HomeMy WebLinkAbout18-20643 CITY OF ZEPHYRHILLS
i 5335-8TH STREET
(813)780-0020 20643
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 20643 Address: 3067 MOULDEN HOLLOW DR
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: HIDDEN RIVER
Est. Value: Parcel Number: 24-26-21-0100-00000-0440
Improv. Cost: 7,860.00 OWNER INFORMATION
Date Issued: 1/09/2019 Name: HUBSMITH, SHAN & MOFFITT ALYSSA
Total Fees: 120.00 Address: 3067 MOULDEN HOLLOW DR
Amount Paid: 120.00 ZEPHYRHILLS FL 33540-4099
Date Paid: 1/09/2019 Phone: 813-382-6283
Work Desc: SCREEN CAGE W/CONCRETE SLAB
CONTRACTORS APPLICATION FEES
DESIGN ALUMINUM EXCHANGE INC BUILDING FEE 120.00
o erg/-
I /
Ins ections Required
FOOTER 2ND ROUGH PLUMB M119G INSULATION CEILING
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 rinspection,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 intendjto 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.
/& /' &-,
CONTRACTOR SI ATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: / �5')6en'1
Date Received: .Z—
Site: 5 06 7 Xplje 1 17411m
Permit Type: ePI
Approved w/no comments:❑ Approved w/the below comments: Denied w/the below comments: ❑
gr �5 �� -
This comment sheet shall be kept with the permit and/or plans.
WC 2a
Kalvin itzer—Plans Examiner Date Con act an or Homeowner
(Required when comments are present)
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department tt
Date Received 7, Phone Contact for Permittin . —74 V/
Owner's Name SHAN HUBSMIT_H Owner Phone Number 813-382-6283
Owners Address 3067 MOULDEN HOLLOW DR Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 3067 MOULDEN HOLLOW DR LOT#
SUBDIVISION HIDDEN RIVER PARCEL ID#1 24-26-21-0100-00000-0440
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR e ADD/ALT = SIGN = = DEMOLISH
INSTALL REPAIR
PROPOSED USE = SFR 0 COMM = OTHER
TYPE OF CONSTRUCTION = BLOCK 0 FRAME = STEEL =
DESCRIPTION OF WORK SCREEN CAGE(NO POOL) WITH NEW CONCRETE
BUILDING SIZE 18'X18' SQ FOOTAGE 324 HEIGHT 1��
=BUILDING $7860.00 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY = W.R.E.C.
=PLUMBING $
=MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS = ROOFING 0 SPECIALTY = OTHER f/
FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA. . . . . . . . . . . . . . ..&. . . . . . . . . . . . .. . . . . . . . . . . . . . .=YES NO �D'b
. . . . . ..
BUILDER I COMPANY DESIGN ALUMINUM EXCHANGE, INC.
SIGNATURE REGISTERED Y/ N FEE CURREK
Address P.O. 340383 TAMPA,33694 License# I SCCO56671
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEECURREt Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
OTHER COMPANY DESIGN ALUMINUM EXCHANGE, INC.
SIGNATURE REGISTERED Y/ N FEE CURREK
Address P.O 340383 TAMPA 33694 License# SCC056671
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RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisionsllarge projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Farms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
•` Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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 licensing 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 application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
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 certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" 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 performed to
meet standards of all laws regulating construction, County and City codes, zoning regulations, and land
development regulations in the jurisdiction. I also certify 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.
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 Official 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 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.
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR c.�l
Subscribed and sworn to(or affirmed)before me this Subscribed and sworn or firmed)b rem this 1
by by r 01'�
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. b'te•i SjQ,_ as identification.
C��"Notary Public 6 Notary Public
Commission No. Comm n No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
JACQUEUNE BOGES
ACommission#GG 27W7
Expires December 12,2022
ds s��.•• Bonged Thu 7my Fein Insurance 80M7019
• I IIIIII IIIII lllil IIIII IIIII IIIII IIIII IIIII Ilil!IIIII IIII illl
2018209118
Permit No. ME NOTICE OF COMMENCENT Rcpt:2013422 Rec: 10.00
DS: 0.00 IT: 0,00
Property Identification No. 24-26-21-0100-OOMO.0440 12/14/2018 E. M. , Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in the NOTICE OF COMMENCEMENT.
1. Description of property(legal description.) HIDDEN RIVER PHASE ONE B PB 76 PG 077 LOT 44
a) Street Address: 3067 MOULDEN HOLLOW DRIVE ZEPHYRHILLS,FL 33540
2. General description of improvements CONCRETE SLAB,SCREEN ENCLOSURE
3. Owner Information
a) Name and address: JUSTIN HUBSMITH,3067 MOULDEN HOLLOW DRIVE,ZEPHYRHILLS,FL nUO4099
b) Name and address of fee simple titleholder(if other than owner)
e) Interest in property OWNER
4. Contractor Information
a) Name and address: STEVEN GREEN/DESIGN ALUMINUM EXCHANGE,INC P.O.BOX 3403a3 TAMPA.FL 33M
b) Telephone No.: 813.949-7545 Fax No.(Opt.)
5. Surety Information
a) Name and address:
b) Amount of Bond:
e) Telephone No.: Fax No.(Opt.)
6. Lender
a) Name and address:
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served;
a) Name and address:
b) Telephone No.: Fax No.(Opt.)'
8. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No.(Opt.)
9. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IPROVEMENTS TO YOUR PROPERTY.A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOU NOTICE ORvO EMENT.
STATE OF FLORIDA
COUNTY OF PASCO Signs O O er or is orized Ofriicer/DircoWr/Partner/Manager
5f lt� c1.3SAA( r
Print Name
The foregoing' ent was acknowledged before mq thig, o day of �: ,20 Li ,by
S.�s T'+ l�v.�Crj AM as_ k A N�(� (type of authority,e.g.officer,trustee,attorney in fact)for
S (name of party on behalf of whom instrlu ent was executed).
Personally Known_OR Produced Identification ✓ Notary Signature
� e
Type of Identiif-cation Produced r(_ C, Name(print)
0 - J -�
Verification pursuant to Secti�o92.52',Florida Statutes.Under penalties of perjury,I c that I have re '�foregoing and that the facts stated
in it are true to the best of my knowledge and belief. I
FORMS/NOC.rn&007 /\
Sigoahue ofN P ve
i
Y
Notary Public State of Florida
Jennifer SatterfieldMy Commission GG 186335• PAULA S.0-NEIL,Ph.D.PASCO CLERK 8. COMPTROLLER,,
Expires 02/1412022 12/14/201 0:19am 1 f 1
OR BK 9831 PG 2202
. .
STATE OF FLORIDA,COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING' IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
1JES ALUMINUM EXCHANGE Inc. License #SCCO56671
P. O. 40383"
Tampa; FL 33694
813-949-7545 www.designaluminumexchangig.com
Sold to J 11t�p-7l tip S r�� Municipality LT
Address -30�o ( Ok-L-De z L L o W Subdivision JA l '
City Z G-P N Y k Ft L��// p Zip 3 S HOA approval Applied for
Phone(1) �7D i �P 9 "'�2 � Received
` / Not needed
(2) �l LST (V J 1 0p 3 Job address(if different)
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Email 0.lV SS es Igo �f( - a gAA LoM
mawww / U%1N 9 / SOUMNROOM / ENO06 w / POOLE3M naw / SUAIWOM /.RE:9OUMN / MK MG / RAUIIMG OONOtELE
white* Dne* kick plate cha�superpan roof*structural roof*fan beam * mansard half-mansard *gable/hip *full gable
Number of doors t Roof attaches to: wall or fascia Roof dimensions Gutter width 5 Wall height S
NOT s
Z 1ao
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y
�pl* ASI muLowm l ,0 `9 D,
Q '= TBBA � CASH or IDOWNPAYMENT
TAMPA BAY BBB.� BALANCE DUE UPON ooMMEnoN �
OffLOR�o� BUILDERSASSOCUMOR
The owners hereby agree that the materials furnished which comprise a part of the subject matter of this contract shall remain in the
ownership of Design Aluminum Exchange until the contract price and any extras are paid in full. In the event the owners shall fail to
make any payment when due, the owners shall pay to Design Aluminum Exchange any and all expenses incurred to collect said
payments, including reasonable attorney fees. If the owners shall become bankrupt or be put into receivership all sums then unpaid shall
become due and payable immediately without notice. Design Aluminum Exchange warrants its work to be done in a workmanlike manner
and comply with the specifications set forth in this contract. Design Aluminum Exchange agrees to repair or replace any defective work
performed by or any defective materials provided by Design Aluminum Exchange for a period of one year from completion. Warranty is
not effective unless contract price is paid in full. y
This lP day of
Accepted by-t— Submitted by r!!l
Approved by
MINUM-110NAN.101ONAL
12/14/18
REGARDING: PERMIT AUTHORIZATION
FOR: CITY OF ZEPHYRHILL
. 5335 8TH STREET
STATE-LICENSE# SCC056671
PRINT QUALIFIER'S NAME: STEVEN GREEN
BUSINESS NAME: DESIGN ALUMNUM EXCHNAGE,INC.
I AUTHORIZE THE FOLLOWING INDIVIDUALS TO SIGN FOR AND OBTAIN PERMITS:
MARK DANIELS
KATHLEEN GREEN
LESLIE GREEN
SIGNATURE OF QUALIFI 14/18
SINCERELY,
GREEN
I DENT
DESIGN ALUMINUM EXCHANGE,INC.
State of Florida
Sworn to and subscribed before this day 12/14/18
Notary P is State of Florida.
(Stamp) C`,%v P�,� Notary Public state of Florida
My commission expires 2 r Jennifer Commission
Satterfield
j + • M Commission GG 786335
Expires 02/1412022
P.O. BOX 340383 TAMPA, FL. 33558 (813)949-7545 www.desi nalurr c
SEC. 24 TWP. 26 S, RNG. 21 E.
RECORD SURVEY (FINAL) BEARING BASIS:
LOT 44 NORTH BOUNDARY OF SUBJECT PLAT BEING S 89'40'43" E
HIDDEN RIVER PHASE ONE B
SURVEYTHT
PASCO COUNTY, FLORIDA. MAZY BE ISCLIOSEDBBYCA FUULLNANDACTS ACCURATE
TITLE SEARCH. ALSO SUBJECT TO SETBACKS,
EASEMENTS AND RESTRICTIONS OF RECORD.
PREPARED FOR&CERTIFIED TO: n UNDERGROUND FOOTER, STEM WALL, AND
UNDERGROUND UTILITIES ARE NOT LOCATED OR
NORTH AMERICAN TITLE CO. II SHOWN.
NORTH AMERICAN TITLE INSURANCE CO. DO NOT SCALE THIS PRINT. DIMENSIONS AND
EAGLE HOME MORTGAGE,LLC �J NOTES TAKE PREFERENCE.
SHAN HUBSMITH a
ALYSSA MOFFITT DESCRIPTION NOT CONTAINING PLAT BOOK AND
PAGE INDICATES THAT PLAT IS IN PRELIMINARY
STAGE AND IS SUBJECT TO CHANGE AND/OR
REVISION.
CERTAIN DATA SHOWN HEREON BASED ON
ENGINEERING PLANS PROVIDED BY CLIENT.
STRUCTURE TIES SHOWN HEREON DENOTES
MEASUREMENT FROM FORM BOARDS/FOUNDATION
TO PROPERTY LINE.
PURPOSE OF SURVEY:TO OBTAIN HORIZONTAL
AND/OR VERTICAL DIMENSIONAL DATA TO SHOW
CONSTRUCTION IMPROVEMENTS.
�R�S�E�NE
5NdO .
TRACT "B-1" E-71.0' 8�
HIDDEN RIVER PHASE ONE A
(PLAT BOOK 74, PAGES 101-121) p� n �851" �i
WETLAND CONSERVATION a ro (�
AREA 15.•'' y /
1�9 0..
0.
LP ` fGO, u no °i $�Q
4xbp dW y
0.
PRM P >�3 N o �� Sao o ?°'6'' ';•�. �� �9c�ss�
(TMP))fG 3 '•'o. GDNG "..\.a�CiO• ;i.' :'.• .e ��p </
.��R a'�• ..� 9' _ _ �zi9
PLAT C ;4'. cKr 1 S _ .�_ -
BOUNDARY y GI`'•PI 1�P 5\OEN ,'•786�
a '0 �a R� E-72.4' O9 O
J` �� 5�\c,
O \� 0.GIr' D+ 460 9
PLAT
�`'�' 4 \�0 BOUNDARY
E-71.6' \
00
Ao 4 = 10' DRAINAGE/UTILITY EASEMENT
\ 518
�Q f\fl6yp0 LOT 45
CURVE DATA(P&M)
CURVE RADIUS ARC CHORD BEARING DELTA
TRACT "K" C23 175.00' 15.55' 15.54 1 S 27'55'46" E 1 05'05'28"
HIDDEN RIVER PHASE ONE A
(PLAT BOOK 74, PAGES 101-121)
LANDSCAPE &
BUFER EASEMENT LOWEST FLOOR ELEVATIONS:
LIVING AREA: 73.01
LEGEND: GARAGE AREA: 72.53'
DESCRIPTION: E-00.0 = EXISTING GRADE ELEVATIONS REFERENCED TO
LOT 44, MAP OR PLAT ENTITLED "HIDDEN RIVER PHASE ONE B", NATIONAL GEODETIC VERTICAL
AS RECORDED IN PLAT BOOK 76, PAGES 77 THROUGH 82, OF DATUM OF 1929. MEAN SEA
THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA. LEVEL= 00.00 FT.
APPARENT FLOOD HAZARD ZONE: "X" COMMUNITY PANEL NO. 120230 0460 D EFFECTIVE DATE: 9/30/1992
Project Number: ------ Square Feet: 6596.43 t LENNAR HOMES
LEGEND:
(C)= CALCULATED DATA, (D)= DEED DATA, (M)= MEASURED DATA, (P)= PLAT DATA, g= CENTERLINE, A/C= AIR CONDITIONER, B/C= BACK OF CURB, C/S=
CONCRETE SLAB, CH= CHORD, CHB= CHORD BEARING, CLF= CHAIN LINK FENCE, CONC= CONCRETE, COV.= COVERED, E/P= EDGE OF PAVEMENT, ESM'T= EASEMENT,
F/C= FENCE CORNER, FCM= FOUND CONCRETE MONUMENT, FIP= FOUND IRON PIPE, FIR= FOUND IRON ROD, FN&D= FOUND NAIL & DISK, FPP= FOUND PINCHED
PIPE, LFE= LOWEST FLOOR ELEVATION, MAS.= MASONRY, OR= OFFICIAL RECORD BOOK, PB= PLAT BOOK, PCP= PERMANENT CONTROL POINT, PRM= PERMANENT
REFERENCE MONUMENT, R/W= RIGHT OF WAY, R= RADIUS, SIR=SET 1/2" IRON ROD & CAP No. 4493, SN&D= SET NAIL & DISK, TBM= TEMPORARY 'BENCHMARK,
U P= UTILITY POLE W F= WOOD FENCE, R = RADIAL
JOHN R.BEACH Sc ASSOCIATES,INC. Drawn By: SMS I HEREBY CERTIFY THAT THIS SURVEY HAS BEEN MADE UNDER MY
SURVEYORS AND MAPPERS RESPONSIBLE CHARGE AND MEETS THE MINIMUM TECHNICAL
911 WEST ST. PAND URG DRIVE Checked By: STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF
ONE OLDSMAR, FLORIDA 34677 JRB PROFESSIONAL LAND SURVEYORS IN CHAPTER 5J-17.050, FLORIDA
ADMINIST IVE CODE, PURSUANT TO SECTION 472.027 FLORIDA
WAY (813) 854-1276 FAX (813) 855-8370 Scale: 1„=30' STA n_
NOT VALID WITHOUT THE SIGNATURE AND Date: 07 20�8
THE ORIGINAL RAISED SEAL OF A FLORIDA FINAL 8/23/18 DJB JO R. BEACH DA E
LICENSED SURVEYOR AND MAPPER F RID EG. LAND SURVEYOR No. 2984 LB 4493
Revisions: FORM BO RD TIE IN 5/17/18 JMM, FOUNDATION TIE IN 6/13/18 DWB