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HomeMy WebLinkAbout20-55 a City of ZephyrhillS PERMIT"NUMBER - 5335 Eighth Street Zephyrhills, FL 33542 BGR-000066-2020 Phone: (813)780-0020 i !r Fax: (813)780-0021 Issue Date: 05/07/2020 ti Permit Type: Building General (Residential) Property Number Street Address 12 26 210260 019001220 5848 Dogwood Street Owner Information Permit Information Contractor Information Name: EARL VON HORN Permit Type:Building General(Residential) Contractor:AND SERVICES Class of Work:Plumbing Address: 5848 Dogwood St Building Valuation:$0.00 ZEPHYRHILLS,FL 33542 Electrical Valuation:$0.00 Phone: (813)715-4368 Mechanical Valuation:$0.00 I Plumbing Valuation:$6,999.00 ZIT Total Valuation:$6,999.00 Total Fees:$75.00 / i Amount Paid:$75.00 Date Paid:5/7/2020 3:37:45PM Project Description NEW PLUMB LINES IN BATHROOM Application Fees Plumbing Permit Fee $75.00 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 subsequent reinspection. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit 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 add fee 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. CO RACTOR SIGNATURE PE r IT OFFICE ERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER a13-7eo oozo City of Zephyrhills Permit Application Fax-613-7"21 Building Department Date Received Phone Contact for Permittin —/ i ` Z t, Ownees Name �p o R.(v Owner Phone Number ! ^7 7��d7 Ownees Address 5Z74 f.�CJcZ� I Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address r^ JOB ADDRESS (( p� � p_ { LOT# SUBDIVISION i PARCEL IMAINED FROM MOPRAW TAX NOTICE) WORK PROPOSED B NEW CONSTR e ADD/ALT = SIGN = DEMOLISH INSTALL REPAIR PROPOSED USE = SFA = COMM r--1 OTHER TYPE OF CONSTRUCTION = BLOCK = FRAME = STEEL = DESCRIPTION OF WORK ab 6�Y1 BUILDING SIZE SO FOOTAGE HEIGHT BUILDING S VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL s AMP SERVICE = PROGRESS ENERGY Q W.R.E.C. =PLUMBING =MECHANICAL S VALUATION OF MECHANICAL INSTALLATION / =GAS ROOFING Q SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO BUILDER COMPANY SIGNATURE REGISTERED I Y I N FEE CURM Y/N Address License# ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N FEECURREn L2LN Address ryk License# PLUMBER COMPANY SIGNATURE REGISTERED I Y 1 N FEE CURREn I YIN Addrasa �)D u License 0 1 L/Z '9 MECHANICAL COMPANY .. SIGNATURE I REGISTERED I Y i N FEE CURREA Y 1 N Address License# OTHER FCOMPANY SIGNATURE REGISTERED I Y i N FEE CURREn Y/N Address License# Illlltlitilllllllifllllllllltllllllllllllltllllllllllllllltlllltlll 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)worfcing days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Sin Fence installed, Sanitary Facilities&1 dumpsler,Site Work Permit for eubdivisions/Iarge projects COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Fortes.R-O-W Permit for new construction. Minimum ten(10)working days after submittal date. Required onslle,Construction Plans,Stotmwater Plans w/SIR 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 ail NEW construction. 6lnetlona: Fill out application completely. Owner&Contractor sign back of application.notarized K over$2500,a Notice of Commencement Is required. (AfC 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 AJC Fences(Piol/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—Ucensing 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$2,5W.00 or more,1 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, Weiland 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"V"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,after,or set aside any provisions of the technical odes,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. F_ n,;n� wo 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 ,,�ATM YO R LEN O A TTO BEFORE E ORDING OR,.S, CO CFLORIDA JURAT(F.S.117.03) 2 7 m OWNER OR AGENT CONTRACTOR w subscribed and sworn to(or affirmed)before me this Subscribed and a tMNby 5.1-ZP20 by N co r Wno istare personally known to me or hasrhave produced Who is/are personally known to me or eve produced m w.m o es identification. as identification. �,. m c� c G) G) t Notary Public \ Notary Public o 0 w Commission No. Commission No.—,� � Ma ST r A-tct Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped Z6 AND SERVICE AGREEMENT 8134454818 DATE: Y i Z i INVOICE#: 9 3 5 0 E Tech Name: WO#: I?o(oGZ3� And Services Saving programs have been f 727-495-7474 � 352-458-4181 _ Hardness PH • Iron PPM Appearance explained: 863-226-5588 s rance &ufrent Member � services ;.._.._..._-_-- ..._ AVConditlon[ng - Plumbing - B.W.1 www.andservices.com ❑Agree to purchase contact@andsondcas.com ..._..... ❑Decline participation CAC 1919a1•,Cf•C-i42t3695,EC•13ep$5B� Softener Information IName: &T ____._-_-- Customer's Initials: Street Address: 58 G CCl �/ Make I have discussed And Services Saving programs City:z 67lR�lirRi��S State:FL Zip: '. .. . .. . ........._..__.....--...._—........ _._......._ ----.....- - ...._...._........__.._-- 335 ` ; with the customer.I have given a copy of the contract —( —� 1 Model: to the customer. All work is complete and is in i Home Tel: l 3 7���0N Cell/Fax: 813 -713 �- -' ------ - '--- — -- _..._ _..___-- --..__.. .._. compliance with And Services standards of v Email: Serial# excellence in workmanship and in compliance with ' _.._-.._....... . ....._, . . ....- - .................... ...._._..........._ __ building codes. t .Reason For Call: ❑Work Complete ' Water Heater i Aga Conditionf S/N Technician's Make r , Signature:�An.Supervisor ❑Follow Up .�/ork Incomplete : I TECHICIAN DIAGNOSIS I RECOMMENDATIONS- W.- DESCRIP 24 HOUR EMERGENCY N � ;......_.__�S.R.�,C�_..��"__..._......---�--..._..._._.........------.._.. ............ . ........ ...... ..._..- •-�--•�--•--..._._....... __..�._-�°�cl �-... ' SERVICE ' 3 -0 0 -....' ....... PAYMENT OPTIONS �- -...... ._. _LL:....---__--. _.—._..-_.. _.._-- _ _.. .. .._..._ _..._. ..._..__...__.._.... ._...-_.._._._._. ._.; _. _ ..... _..--__-.. __.. .. _ -- 4 ❑Cash ❑Check# 1�redit Card i r ,� U ( ,q VISA ❑MC ❑ AmEx ❑ Discover ' ^ ""_/ ���,r .. 0 .l~ d F.--- tom ....-- -��[-•• '�`--- __.-. ; Name on Card: / fJDJ f t U1 f 9 ? Zr� `` Z �,( a i SLrOw�.._.f/u!� f- — Card No. `✓�C. C(J w y3 7 Z J�I7: ./ Ir-y --�•----�--�-�--.__..._........ __. _�....... .-----..t"�_,.-_ .�_. _-._._.,Y. !'��.. .............. .-• --------- --......_...._.__ CV2 Code Expiration: �O Za •i / '-""i : �� Expire' n: / . ,...-- .-..- ._................__._._.. _...._........._ .........._._.............. ...... .............._._ ....- . .------ --- -- ......_... Si nature. C.,T_..-----.l f -- Gam... � e-_._.._.-.__.._ .._ 'I hereby vocItga�eettlryemeta not noted .----- o ine. aer d �tthe rr wit rtion of etain any yQ equipment or material unfit final and complete payment is made.If the i ;. ... .. _ _. ..... .......... __. . _.. - . .-.. ...-----._._......... ... .-.. ...-- ; ... .-. .-. settlement Is net made as agreed,the seller has the right W remove ( - ent and setter will be held harmless for any . .. _ .n,_,.v _._::a,3 - h w ,s" �'"'''""- T4'. sF^:•a a ma s resulting from the removal of equipment.Terms include 1.S% and Agreement for Service:I,the undersigned,am an authorized representative of the_j;. ;;:'.:••;;:7 9B remises at which the work above is be done.1 authorize the performance of monthly service charge r7 net paid in 30 days, in the event of non - promises �g Pe e v. i`.(� w J 1_ �.... •' a'� ,=.:-*:t-•.--.-:qi men of 'toter.a lien against m be . the work a9 rested on this invoice.I admowled a That the estimated does net i^"��---*"�` ';^rh�m:^='� payment the specified 9 my ProP01h'may 9 P qTv '°., ctl fe cone on e responsible for radical s,sued and I will be u es Include unforeseen parts or tabs which may he needed after the work begins.My D Po P �•y 1 �::..�Y' d �t�{'� .�!+'::r:...t% .��. %;Yfi?':.•`::.•:.;'. .,;:: costs.and Interests. rJ� written authorization will be ad betore beginning arty additional work.I have rt /_ � C� !�"✓� read this contract.and a fire bound by ell term mained herein. ,,/ ,} Parts and Labor Warranty: �yy��_Z All parts as recorded are warranfdd as per manufacturer specifications. • S' nature: Charges • • fs We do not guarantee other parts than those we supply.If repairs later IhcreDyack eomplefionddraaDovowark - !� se�paratelyeWaguarecessary dMeethal�rtdetegive parts,ttre}hLvnl7fle Bdta charged repairs are done ri pal _ during the season,we will repair it again absolutely free. 813-780-0020 City of Zephyrhills Permit Application Fax-813.780-0021 Building Department Date Received I^�` , (� Phone Contact for Permitting Owners Name CEafl�(I� V�!J r 7 0 2 Owner Phone Number ~7J� Owners Address 58�+ V W0bC11, Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address � � r� JOB ADDRESS S Ike,W O a � � rr LOT#��7 SUBDIVISION I O PARCEL ID# ZAP 21—� ©CN' 9 W_ (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR B ADD/ALT � SIGN = = DEMOLISH INSTALL REPAIR PROPOSED USE = SFR Q COMM = OTHER TYPE OF CONSTRUCTION = BLOCK FRAME Q STEEL Q DESCRIPTION OF WORK _ a -'� Vy--V-e- BUILDING SIZE SG FOOTAGE HEIGHT =BUILDING $ VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY = W.R.E.C. =PLUMBING $(Q =MECHANICAL $U VALUATION OF MECHANICAL INSTALLATION =GAS = ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA =YES NO BUILDER COMPANY SIGNATURE REGISTERED I Y/ N FEE CURREA L Y/N Address I License# ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N FEE CURREr LI.LN Address License# PLUMBER COMPANY ` -RN1C, SIGNATURE ff+� 11 '1I REGISTERED Y/ N FEE CURREA Y/ ,/ Address �llJ) N � License# C / e�Z 0 V `7 MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURREK Y/N Address I License# OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURREN I Y/N Address License# IIIIIIIItlllllllllllllllllllllllllllllllllllllllllllllllllllll"I1111 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 onsile,Construction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster;Site Work Permit for subdivisionsAarge 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 dale. Required orate,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. (AIC 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 IMPACTIUTILITIES 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 1, 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 V'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. d,�•No, o 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 7°9ioa,�c0o WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F.S.117.03) M S o OWNER OR AGENT CONTRACTOR m C z Subscribed and sworn to(or affirmed)before me this Subscribed ands rn to(or affirme b re a this co by 5 I-Z02G by �a j N _ Who is/are personally known to me or hasthave produced Who is/are personally known to me or has ave produced rn S o as identification. as Identification. No G)) o_ n O T Notary Public ` Notary Public Ica 0 �,,y�(�a �v 33 m W � Commission No. Commission No. Irl r ' ►_,� y Name of Notary typed,printed or stamped Name of Notary t ped,printed or stamped A DATE: Y /Z / INVOICE#: 9350 AND SERVICE AGREEMENT ---] 813-445-4818 i06CaZ3% And Services Saving programs have been 727-495-7474 Tech Name:`/ �� WO#: �� 352-458-4181 , FREE-water explained: servt•,ces 863-226-5588 Hardness PH Iron PPM Appearance urrent Member Alr Conditioning • Plumbing • Electrical www.andservices.com ❑Agree to purchase contact@andservices.com J ❑Decline participation / CAC 1816819,CFC-1428695,EC-13002594 ---._._...- --- -- ------------ -.-.... --- ------- ..-.._......_.... I Name: 011 !��/ij�y�l/J Softener Information Customer's Initials: Street Address: &V= Make: I have discussed And Services Saving programs City:7,e-Dk f/kkS State: FL Zip: �3�Y� with the customer.I have given a copy of the contract ---r--� 2/ Model: to the customer. All work is complete and is in Home Tel: (� �G� � Cell/Fax: q v l J '�1 J,,Z�" compliance with And Services standards of Email: Serial# excellence in workmanship and in compliance with building codes. .Reason For Call: ❑Work Complete Water Heater Age Condition S/N Technician's Make _ Signature: ❑Attn.Supervisor []Follow Up -Work Incomplete I DTEC'HICIAN,DIAGNOSIS RECOMMENDATIONS- WORK ESCRIPTION Standard .- 24 HOUR EMERGENCY N 4 ite ��4 SERVICE 3so o TL7, 0 PAYMENT OPTIONS �- - ❑Cash ❑Check# credit Card o 14 kno' se &,( _yli Q ,,,-_/� VISA ❑MC ❑ AmEx ❑ Discover o /C Name on Card: 6tr W vu �. �Z 3 y 2Gi C W >G1Dt�'� fib Gt - y� ( Card No. GjJ �� `J �o ri`r-t fiyesi� (7� Gluey 4i� I U ZO e— iG, s Avg' L"� /vCS G --- CV2 Code: 7 I Expiration: / ,Ile - - cc - - Signaturecc w a /] /' cCJS I �L( BUT— %�� �_�./J e— _ (� !.� I hereby acknowledge the satisfactory completion of the work as noted —�J — —�— 1 on this Invoice. It is agreed that the seller will retain title to any 3 --- equipment or material until final and complete payment is made.If the ------------------------ ------------- --- ------- -- -- -- - - - - -------�' --'- -- '- -- settlement is not made as agreed,the seller has the right to remove ! e i ent and material and the seller will be held harmless for any Agreement for Service:I,the undersigned,am an authorized representative of the � ..; I damages resulting from the removal of equipment Terms include 1.5 premis.ps at which the work above is being done.I authorize the performance of ;STANDARD vs SERVICE AGREEMENT- Q Q monthly service charge if not paid in 30 days. In the event of non the —__--..- - - — L== payment of the specified'total', a lien against m roe may be the work as noted on this Invoice.I acknowledge that the estimated price does net _ � � .' --�= �— - - _ P Y P g Y property rtY Y include unforeseen parts-or labor which may be needed after the work begins.My SERVICE-AGREEMENT.SAVINGS pursued and I will he responsible for practical attorney fees,collection written authorization will be o ed before beginning any additional work.I have : - costs,and interests. n ;-'e- t/4e 6,, - read this contract,and a re o e bound b all term ntained herein. -.� •. Parts and Labor Warranty: 57-y q T Ali parts as recorded are warranted as per manufacturer specifications. ••' TOTAmount Q /% I, -'-. We do not guarantee other parts than those we supply.If repairs later �P 4 LLL/// 6/ l/ ) _ _ became necessary due to other defective parts,they will be charged Signature: Charges �. I hereby acknowled9 a sa8 ctory completlon or the above wo k v i separately.We guarantee that all repairs are done right.If a repair fails during the season,we will repair it again absolutely free_ _