HomeMy WebLinkAbout20-22194 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 22194
BUILDING PERMIT
9 ZK4,0,M 0 0 IN W I NOW IN I_GN I
Permit Number: 22194 Address: 5824 16TH ST
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-07400-0201
7 _-OW I'llf OR - 'K
Improv. Cost: 1,900.00 SK .456,Mrffffifiglil 11INKIRREEM
Date Issued: 1/24/2020 Name: NICHOLS, FRANCES
Total Fees: 75.00 Address: 5824 16TH ST
Amount Paid: 75.00 ZEPHYRHILLS, FL 33542-3762
Date Paid: 1/24/2020 Phone: (813)469-7973
Work Desc: METAL REROOF M _Nrl ONI F5
ITRTA �NIRWIQA I
HOMEOWNER REROOF RESIDENTIAL 75.00
Lq
DRY IN ROOF INSP
TAPE JOINTS ROOF INSt; e-7 n
FINAL
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.
_00VIN
0
CONTau SfdN—ATGR PERMIT OFFIVR
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
f U 1�1 OH
w�
r
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner:
Date Received:
Site: `j 2 6c"L
Permit Type:
Az U
Approved w/no comments• Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be k t with the permit and/or plans.
Kalvin Sivit —Plans Examiner _ Date Contractor and/or Homeowner
(Required when comments are present)
813-780-0020 City of Zephyr-hills Permit Application Fax:81�-780-oozy
ul
Date Recelved s
_ ::;PhonesContactfor'P.:ermitting�h;� N._.,... . s _ -
lef
ra,�e,e �1
Owners.Ns`me' S =;Owhdr,P,hO "be
r..
Ow ib s-Address` - c� OwnetsPhorierNumber;'
.° '2�cQ�yi^h;l'�S 335y owner PhonetNitmbe.
- . .
:JOB=ADDRESS LOT'#'
41
1UBQIVISION' PARCEL•ID#: ���o7U' a -" c) '0'�7u v oc;)aA
='idbTAP1 - -
_ _.• .- ED�ERCrd�PROPERTY•TAX'NOTICE):.'_: .. ..
WORKcPROPOSEI) NEfN'CONSTR' AGD/ALT' SIGN :DEMOfiSH
: . INSTALL REPAIR _
PROPOSEWUk". '. 'SFR COMM`` OTHE12 a "'
TYPE`OF CONSTRUCTION BLOCK FRAME .S.TEEL Y.,.
DESC•RIPTIQN,OF.'W.,ORK
BUILDING SIZE..•... ;_$Q'-FOQTAGE 05U •,-HEIGHt?.`':': •u. '}`'/
ILDING; $ VALUATION OP TOTAGCdNSTRUCTION ''
._. r
QEL•ECTRICAL'> $'' ''�-AIVIWS VICE ` `' D.UKE`ENERGY.
=MECHANICAL $ VALUAi ION;.OF,MECHANICAL.INSTgLLATIQN.= .
=GAS ROOFING Q 'gSPECIALTY,Q. O]'HE#4'
FINISHED`FLOOR'ELEVATIONS•` ='"' FWOD''ZONE'AREA ' =YES` O
BUILDER COMPANY
SIGNATURE REGISTEaE YF'N :' ,FEE'cuRREn `YIN
.,Address'r• :Cleans#'#
ELE•CTRICIAN. ... COMPANY
SIGNATURE REGISTERED
.address. .a ;.ucertise'#:
PLUMBER COMPANY
SIGNATURE.. ;REGISTERED. Y.%i.i11'•,': f• 3 r. ;
Address ,GicQrase:# _
MECH!�NICAL. '- COMPANY :•: - -
SIGNATURE':` 'REGISTERED. - _. .
Y'T N' FEEtC_URRE� :»Y/N•,:'
'Address.'• .
SIGNATURE ,
OTHEII' COMPANY'
. .:: .REGISTERED � 'Y'%`fJ
Address
RESIDENTIAL Attach.(2);(?IotPlatis:(2);sets;of,;t3lil dliigsPlai�s°(;1,sseti0f Ene F Fins;R=.O-111lPerriit)$fo�neuv-constructloh
-- ,�. r, ) !'Ey � . .... .1.
Minim`uni"ten(fOrVVortiirig`days`aftersfiti`Mtttal date:'Requtred'onsife,Constructlon Plans;St`ormwater Plan�:w/Silt°Fencelinstalred;'°
Sanitary Facilities&1 dumpster;Site Work Permit for.subdivisionsAarge projects,
COMMERCIAL Attach:(2)..complete.sets•of.Building Plans•plus:a,t:ife'cSaf#fy'Page;.11)set of-Energy.-Forms.R=O=W-P.ermit-for:new constructlon:-
Minimum-ten(10).vV6*ing,days affet`su6mlttaGdate: •ReyuiPed on§ite,Construction Plans;�Stoririwate -Plans'w/.SIICFeince=installed;
Sanitary,Facilitles-&,7'dumpster.Site-Work•Pem'ltsfor:all:n..ew•projects.Ail eommerdal:requirdnients'must•meet..Compliance•., .. ..-
SIGN PERMIT Attach(2)aetaofEligineered'Pians:
•'•'PROPERTY"SURVEYlrequired-forall NEW construction.
----------------
Directions:
Fill out application_completely.
Owner'8'Contractbrisign-bade;of'applic#tion,..notafted =
If over$2500.a Notice of Commencement,N "julked."`(AIC�upg�ades:over:;67500)
. ,
Agent(for the contractor)or.Power;of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THECOUNTER,-PERMITTING:.;; (cony f�eonfracF�equtredy
Reroofs if shingles Sewers Service U0graddie,4'/C' Fencesi(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
Nt1TICE:t3F DEED:RESTRICTiON& The-unde,gi ed•: i <
fs'gCl.. .,utldersands that.thls permit may be.subject to"deed°restrictions"
whiich:;inay.be'more;restrictive:than,;:Countyregulations ,ThWundersigned:assum,es,responsibilityfor:compliance:withany
oog1'cable:deed::r+strictions:
UNIICIwNSED:C TRACTORS; ND:'CONTR.-ACTBR'> ISPQNSIBih :a h o ner:hasH=hired-:
.- ..•. � ,..{r , L : -�.; ..,;:. , .T!E�§.,_':� .f;# e: w a�:conti~a:tor.'or
cont actors;to�iindertaiCe'work, the)/may berequired to..be Licensed in:accordance.W h state::and'local regulations „-If the
cor?tiaGtor is not l�neltsed as rei U1i tf by, to r6a#h..:the>owner.:and;Y_co Ai ac br na} ::lie:cited:for'a misdemeanor.:violation
under state;law:"if`tti'di-"6w'odr:or,.intended.contractor are,uricertairr as�to:what licensing.requirements•maytapplyforthe
inteCtded work;:tl ey;are:actVised to. of tct''ti dl'Pasco•Countyf!$uifdiia Iris e�itionx'D visiet�r Licensin "Section at 727-847-
g:.�:.-p... .. 9
80p9: Furthermore;.:,if?tf e•owner';fias;hired;,a.contractor or°contractors, he is'advised to have:the;:contractoc(s)."sign
ortions of the contract. 5
-. ' or°Block"'of this application'for::whichrthey:willberesponsible:"-If.'you,'as:the,owner sign as the
contrctor;-that"may:be:an;indication>that he:is.not.praperiy licensed and �s not:entitled:to permitting.privileges in Pasco
:,County;=
`T j CANSP4R�TATI4N+1lIl! iP►C'lUfTtLI>FtEStitIP.,AC °AN'DRESOURCic Rt*C,OVERY FEES:~Theuridersignecl:understands
:.,
that;Transpo tatorl Impacf.Fees:.and Recourse.:;Recovery:Fees-may_apply,to:the.;construction"of�newb-Olidings;Ichtrf of
P._
usemy.existin bu ldin s�.or,ex ansionafexisting�buildirigs "�� ' `� ,>as'-specfied'iri ounty:Ordinance'..`number"89=07:and'
90=07`gas-'amerided_':Thb undersigned also:uriderstand'si.Jhat 4ch;:fees;as;:rnay be,--.due;:wilt:be:identified.atvthe::time=:nf"
;permitting': 3t4is fu'rtl;er;:undecstoaC(,tl at°rT�ansportationAmpact:l=ees:and Resodree:`Reeovery'Fees Faust be paid prior to
receiving:a°csrt sate ogoccupan' 'orffino[(power release:::;,lf`:#he.::pr,.ojdet_does not jnvoive a.der# sate<af;occ' an .:.or
iinat'poWpr-4efease; the fees'rnIM-be pai 'prior-Ad permit issuance: Fur h'ermore�rif.Pasco'Gounty Water/Sewer impact '
fees:ace'tlue tl ey mustb�e:. l ;prtir to:p rm:it ssuance in:accordance:withappllcaale Pasco- ounty.ordinanc'esi
CQN,S7J"tU;+C ;IQN;I .ENE AVN(Ct�ipt$�r 713;z 1=1oida.Statufes `fis amen% ecl lf;uatiiationof"i�vork`.i ;`$2;50 OtJ or more,.!
certif`"•-`#hat:'1, aFie'a " 'licant'::FiavesAtieen 4' 'rov"raed wi `°a..co°"'' i�f:.the w"Florida';Construction Lien'aaw=Wonieowner's.
Piotectian Guide: pr. pate�l:thy-tFeFl6nd; .`Dep.'artmenC`ofAg(icuiture:anrt.,,'6 surnerAffairs,. IfAhe.applicari s,someonei
)ther.;than the"owner°,AIjcer ifj%that l have obtarned:a:copy:of the.above:deseribed;document and;proiriiise iri°good°faith'to
deiiver:if to:the,°owe:"pricsr to= "oifimencemerit:'
CONTRACTOR'S/Ci.Wlk�R'S;AF.FIQ,'-'VI =:klcertify:that:all;the'irafarmation it hYs apptication is-.ac..urate:.;and.that-.all,wotk
,t+r1:•.Y 4' - •.�A J.a'n' {: 'J f.::i., ,. ;pn
Cex °tha ti tic'"'bleaaw �.re u stirs' : oits4r ction':2"rtin 'aid and'deve o me'a: A lica i"n'is
�►5...': '.MQ.:.,t: ..,},nap..l.n. . ".wt .iiapp. a s,. . .9, t. . 9.. . u , ;"a. ..9.. .,..L._...__ t p .. n :.pP. ., to
Hereby°made-°to obtain'.a perr»t`to dot;work.arto installation bas: ind ca#etl. t certify-that J o:work or 1n'sfal#atiori has.
commenced prior;to'issuance of a;;permit-and that;all._work: it`be performed:ao:meet..s'ta'ndards.of'all:laws.regulating
coiistcuction,:-Courtty.:and;Cltod:es� ;zoiirtg'.-rogulations;:actdlakdtfevelop_meet-'regulationsr in'the-jurisdiction.: 1.;also
certify'fFiat is understand:tha'"t(ie`regulations-of.other;•government:agencies:mayappiy to.the:intended'.work; arid:that�it is
my:responsibility;to'idenfifywhat:octionsl;mustaake to".be in compliance:::Sucl ageneies.incl'ude but are not,1i0ited:.to::
Departfneriti t3f Environmental:Protec#ion-Cypress Bayheacts; Wetland Areas and Environrnertaily'Sens'rtive
Lands,-1NaterM/astewater Treatment: -
- Southwest. .Florida: W;411:er:.Management` District'Vt`1611s; Cypress Bayheads, Wetland`.Areas, :Altering
Watercourses.
- ' SawfiD -N�v"iArnyCocps ofEngineers ; a ..,.ble!.Waterwaya.
DeRartrienfi of:Health & Reaiitativeevie .nv Wastewater,,Treatment,,'.
SeptcTanks:
,
- t1S Envirorinientat Protection A en Mbestos abatement.::
tI lorrAutC%grityfunwayst
iA tw restriconsaotf ply.tothe.uso offl „
:.:Use ofkfills,snot`;allovtred:in_:Flricl-Zone"V"`"unles,'iezpressiy perrtlittod.: i
If #1 e":` Ii'-rriateria( is':a"a, be' usetl'in Flood` Zone :''A";•:its=:is>understood-Ihoif a ulna_ -.' lan-addressing a
"compensat�rig;volume";;wi�l be submitted a#.#ime.o#permitting wh'ich:is_prepared:by a pt9fessionai:engineer
__ . -�icerlso'd�tiy°tfie'_State:;of>Florida::. ''
- If the fall material>.is:"to:be:used-:in Floods Zone.°Ax==iri:cc nection-with,-a permitted.building using,.steal:';Vir61l
Coristn ction;�.I cettifj%tha#f1l�nrill tie.used only twYlt#He`area..Within.the..stem•wall'
- If tilt.material:is.,to•<be,:used i`h::af y;urea, l :certify tt"ot use'of'such°:fill will not":adversely:.affect.adjacent
properties:. ;tf".use;of.fit: s fpuntl.to:.adversely a'ff_ed3bdj t,,*..�propertie�;,-,the-,-owner...may be-xited'tfor.-Miaiing
;: :'ttie;conditions"ofaf,e buiid,'ir g''permit.issued underthe:,6 tached:permit'applIcation; for lots less:than one:(1':)
_ , re<whichace::eloyatedvl}yrfill;:an:engineered:4rairislge plan:is required.
ff't-am:the`AGENTz;1 OR;THEwO1NNEK .tdmise m good fai#h;to inform-the',ovsrnerof.#he:permittingticond..itions'set'fohh`�i6
1. �. . . .:,„ �.
this':aM avit prior+tb:cornmenoiag construction: I understand°that a`separate':permit".may be:required for'electrical work;
ptumbing;'signs:v+retls, pools;;air condltionirig,;;gas;::ar.other iristaliatiorisznotspecifcally.:inclined':irt:theapplication. 'A
permittissued ahall.=6e construled.to�be a;licen's'®''twpro:deed with the work and'not.as authorifyao"v olate;:.cancel;
set=aside>attyaprovisions::of..the`.technical codes;,riot,shall:isst ar ce"of:a permit prevent the�Building.Official-froiri ther8affe
requiring:a;correctio ot_errors,in'-plans, canstrsiction orwiolations:of'any cod'es:bM,Every;permit.issuedtsFiall beGome`:irival-6
unless•the:work'ratathorized.°by°suchpetmit:'is.commenced Vvittiiin:six months'.of`permit'issuance,.or.:if";wor(authorzedty
ttie pernett'is susperiiiedTor.•abandoned for°a:period-of..,siic(6)'mbriths after°ttie°time'the work':is`: om"mertced -An extension.
mayae requested 1;in:;wn ing;;.from'..the:Building off'iciahf01r,_+:,gartod:not'to:exceed ninety(90) days and will.demonstrate::
lust able cause€or ttie,e}�tensiart:-:::If:work,cea"sos for-ninety;(90),consecutive-days;:the.job is considered,obandoned.::
WARN NG:TO=UWNERt--YOU .:FAIL;URE;_W'.RECORD;A NQTICE.:4F:C_QMMENCEMENT MAY RE$ULT;IN xOUR:
t.L.. n
PAYiNG�TIN ,15 5,OR IMPR'�Y '+�,ryE,+TS`�: ;O YO.0 QPER�TY° fF pYO �I�IT�rr1 .D TO 41BT ,`i,N FiltlAi LNG;{C0'SO T':.
'.fit. :�,1. .dA7%=s {tTL•;:1H�t,, .t,.•}.a� .ti.•y rr7�i'r, .t �r !.Eft TX.
.4-.,bt ,. .,.y i?:�. - i ;. A ..
'WITI �Y0 124L1`NDEiRaO►R AN}ATTORNEY:BEF Ea (EGO tt)1N:G~YbUR;tVO'I ICE�:O 'C:OMIVIE IC M NT
FCORlDA.`JURAT{F: 17:03}..;'.': '-.
OWNER:oR:AGENT7 '`J�_ C�. CONTR_ACTgR
..: :
Subscribe DO- s om, orafBrm" }•be me:�h1 .. ubsoti anii`.s #o or:afftirne¢}b re' e.this:
by =FAA Vet: 7-0
by.. 32,
Who;i /are-personal yTkrio' •to m'e.o�aias%ha've produced Wh f'repe to me,vr;lia.:have produced..
fin s`G#X M�yt- as-fdohlificatien. �(J1 as,tdeiiti#icatson:.
A ---Notary Public �•� `Notary:Pubttc.. ..
Comnttsstori No. a rl�t 3 D 'Cot!i ' SIQ ,3 eaue,nsui Uie j�ta�nt41#�R� ,,av eon.,
✓ `.+'w.i/�/� 4.�� V v V��� - Y.��Z V�tt V.�""'i�iWO�:f: +if:
Name of Notery'typed;,printed opRYstamp Name.of"N -ry typ'ed,Prirgq#{ttg t#tM }�C
eleve Hazelwood
oQ NOTARY PUBLIC
+STATE OF FLORIDA
Comm#GG090036
Expires 5/8/2021 —�
11-26-21-0010-07400-0201 1 Pasco County Property Appraiser Page 1 of 2
Parcel ID 11-26-21-0010-07400-0201 (Card: 1 of 1)
Classification 00100-Single Family
ailing dress Property Value
BENNE FRANCES Ag Land $0
5824 16TH ST Land $8,820
ZEPHYR 42-3762 Building $13,722
Extra Features $640
Physical Address
5824 16TH STREET, Just Value $23,182
ZEPHYRHILLS, FL 33542
Assessed (Non-School Amendment 1) $23,182
Legal Description (First 200 Homestead -$23,182
characters) Additional Homestead -$0
See Plat for this
Subdivision Non-School Taxable Value $0
CITY OF ZEPHYRHILLS PB 1 PG 54 School District Taxable Value $0
WEST 1/2 OF LOTS 20 21 &22
BLOCK 74 TOGETHER WITH AN
EASEMENT FOR INGRESS & EGRESS
OVER &ACROSS SOUTH 5.00 FT OF
EAST 1/2 LOT 20 OR 8859 PG 2763
Jurisdiction
CITY OF ZEPHYRHILLS
Land Detail (Card: 1 of 1)
Line 16se Code Description 11 oning,Un t�s Type jPrice lConditionLyalue
1 1010OR I LP1-1 SFR 1 00112 16,300.00 1 SF 1 $1.40 1.00 1 $8,820
Additional Land Information
c Tax
a FEMA Code _RZHHe CoZCHde condo
O14� 30ZH H �
View Sketch Building Information - Use 0100-Single Family Residential (Card: 1 of 1)
Year Built 1900 Stories 1.0
Exterior Wall 1 Asbestos Shingle Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Plywood Panel Interior Wall 2 None
Flooring 1 Asphalt Tile Flooring 2 Carpet
Fuel Gas Heat Convection
/C Window Unit Baths 1.0
Line Code Description Sq. Feet Value
LIVING AREA _828 $12,896 _
2 _FST01 FINISHED STORAGE 77 $607
3 _FOP01 _FINISHED OPEN PORCH __40 $156 _
4 UOP01 UNFINISHED OPEN PORCH 25 $62
Extra Features (Card: 1 of 1) _
Line Code _�Description Year Units _ Value
1 RUDU-M _UNFIN DETACH UTIL MT 1988 1 _ $208
2 _RCLFENCEj CHAIN LINK FENCE 2002 960 $432
Sales History
Previous Owner: CARR GARLAND W &CARR MARILYN
Month/Year Book Page (Type DOR Code Condition _A om unt -
_ 04/2013 _ 8859 / 2763 Agreement For Deed ____01 Improved 1, $26,50_0
07/2011 8574 / 3094 �� Warranty Deed I 12 Improved $15,000-
- - -- — -
https://search.pascopa.com/parcel.aspx?parcel=2126110010074000201 1/21/2020
rForceineering&Testing Inc.
btM Ramblewood Drive
Ilurnble,TX 77338
Product Evaluation Report
ADVANCED ALUMINUM
26 Ga.Advantage Roof Panel over Plywood
ALL WORK SHALL COMPLY WI,rH PREVAILING
Florida Product Approval # 1763.1QUES FLORIDA BUILDING CODE,
Florida Building Code 2017 NATIONAL ELECTRIC CODE,
Per Rule 61620-3 AND THE CITY OF ZEPHYFJqILLS
Method:1—D ORDINANCES
category:^Roofingr
5u6category;Metal<1166fing
Compliance Method-:61G20n&66(1)(a IRS,WEWbATeJAN 2 0 2o2
HVHz PLAN
EXAMOF ZEP HYRHIL
Product Manufacturer: INER
Advanced Aluminum
2941 Parkway Street
Lakeland,Florida 33811
Ensineer Evaluator..
Terrence E.Wolfe,P.E.#44923
Florlda:Evaluation ANE I0:1920
Brian;Jaks P .470159 _
Evaluation:Report, „Pages 1=4
NGEE
Pb.
JO °
.:.o STATE OF
Z ORI 9 .•�+ •
FL#1763.1 R3 "' r
:;-September 5, 2017
DISCLOSURE STATEMENT FOR OWNER
CITY OF ZZPHYRHILLS BUILDING DEPARTMENT
have read and fully understand and
agre4g to the provisions of this instrument.
The undersigned states and affirms that he or she is desirous of constructing,
renovating, adding to or reroofing his or her own domicile, that he or she
-actually occupies or will occupy by said domicile, and same is not for
rent, lease or sale. That he or she shall comply with the following conditions:
1. That the owner and he or she alone shall act as the builder for all phases of
I I construction.
2. That the owner will comply with all provisions of the City of Zephyrhills
ordinances and codes pertinent. to the building.
3. That in the event various phases of construction are subcontracted, he will
engage only properly licensed subcontractors and will personally supervise
such work.,
4. That -in the event the Building inspector shall require corrections to be made,
the owner will assume full responsibility to insure they are made, and upon
completion will call for a reinspection before proceeding with the building.
5. That the owner shall assume full responsibility for the construction and will
not expect supervision of his work from the City of Zephyrhills Building
Department.
6. That prior to final inspection any additional fees, including reinspection
fees, must be paid in full. A written request from this office shall
-con I stitute an official notice to pay additional fees.
7. That
at 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
Industrial Commission.
9. State law requires construction to be done by licensed contractors. You have
applied for a permit under an exemption to that law. The exemption allows
you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a license. You must provide direct
6"ite supervision of the construction yourself. You may build o:�.improve a
one-family or two-family residence or a farm outbuilding. You may also build
or improve a commercial building, provided your costs do not exceed $75,000.
The building or residence must be for your own use or occupancV. It may not
be built or substantially improved for sale or lease. If you sell or lease a
building you have built or substantially improved yourself within I year after
the construction is complete, the law will presume that you built or
substantially improved if for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person to act as your contractor or
to supervise people working on your building. It .is your responsibility to
make sure that people employed by you have licenses required by state law and
by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not
licensed to perform the work being done. Any person working on your building
who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.X.C.A. and withholding tax
and provide workers' compensation for that employee, all as prescribed by law.
Your construction must comply with all applicable laws, ordinances, building
codes, and zoning regulations.
a-A-P. �) DATE 0 L,-�
OWNER'S SIGNATURE
.4 (�42
ADDRESS L
PHONE
WITNESS PERMIT #
STATE OF SOUTH CAROUNA
LICENSE AND CERTIFICATE OF MARRIAGE
2013M L0700472 BEAU FORT
LICENSE NUMBER COUNTY
GROOM-NAME (First) (Middle) (Last) (Suffix) BIRTHDATE(Month,Day,Year) AGE
(1) MELVIN SHAWN NICHOLS (2a) 09/11/1967 (2b)45
BIRTHPLACE(State or foreign country) RACE No.OF THIS MARRIAGE
(1st,2nd,etc.)
(3)FLORIDA (4) WHITE (5) 2ND —
RESIDENCE(Street and Number)
(Be) 38051 CHURCH AVE. _
CITY,TOWN OR LOCATION COUNTY' STATE
(6b) DADE CITY 1(6c) PASCO (6d.� FLORIDA
BRIDE-NAME (First) (Middle) (Last) (Suffix) — BIRTHDATE(Month,Day,Year) AGE
(7) FRANCES ANN BENNETf (aa) 03/29/1963 1,81))50 —
BIRTHPLACE(State or foreign country) I RACE (NO.OF THIS MARRIAGE
('lei,2nd,etc.)
(9)PENNSYLVANiA l oo) WHITE j(11) 4 T H
---------._-..--- _— -- ----- --- _ --__ — _ -- ---- -
RESIOENC@(S+roe!and IvuniL•erj
(12a) 5824 16TH ST.
CITY',TOWIJ OR LOCATION COUNTY STATE
(12b) ZEPHYRHILIS (12c) PASCO — (1zd)FLORIDA -
MAIDEN NAME OF BRIDE(If Different From Above) ;I CERTIFY THE BRIDE/GROOM HAVE MET THE STATUTORY REQUIREMENTS TO QUALIFY FOR THE STATE INCOME TAX CREDIT
AS PROVIDED BY SECTION 20-1-230 OF THE SC CODE OF LAWS. L I YES ❑X NO
(13)GELORMO — j(14)
Application for a license was filed with this court at 01:30PM (time), on the 18tn day of April 2013
These are,therefore, o av,thorize any person qualified to perform marriage ceremonies to perform the marriage ceremony for
the persons above named and for the so doing this shall be sufficient warrant. Given under my hand and seal
at 01:30PM (time),thi5'th _ 19th day of April 2013
Kenneth E. Fulp,Jr., Probate Judge
SIGNATURE OF ISSUING OFFICER TITLE OF ISSUING OFFICER
GROOM
-SIGNATURE( 1(x�J -- BRIDE-SIGNAT/U'R-E' �q ,, ,. f�
(15) • �-�^ `eet7.'�r�. (16) �(uo WW'►1�
I CERTIFY THAT THE ABOVE NAMED PERSONS WERE MARRIED 0 PLACE OF MARRIAGE
J U N �0 f/� _ _ QQ� ��$
uW
(17) (Monti) r ( Y, 20 hear) - i t161 �i�"Y; iCuurny) SOUTH CA`�OLIN
OFFICIANT-3f NATURE ( I OFFICIANT-PRINT NAME
(19a I(19b) nle;a Ann _ —
OFFICIAN,I- ITLE
'kdowy, ,ate,Qarolina, to At Large
�m Feb 19,2018
(19c) ----
OFFICIANT-"AI�INGADGRESS —
A sox,1 171
(19d) "Beaufort, 2990E ---- -- ---
DHEC-0681(07/2.00) BRIDE/GROOM COPY