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HomeMy WebLinkAbout19-21710 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 21710 BUILDING PERMIT " PERMlT=,lNF.ORMATlON'. LO.CATI;O.N,:11lJFORMAyT,.I:QN; Permit Number: 21710 Address: 39717 MEADOWOOD LP 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: MEADOWOOD ESTATES Est.Value: Parcel Number: 13-26-21-0140-00000-0510 Improv. Cost: 649.00 O1NNE -ARF-40RMATLt7N,' Date Issued: 9/05/2019 Name: JAIMES,MAXIMINO Total Fees: 67.50 Address: 39717 MEADOWOOD LOOP Amount Paid: 67.50 ZEPHYRHILLS, FL. 33542-6779 Date Paid: 9/05/2019 Phone: 813 783-4333 Work Desc: GARAGE_ DOOR REPLACEMENT 9 X 7 CONTRfACTOR S, :_:APP:LICATIONt,FEES DISCOUNT GARAGE DOOR , INC BUILDING FEE 67.50 f Jns .ec#ions_Re. wired F OTER 2ND R _ PLUMB MI_5Q 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)Wlth respect to Reinspection fees will comply with Florida Statute SS3.80(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 properly 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. -49:CICTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER .. `813-780-0020 City of Zephyrhills Permit Application Fax-813-780 0021 Building Department Date Received Phone Contact for Permittingg 352 631 - 5018 1 1 1 1 1 1 1 1 I l l i l Owner's Name Jaimes Maxmino Owner Phone Number _ Owner's Address Owner Phone Number Fee Simple Titleholder Name I N/A Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 39717 Meadowood Loop,Zephrvhills,FL 33542 LOT# 51 SUBDIVISION Meadowood Estates PARCEL ID# 13-26-21-0140-00000-0510 (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 Q FRAME = STEEL = DESCRIPTION OF WORK Garage Door Replacement-Same Size 9x7 FL#8248.6 BUILDING SIZE SQ FOOTAGE HEIGHT =BUILDING $ 649.00 VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY Q W.R.E.C. =PLUMBING $ `� ) � �aif1S� _ MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION =GAS = ROOFING 0 SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO BUILDER r V C MPANY Discount Garage Doors Inc. SIGNATURE REGISTERED Y/ N FEE CURREN I Y/N Add ss 93 Sunshine Grove Rd, Brooksville, FL 34613 License# I CBC1254791 ELECTRICIAN COMPANY SIGNATURE N/A REGISTERED Y/ N J FEE CURREN Y/N Address License# PLUMBER COMPANY SIGNATURE N/A REGISTERED Y/ N FEE CURREN L11 N Address License# MECHANICAL COMPANY SIGNATURE N/A REGISTERED Y/ N FEE CURREN Y/N Address License# OTHER COMPANY SIGNATURE N/A REGISTERED Y/ N FEE CURREN LY/N Address License# IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIItllllllllllllllllllllllll 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/Slit Fence installed, Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(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 all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. "PfWPERTY 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. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. 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. Such agencies include but are not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,Water/Wastewater Treatment. - Southwest. Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. . . I understand that the following restrictions apply to the use of fill: - Use of fill is not allowed in Flood Zone W" unless expressly permitted. - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. 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 CONTRACT Subscribed and sworn to(or affirmed)before me this Subscribe and orn to or affirmed)befo a me this by y J�FG�GJ] ��rJo:J Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as identification. as identification. Notary Public \ A��NotavPblic Commission No. Commission No. E E E &0 Z.! Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped �oV"cj�, Notary Public State of Florida Linda Ann Krumholtz •„ a My Commission FF 916028 '�orwp` Expires 0 9/0 712 0 1 9 `il t l:rr 9 City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: D1Se( r I IqC r� f? r- Date Received: 8 - Z Z-- 1,/ Site: IJCy `�`i- Permit Type: �a �C 7 Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ This commen Veea1K 1 be kept with the permit and/or plans. p p Kalvin Switzer-Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) STATEWIDE PRODUCT APPROVAL SUBMITTAL 1108 Revision Date: 06/18/19 Application/Permit #: Building Address: Owner: Contractor: Discount Garage Doors, Inc. Openings: Sliding Glass Doors, Exterior Swing Doors, Overhead Doors, Fixed Glass,Windows, Mullions, Skylights **Pressure Product oval Product Model#or Glass Attachment Approval Expiration *Qty D T Manufacturer Categ Number/ #. Name Series Type/Size Method Entity Date 1 37 41 Wayne Dalton 364213 I8248.6 8000 N/A Single Wood Laas Scates N/A ,�s , @4 ®P GV *Only one entry required for Multiple units of the same size and Design Pressure _ **D=Design Pressure T=Max.Test Pressure 0696-bLb(OM) £O'4W8 f9S 3d XL 'Twlw NDIIOMMM OVOIQA\30 NOLLVMQM Od ��Z�9� BOLL 3000 NOLLdO NOliV:DId103dS OVOIONIM bLst£valaold VWVSN3d L£LLS 3d ld 9m A-M 00"M WM S,tmNMM-MMES33DUd A3M3AIa0 NOSlaav Sef£ 9sosL XL'3T11Aswm Od 'ON laud ONIA1Va0 MOO aooa av3Ha3AO do NOISING .00,50-S£�8S:1'L£1'0L'8L0Z:9;e(i bs-ZL#ale anHLav ONDI OM Z .40 L 133HS OOZ8/00 L8/0008 S7300W S 210 0 0 3 0 tl a tl 0 3d salvos 3 NHor .3.d s9leDS•3 uyo f Aq pau6ls Alle;i6t .LZ1HOI3H N S3A / 031Va o VdVil 'uo •D�a •�/ 3s3 eL/zL/oL vaa 0 d153 1tlN/ :(ONS � �a 3WVN 3LV0 0-•6 :HLOIW XvW 00'L4/001£+ :(3Sd) NOS3a GUABM V 'S1N -31VOSI SMS a3A0addV SONIL" 3anSS38d OILVIS 0S�z Q1\Q y sret/S•99t+ TIV .0-.6 _�►A; J0 3itliS ;�•�_ O'b9L- OvtL+ T1V O- (37d)ampIiOr3 OVoI Na030Jn IM13H HLOVA aooa aooa MfiLOf1M1S ONLL80ddnS NO SO`d0I i 38nSS3Nd NOIS30 03SOdA183dns d►'-:��N37��%�O�\\� 3AO8V � � 9 xo-+L �ani �otaSba ,' Moms sv irw aNvilo8 VaLL % z / HuA>iovu 3H3v.Lv xvae ar mLwa S3is oS I SNVAOTH) R MO'138 31ON 33S(sn-w) L S - L- 96 S -er 8 S b£ -er b - l S Z 9 0- Sfl-H' Z L-DL Sn-81' 9 L-YS Sn-8I' Sb SO-Bf` 9£ Sn-8P b£-9Z Sn-91' 4£-9l 5f1-9' OL'Sn-8I• Z 9 S 9-L Sn-9' b L-£8'Sn-er Z L-ZG'sn-el` b'sn-er b f-n•sn-er b£-Lz 'sn-er OL'Sn-er Z L b .0-•L Sn-BI` b L-LS*(sr-w et Sn-er 8£ sn-r b f-BZ Sn-er b £-LZ Sn-9' OL Sn-BI' Z L b 9-9 (.Z:F SNOISN3NXl TTV)XJval d0 (BNVr t00 SWM03S IHODH N01108 now a3HnSV3N SL3)0Vae S13XOVae jo'ON "a v Nv 31f)03HOS 13HOV88 BWtlr 'SNOLLdO DNa:VIO 11O3 L93HS SIHL t 31oN 335 ONV HVnb NOLLo35 a3H10 HLvA LYA sa000 SL3XLVa8 d01 aHl 30 dDl NO mTIV15Nl 38 No SNOILV001 MVe-n a0d TIVHS NOI1035 dol No ave-n'ONvAvHa SRLL u 3LLLdMaO ONTi1Rt0 z 133HS 33S Boom GnoS NO OLL 3S(11)�-MUR LLdMW UNTRIa ffM.8/LX*L-+ sus.9/1xi L-►/1(1) (£)d0 NnNININ v Rum nxavae N3H0S 03a d01 b/L MM VO£L V 38 T1VHS L3)MVHB 9NL1"IRIa dT3S,8/9XtLSXbLi/G d01'SNOLLION00 1_dl NOOa aV3H MOl a0j'8 (L)GNV SA13a0S 3LILdNRO ONITIRIa AM.B/LXbL-b/L AUMM NOZI NMOHS 38n10nHM 3N&HOddn5 (Z)HIM 03HOV11V X001 3arts '(£3LON O1 IN3nH3V11V BOA LN3N3lddnS .3XDVae n01108 VO bL 33S-aO1Va3dD HLNL NOLL33MM SAVr 01 a3d3a 3NId cmin03a ION)ON3 3NO N93HLf105 Z 3GVW 38 01 Mr WOO B X001 3GnS a0=1 AMI 'ONLMVHG p' d13S.B/SXf llli/l 3dAl ONV SIHL NO 03LSn SaWn 3HL WA S3000 (b)H11M 03IfJVllV Nouv001'ALINVf10 ONI3Hne 1NIS HO NIC nS 3HL p0OY NI 0NY aoi 31na13HoS 3$ 3an10na15 a0 ONIfTAf18 3HL a03 O?l003a 3ONIH 31VI03Na31Nl 30 I4No15S3d08d 3HL d0 A1111etswd53a • 4 A008 IAOMNVN VO 8t 11 VO Sl 3H1 38 VHS SLNRUO WHftLOnaLS ONLWOddnS 3HL d0 MISM 3HL'L 'S53NX01HL • VO SZ NnNINM V 3AVH 01 T3315 14OLL03S'9 SM3HOS OMddVl JUS • o V9£l L3aV(3AOBV TTV GNNV)339NH£S 13XOV90 eNVI• ONV_ SN003a SRJ830 3Na06--0NLM aNIH 03 SLN3113a1nD3a u VO CL SI 39NIH Z/ HOV3 IV AUNDS ION 3av 5a3A0 N00 O�3S NQ1108 3 ISISM VdM VO bl SI 30NIH w OVl.B/S-lX9l/S arwiw SM3sos.LXet(OL)j0"MtMN V m. 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Zsotr 9L/6XOZ-b/1 aNV lOIS a31NM M 5NIN3dO av30 SL'6 X M aid'ONaviia MN LnN V 1109 9t-9t/S HIM 13MVHS 310NV WON VO£L :SNOLLdo ONUM MdNI NON 3 SNO VGH - 01 mHDV1LV 30rr.H3TIDa VO ZL _sxM REVISIONS ` CENTER STILE&INTERMEDIATE HINGE LOCATIONS PO NEW DRAWING,PER y ER 31052 ESC 10/12/18 .� (8)SECTION DOORS MATH (8)3-20 CA 80 KSI U-BARS 0 0 o LOCATED AS SHOWN 0 0 0 • (7)SECTION DOORS MATH SHORT LITE GLAZING LAYOUT (7)3'20 LOCATEDAS OWGA 80 KSI N SH(s)SECTION DOOR S WITH o o o (8)3'20 GA 80 KSI U-BARS LOCATED AS SHOWN LOUVER- OPTIONAL IN 807TOM SECTION (5)SECTION DOORS WITH • ! (5)Y 20 GA 80 K9 U-BARS $gS$T g^�41, LOCATED AS SHOWN .O G aZ5 G • i (4)SECTION DOORS WITH (4)3'20 GA 80 KSI U-BARS LOCATED AS SHOWN / INTERIOR FRAME / SHEETIIETAL SCREW I I EXTERIOR / FRAME 1/4'POLYCARBONA7E \\+O��,C NsAA V1,'' I�PA��NDDW�ALILNINLIN FRAME DETAIL��P���A�I��N0�21 C ♦ I ATTACH U-BARS WITH • [2)1/4-14V/8`SIIF s i No.51737 ♦; - RUT aDNPnTE SCREWS * = AT ALL STILE LOCATIONS, TYP" Z. STATE OF :�4/` STATIC PRESSURE RATINGS APPROVED SIZES SCALE: N.T.S. SIZE: A /O,p`♦��OR�pP \�\� Wayne DESIGN (PSF): +37.00%41.00 MAX WIDTH: 9'-0' DATE NAME TEST(PSF): +55.50/-61.50 MAX HEIGHT: 14'-0' DRAWN 10/12/18 ESC �S�ONA1.����� p1{N E SCATES PE �Dalton- IMPACT/CYCLIC RATED (YES/N-- YES MAX SECTION HEIGHT:21'CHEgCED 1E0E218� 2 p( �irr 111 2560 KING ARTHUR BLMD 0124-54 MODELS 8000/8100/8200 LEMSNLLE.7X 75056 DIVISION OF OVERHEAD D DOOR DRAWING PART N0. REV" 3395 ADOISON DPoVE ENGMMVS Y TX PE 56��03 PENSAcoln FLORIDA 3.14 WINDLOAD SPECIFICATION OPTION CODE 1108 364233 PO 850 474-989C . .� .g Iy k ^ate. 3 a�t `�Llri���t9"tEa N�0,1' GDo t �iseatart��+•�rrn G�caex,t;<ttw l�ttRtfa •_•:' . ' i +�'csf�trttt.tlle.�:�Ea��anal Ett:�t��lt�tki.i�a�.ct1'at hla��o ,sri�;k�;tr 0��a1"a� � a_,..t� t{.t C 1�4!!:Slr l i\ Itiil�I!7$jl{4Ct�atA?�C `3Ct',i Xg?SiC% `°'F ". +�=• Cie ':., 0°' r ,,,gr t: Q E:a 0 iacair3f St WY Yea Cii t, Lug ir1. T+ ter 1°It ,fl. - b d' a rl.B.0 Y,ES 0PIQ (S t o,8,l70) , '. _, __. ;a^s�,:,r�g Nw?Ic�l�c�t a�a�r:�r tE�"s��l'L"lita�t^F�t�i�l°irt,��1>4>`ltir;rh'' - .. , ;�"c ..�..._Y•,-.- ..-.o.�__-w,. t ttti:i : 16!" LIwFI{at1CI 51 ,{ Jjµ spring +r $ la<ti' f a .TkttSl i I l , PaoNleedeO: YES lC��i�� � �sr�pl�tlGktz i`•Jt+cried,. YES. � ,. •.�.<.. - , ' el Relnfvlrr-e Existing i$50.th1 rE$ 0 Type of WOOD LAGS, t Trig! < c�rJt�I b+4'inda+at,u: YES NO Typo' C LEA Fl, IMPACT ' 0E.SI'Gt'ER _._ _.� �:. .__ .-__. W_.._ _ _ S �- ._•�°`_'� n In tk'Pt.s or car aqs ovs i rt° INSIDE SLIDE LC-ck J,`SwJ5.00) OUTSIDE KEYED LOCK ($75,00) NP LQCI -...... ._ _....__._ �'' .�•- `"�" �� boor sub..iatal t . . - HaWviaru Perforjiin. t;:a Upgrade f,IG Year Wationly S• borve;go,rentn:n>a;` ' `1w,CL• "dd000t$7{}Mf FIBEr1kJi�t? 1 rirJ 4,,10{ ponar- NC1 brand: ,�t Re.-Hang: 'YES ,k,ao) Ne+rr''eratsir!n;ra(;!#ic n:� l.k; �'1prl:?I: �y 1'ra.ns; I+'i+: 1 <atcrPrct 'ins?Plsrt�1 'a`„rr 4F�'arraraEytirlc:UdG,SuiYtac:iutl�nYES R s tl , t � Perms Taal Mlsc. 0100 .1 cl r�~ W hra6k and tvid1h of aa(a�nl�t . .._. ., 4�t l�{r���547.t?t�I'rf Y ar�;tfr c:lstril'Iia ltrerntid`c�,;emrn.ur!aiJllyartrt 1���I 't5�>�I3+>titrle ' gI1t71C75:3rr3llQn Sri fi'txtlt 1'�,.iw-y1r-'vJY t7,i' -:3T1S Ltt zftCltCftl 110 I rr3lG;ii::: i4%ttlldifiii?ls, • ' .• - t,3";f11'rra+.•:and 1d a Lerm+tl,'t+;�C;UI'U'i1it",t'�l b0)%flit`ve rind on4lib ravvr:-4{7�`l viin»it:{i`.�s;Y om I]ukt'iDrizb DGD to rtorrn 1.1' tL^:irk.3i,�rmr.��'ort6t t,�roi3 tt9 s.idals.~ I?a p rt �,� .Gredi 31,srry..si �i'1411 e by vk'r au l lur!2.trfk,t:�c� l Ira�hi, r�"cLTc. ur ru ant ICr�r�?.aurCa i ell rGlftltt51 '�uin8lEtrta ` RED CARD # ESP. DATE;. CV# ^CHECK*' § DRIVER- L10ENSli;?�.