Slte Work�P.ermlt#or subdivislonsflarge projects
COMMERGIAL Attach(3j oomplete sets�of Buildirig Plans plus a Life Safety Page;(1)set af Energy Forms.l2-O-W parmit far neuv construction.
Minimum ten{10)working days after submittal date. Etequired ansfte,Constructlon Pians,Stormwater Plans w/Siit Fence Insta�ied, --_
Sanitary Facillties 81 dumpster.Site Wark Permit for aii new�projects.Ait�mmerciai requirements must meet compilance � ---
SIGN PERMIT Attach(2)sets of Englneered.Rlans.
""PROPERTY SURVEY requlred for a!I NEW cansWc@on.
Directlons:
Ftl!out applicatlon completsly.
Owner&Contractor sign back of applEcatfon,notatized
!f ovsr S250Qr a Notice of Commencemsnt is required. (A►C upgrades aver�`,750d)
•* Agent(for the cnntractor)or"Power of Attomey�(for the qumer)would be someone u+dth notarized letter from owner authodzing same
t?VER THE CQUNTER PERMlTiiNG _. . .(Front of.Appticatio�t,�,ni��w, � - .� t_ .. .L� .__ �..�,.:,,.�..�,..,�
Reroofs 4f shingles Sewers' Senrice Upgradss AiC� fienc�{p1oUSurveylFootage} A , +, � s
. .� � 3' , � . . �
Driveways-Not aver G�unter if on pubitc roadways..nead�ROW ": � i �'
. . .. - . - , ?a.
i , . ' .1 � ,. ._ . ,.. . -, .. , ,.. ,.»�.
_. .. . .. . � , , e.b-.�,�y� .
jii
1�
. f
Y.1
E '
. ;
NOTiCE OF DEED RESTRICTIOMS: The undersigned under,stands�=,th�t;thl��.p�rmlt�.may.be,subJect to"deed",restrlctlons"
which may be=more�.r:est�lctive-tha�County���egr�latCons:��The underslgned�'assumes•r'esponsitilltty�for'complianae wilii 'any
applicable deed resWctlons. •
UNLICENSED CONTRACTORS AND CON�'R�►CTOR RESPONSIBILITIES: if the owner has fiired a�,contractor or
contractors io undertake work, they may be,r,e�qulre,d.to=:be;itcensed In accordance.with state.and•local regulatlons. if the� �
contractor ts not I(censed as requlred-by law� botlr the owner and contFactor-��may be-clted�for a�misdemeanor vlolatlon
under state law. IF the ov►rner or Intended_contra�tor�ere,�uncertaln as to what Ilcensing.requlrements:mayE�applyr�for:the
intended work, they are advised to contact the Pasco County Building"Inspection Divislon—Licensing Section at 727-847-
8009. Furthertnore, If the owner has hired a conUactor o� contractors, he Is acivlsed to have the contracto, s slgn
K�,).,....
portions of the "contractor Block° of.this appllcatlon for,which they will be,responsible.�. If.you, as.#he owner�'sign"as`the
contractor, that inay be an indication that�he�is not.prope�ly Ilcensed and�is not entitled to perriiitting privileges in Pasco
County.
TRANSPORTATION�IMPACT/UTILITIES�rMPAC'��ANb RESOURCE RECOVERY�FEES: The undersigned understands
that Transportation Impact Feas and.Reco.urse Recove.ry.Fees may�:apply�to�the constructton_of new bulldings,�change�of -
use In existing buildings, or,expansl�rr:-of�existi�i�g'i6uildings, as specifled.in Pasco County Ordinance number 89-07 and
90-07, as amended. .,�'he. undersigned also:understands; thaiE:�such fees��,as�,mayr 6e��due;,:wlll:hbe fdentifled at the��time�of
permitting. It is furttier understood that T�aasportatlon Impact Fees and�Resource.Recovery`Fees must be paid prior to
rece�vtng a."cerfificate.of-occupa�cy" or flnal�powe.r..release. :If�the.project..does.not�involve<ar.certiffcate of occupancy. o�- -
final power release;the fees must be pald pelor to permit issuance. F��thermore;if.Pasco County,Water/Sewer�:lmpact
fees are due,.they,must be-pald..p�ior to permtt�•Issuance-In accordance witFi applicabte Pasco'.County ordinances. �
CONSTRUCTION LIEN�LAVII(Cfi�pter 713� �lorlda Statutes�as arroended): if valuatlon of work is$2,500.00:or more, I
certify that I, the. applicant, have.been provlded -with a copy of�the "Florida� Construction Llen Law—Homeowner's
Protection Guide" prepared by the Flo�ida Department�of Agricuiture and Consumer Aifairs. If the applicant is someone
other than the"owner°, I certihr.that I�h�ve.obtained�a�copy.of:the:abova.descrlbed docu�ent-and.p.r.omise�in,good faith.to
deliver It to the'owner"�:prior�to�cornmencement:' �
CONTRACTOR'S/OVYNER'8 AFFIDAVIT: I.cerki[y.,that�all.th�;lnformation:in•thi� appltcation is accurate�nd that ali work
will'be done in compUance with ail.applicable laws regulating construction� zoning and land�devetopment. Applicatlon is
hereby made to obtain .a permit to :do_work:,and installation as indicafed:. �°i certify that no work==or tnstailatton has
commenced prior to issuance of'a permiC and that.all work will be performed to meet standards of all laws regulating-
constructlon, County and City codes, zoning regulatiQns� and land development regulatlons-in the Jurlsdtctton. I al'so
certify that I understand that the regulatlons of other government agenc(es may�apply�to the Intended work, and that it is
my responsibll(ly to identify•what.actlons I must take:to besin:.conlpllancs: Such agencle�-include but-are.not Ilmited to:
- Department of E�lvironmental�Protection=Cypress.�Bayhead�, Wetland Areas and Environmentally Sensitive
Lands,WateNWastewater Treatment.
- Southwest Florida Water Management: .DisUict Wells, Cypress.��Bay.heads; Wetland Areas� Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, iVavigable Waterways.
- Department of Health� & Ret�abllitative Services/Environmental Health Unit Well.s� Wastewater=Treatment,
Se�tic Tanks. � .
- US Environmental Protectlon Agency-Asbestos abatement.
Federal Avlatlon_Authority-Runways.
I understand that the following.restrictions apply to the use of flll:�
- Use of�flll is not allowed in Flood�Zone"V"unless expressly permittsd.
- if the flll material�Is to be usetl: in :Flood tone. "A°, It is understood that a drainage plan addresstng a
"compensating volume"will be submiited at�ime of permifting which is prepared by a professional engineer
Iicensed by the State of flarida: .
- If th� flll materlal ts to be used in Flvod Zone "A" Ins connect(on�wlth:a permitted building using stem wall
� construction, i certify that flil�:wall=be-used oniy.to.fill the area wlthin�the stem Mrall.
- If flll materlal is to be used In any area, I �certify that .uss of such flll will not adversely affect adJacent
properties. If use of flll is found to advereely.�ffect ad)acent�;properties,.the owner may be clted for viofating
the condl#ions of the building.permit Issued�under the attached permit application, for:lots less than.one (1)
acre which are elevated�by flll,�rr englneered dralnage plan Is required. •.
If i am the AGENT FOR THE OWNER, I�promise In good faith to Inforna the�owner of the permitting condftlons set forth In
this affidavtt`prtor to commer�cing construcUon. I understand.that�a;separate permit may be required for elecMcal work,
plumbtng, signs, wells, pools; air condl8oning, .gas� ar other install�t(ons not�spec�ically Included�in.the appltcation. .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 provistons of the.technical codes; nor shall issuance�of a.permtt.pcevent�the Bulidirig O#iictalfrom thereafter
requ(ring a correction af errors In�plans; constructlon or vlolat(ons of any codes. Every permlt issued shail become invalid
uniess the wrork authorized.by such permlt:is-commenced•withln six months of permit Issuance. or if work authorized by
the permit is suspended or.abandoned-for a�:period of�six f8)monti�s.after the tlr�e the�wo�k�Is commen�ed, An extenslon
may be requested� In w�iting� from the�Bullding,Officlal for a period.�not to exceed ninety�(90)�days and witl demonstrate
justffiable cause tor.ihe exten�lon: If work ceases:for ninety(90)cons.ecutive:day:s,..the Job�is considered abandoned.
WARNING TO OWNER: YOUR..FAILIJRE•TO..RE.C.OttQ A:I�OTIGE:OF��COMMEMCEMENT�MAY�RESULT IN YOUR
PAYING TWICE�FOR IMPROVEMEN'�S�TO YrOUR;PRDPER7Y.~IF�YO.UaiN'�END�TD�i0BTA1N��FIP1�1t�E1NG;�CONSULT
WIT U . D � A O OREk, O �:, p , , � ., ,. , .
, :. . _ _ . ,. .. . _ .
�LORIDA.lURA�.(F.S:i17.03 - - - — - - _ -- ——.—e==- -- - ---- ---- -
��-
OWNER OR AOEN7 �'Y�-e-. CONTRACTO
Sue��bed and swom to(or af� ed betore me�Is Subscribed'and' `to of aHirm�dpb�fote5�me; i$_
'/ �- L i'
Who Islare p rsonally kn me or haslhave produc�d Who.ls/are rsonallykno • me orheslhave�produced •
ae Identlncatlpn. as identlflcatlon.
` ����j Notery Public . . .✓"`�C� Nofary Public
Co Isslon No:` Co , isslon.No.
,,.,i�va�•-. • � ���'����,�,, SYLVIAA.CAMPB
r z°� .`�-, Notary Publit-State of florida �`'"
at Public-StateofFlorida
Name ot Nofary typ � ,�arr� Name of Nolary typed, inpedommission s
, y mm,Expires Jul 19,2021 My Comm.Expires Jul 19,2021
'•�Eaf F���.` �, r�:
BondedthroughNatlonalNotaryAssn. �'��!���,,.•'�� yp�dedthtoughNalionelNotaryAssn.
�nnn��
� � . - � ..- , � , , �-r�.-
k •
� � � PROPANE GAS Main#enance Order
AND AIC ►rtc.
S�ce�988 813-782-50�3
. ,4���sRl'' CiRi!C:��i#%�c�'���J.����'=1f?�d F,'i 7'�7 F1RF7
Sales,, ' e & Installa#ions .�,�-;-E ,-, �.►F� ;�at;F;� ; �.'�f 1.�,' �.� i�:�=�'
�"" ,e � ' • Z� hills, FL 33541 . - -��aF;E.� ;�:�,�; , i;; h; +��
' �-Y J��� v r i�'F=1�r�. ' !' r:'�l- �-'��'�.��`�.�:����,i -
_.� / f:l.lc.;�'��r;��. e�,;.l. i.li:►-t i�i[j1,` c.'�..' t�t4'� -
S� �/���� � r'�i_�(, r.�r".�' �.! "' ^7._� i,��V
/ 1' i �1�I�Yi• .J" f r '1��) •
N�_f' I-i-: ;�:'i,_l>S i.,.;F��i
�'�aP1Yi7�;c� l�:f�:.'f�.1,a, 4� /:.J���j ' - . .��N11`d'�C1RX., �J):^TC�R
;?,7``1�� �ER��r�di.T'r (1'JE. ??ai':; �.t:f?!�r•i:[�-.i �i,��
� , ��.'�l. ! E w•[tt',L �� �,A"rF ('��DE: .#��.��� .
,� �-
�EP�-!YRHT!I_`•:; FL_ .:�:'•������� rEr'I�''r�RHT.�_�._•�� F'i_ �=:;J, .��;�:
���I'!.�:!_..t���.�;.�t.
P�!I�i-;FiC'�E::f1'r'.aY; � �..�G,.7 J trF.�i::��
�a�;�E;�._Y ��o�a�o �;a�� hr�ra L;,,,��'Tf=H •1"!:�1 �r.a
.�.
. � -�.::
. _
. . . . . � - -� ... _•', ...._,r�...�..n.P.��..� .�..._.-..�._. _� _ _ _" _
. - .. ..._ : �._.. -,- .,.,. -�__ . _..�_,s...:._.a:...:..........i., >a., _p....L+-'."`s.li': �Jt"-.. -- _ �`��`
_ . .,...,. ..,.. � .n... ... .. . T ....,..^....�x �...... . .. -T -r, _:_..�..:.'. - - ' -
. ;r.r . ..,:."^ ' .'..r^r ...r...,.,_......� ..,.-r,.. ..-..k. .�.__c ..^::._..,. - � _ �(`!�n�/+
--e.r�.. ,.� ...:: `y/+
.".�.. ,: .1 ..st -� - ' y�.L1'J,�_`'-�"
d- :-�V.�
u:.^- s".. Y•a� - e _ .:.1'�'�:`_
�� �:f'=:=z - :� :1%'rr.14
-,.r`"� ' ' - �'a:a' - " �
:vt..?`�al'-r `<v„ _ :.:it"-' "i.ti� '�V.\aEaS:`� _,i
��•..�,�r n k( =t...��- :R. ''S�:SE l. -
�,�._ ;rv... - :��;-11AA7'E_l�L �
- �x�,
,::,�� '� -
,�.� _ :s`;,��
�=a:::
:��� -
:-,:,t ,,,..,: :-;�.��;.
_`�,...,....
'� �. ri+� �
_'#' `U.F`' k�C."''��';:5- -�. -
�J.,. L^.'' - _
t.:✓'- F {� l. -
7,i� '� �e� rr -
> .-,�.� ( (' :;:.
� .��.+, ,......r..:.r .�. .,r.w„�., s
...=ryr
�� ,�..�_'_J _F.
'f:K..�.-:ea;✓'�,..,r.� . „�. , . � ..� ,A..!�._ �..,, . . .�...,..:.�:.a:' >_ .... :aie,, _- - -
�.r. .. ..sl;rl a �X•r..�;1� w.;,. ,:.7. .- �.. ......,i, ,.. 1._._,n_-�...r,�..,.J..u...;,.....- - - -
`-�M,y:`.,:rc�re�.���,�v�;s*:.��.a��'.,,+vw<rd•r.�.�t�:� s�t%.,.�,�.e., .4,_ _ -
•-- �t14�n -�cc�"— •ler�• �e_-5'Sot._ _.F+� -�... _. _...._... .�• ��C�• �e•,K � ��-( •!•�-5-�'^�.__. __ _.. .__ .1.. ._ ..---- � -•. _.
5� �. � � u.��. o k� t-����,f. � �
I � �
^,�,� h�,,:•'c�- �, ac� i i
i i
� �e � o�l�<<..a,,,,P�t� o� L��o< � �
,.>5x,�.,:,.,�..�.:,i`!,:'y,:�.�xatii<„�S'Y�.: ' � ;y;�;>;._':jT;;�:ta.`3�.�;,:�;;r.�i'i,'L'r,'.,`<;r:,;f,'?':_^:..a �.-".xY; __ ' I �{ � �
�E�Tw�:; ..F'�,Fi:S:,;r�,;r ';'t�i:,sl�.r"�'^'ti:;' .-7. .i'�`, -:�;==---- ,�r�,�,st;�`>'�.:^,z=��i" � I , l
�;�:.,���:��:�� �;::..�,. ;G��K�LiS'$���.r�}h- - -- �s�-._?�=�;•�y__�..r� I� C u c S
:_�� - .�.�wh�<: �.�.;_ :,,.. .:�...�;�., _ :;.�.�. ,
'��i�,'s`V�ii� ... :::-.v- - ;�.'4,. _R.,Yf_�. .. .,s.., .::".::y_y.'��_.'�;��/ ..,, .. . � I
p�'4 Lo HI E5a`�;Goii;a. ❑Cleaned`Caiid;Ca� ❑Cleaned
f'�='����'t� ` ' � i
��� Cond.Fan Blwr Comp Heat Strip 3 0�.J �a�f���,� �� 'FE'� `-' 7� � i
A�i�As';�_;,.
�-^.'r'. _` . . ) " �,( � Ea� �4U
` u�r:<.�-J'r'}•;2. ' I� �...J �C C T��r �
�t�6rS Cond.Fan Biwr Comp �
i i
;,;�_:_":.��.,;�E� i i
p(8�`�?,,;` PrimarylCondiGon ❑Cleaned SecondarylCondition_0 ciea�ed
�T�ta�'���Type 9�1f°TYPB ��C,�U c>��`L �O'. L�t. c..���C., � �s�!h
:•t:�w.:;�?�.+,w.�f,,r,.�,.�y,�:'- - �l'r.;� _- �r,.:- -- _ _ ;:,v:[•:, � � �
__�;.�.. :-:��::�.:� -�:a:: �i a
���r"-:r��;'' - - �;-�-
�.:� - �;:�� �-;R�cohi►iw�i�iAA r9. � .
r.�- - �.. - �
A%��.�/v.n`„S�'n�A.�i`�-'�n =:�,y5;7��F',dFr`" -'^,,'r.:. ":5`.:i- '."i"r'. - __- - - (�
•.L'. 1
' " I � 'f �
aZi'^
- - ",:j=:;. - - (
- r�'}� /
i5�-�
L
rt<��. ,�.:. � S
_�` -
.=�,�` -, S �
�._ - f- � �
;;i7.
.y •-7'
- , aC'
.. I
�Q 'SC
� Y
`.�J`�An .� ��
r,��ce�Re�'m��ei�d�'.�i�''qll�� '`ui`�men �ON �
� � _ .. �,... .
�, ; ..
i�� '�n R Go � .P
, .:
.�. .. , .
.
,�,�fi�tatta�:�r�6... ....,.... �i7... _ _�Y - ;,:'�!�ac�iiii's.:'.
�r:S��r��vna.:•::.�,r. :.:,ro,,,� .� .. � _ _..1:, _ _ ' ' _ _
: �
. .... .,...;��5::. ......, ,.:: _
.
. ,,. '
.. . ., �,.�,�.,:,_,......._....w„ .... . . -.,._. >... - '
:REFRCGE`RAN;'f.R'r - `6BS. - .1�cpe'r',:1tis:.: _-':jr,�.-,%';� I
, = - -- �¢t:.
• -. I
� , FILTERS x x Changed Monthly �
�� ~ FILTERS x x Changed Monthly �� �
. ,ei. ..�-.-,:�.,7�:°;r`4;�.
❑ REGULAR _ `X�7A�:$�1��f'_�r.:;:�;;,�-
0 WARRANTY �Ui�; ,:�;_° _`j;�;;,,,;
'�^zs.'t%fr��
:,.�� �_,:*.;;��-�--.r:..,:--.._.....,_ , ._, -
=i- -
.,..�.�.�..-`:r..i ,,,.:.;.� f,�r�..,;.:
��j8��]ti3��r�}µ,�,�u$ftiii�5;��?When here:r¢�;�When Away§,Q;'�g;'T-Stat� i� ❑ MAINTENANCE CONTRACT MAINT
�x�:`>�,,�.:�sx,�;:.,rt,.r,�,t:�,;:..�::, _... �:;,. ;;<;«,:,r„• �t _
v..,, ,..:.. -�� .
ENA i
,...,.,:�.,•: - PF,ICE i
LIMITED WARRAN7Y: NI materials,parts and equipment are warranted by the manufacturers' �: _ - _ ����iO�L�AYME}�,,�;;,,:::.; :.
.�:.;;.:.,_,; �..
;-,;,_..• �,..,....:�::,r:r;.:cc::o�,:-^-- - �=-� --: • . _
or suppliers'written warranty only.All labor performed by the above named company is wartanted for ' �� �` TOTAL i
30 days or as otherwise indicated in writing.The above named company makes no other warranties, ❑CASH ❑CK# MATERIALS i
express or impiied,and its agents or technicians are not authorized to make any such warranGes on i
behalfofabovenamedcompany. ❑DEBIT ❑CREDIT ❑OTHER MAINTENANCE i
PROG. W / C
� I have authodly to oNer the work ouUined ebove whlch hes been sa6staetorily campleled.I agree that Seller
retalns tille W equipmenVmatedals fumished unUi final payment is made.If peyment is not made es agreed. CLAIM# �
seller pn remove sald equlpmenUmatariels at Selier's expensa.My damage resulting hom said removei s�all , I
�not be Na responsibllity of Sellec NET 30 DAYS:A 1 72%SERVICE CHARGE WILL BE ADDED MONTHIY TO DATE COMPLETED
/LLl UNPAID BALANCES OVER 30 DAYS.NQ REFUNDS
TAX �
/ {� TECH: i
`� G� '
�� . `% •i�. ,-:;,��' i n� ;'� — ��� you TOTAL i0
CUS G R ,r'� / '� � DATE�