HomeMy WebLinkAbout21-1348 City of Zephyrhills 6�6EjRMIT NUMBER
v: 5335 Eighth Street
Zephyrhills, FL 33542 BGR-001348-2021
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 01/14/2021
Permit Type: Building General (Residential)
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Property�;IVumlier ,� 9 $tr�eet Adtlress
1126 210010 18700 0040 5051 5Th Street
Information:w„ 0�1 , °0 mit nformation, Contractor Information
Name: STEBBINS MADALEINE Permit Type:Building General(Residential) Contractor: BALANCED AIR INC
Class of Work:HVAC Changeout
Address: 5051 5Th St Building Valuation:$0.00
ZEPHYRHILLS,FL 33542 Electrical Valuation:$0.00
Phone: (813)782-2417 Mechanical Valuation:$10,851.95
Plumbing Valuation:$0.00
Total Valuation:$10,851.95 SIP
Total Fees:$94.26
Amount Paid:$94.26
Date Paid:1/14/2021 2:54:24PM
Project Descrfiption
A/C CHANGE OUT 3 TON
,4pplica_tion Fees
Mechanical Permit Fee $94.26
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.
CONTRACTOR SIGNATURE PE IT OFFICE
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
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Building Department ,/ D` ^ y
Date Received Phone Contact for Permitting
aItaaaaaa aeaaa pp
Owner's Name Owner Phone Number (O
Owner's Address th Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS r FL LOT# A
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR e ADD/ALT = SIGN = = DEMOLISH
INSTALL REPAIR
PROPOSED USE = SFR Q COMM = OTHER
TYPE OF CONSTRUCTION Q^ BLOCK FRAME = STEEL =
DESCRIPTION OF WORK
BUILDING SIZE SQ FOOTAGE= HEIGHT
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY = W.R.E.C.
=PLUMBING $
MECHANICAL $'O O o SI C 7 VALUATION OF MECHANICAL INSTALLATION
=GAS = ROOFING 0 SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/N FEE CURREN I Y/N
OE
Address License#
OTHER COMPANY
SIGNATURE REGISTERED YIN I FEE CURREN Y/N
Address I License#
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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 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/Sill 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
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
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 peril 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 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 I PROVEMENTS YOUR PROPERTY.IF YOU INTEND TO OBTAIN FIN CING,CONSULT
FLORIDA JURAT IF 11 3)
C t
OWNER OR AGENT CONTRACTOR
Su scribed a d swo or ffirme beforelne this S bs ibed and sw or affirm b re me Shis
by 1Y8�`2p1a_by L
Who is/are personally kndwfi to me or has/have produced Who is/are personally known'to me or has/have produced
as identification, as identification.
Notary Public Notary Public
Commission No. 6�5Commission No.
Shin L. Wriom L.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
��SP3tyAd' Shanna L Wright SNgy Shanna L Wright
NOTARY PUBLIC NOTARY PUBLIC
_+STATE OF FLORIDA —STATE OF FLORIDA
wt Comrrr#GG212765 a Comm#GG212766
`y7r'�CE 19�� Expires 4/30/2022 `�7NCE 1��� Expires 4/30/2022
Parcel ID 11-26-21-0010-18700-0040 (Card: 1 of 1)
Classification 00100-Single Family
Mailing Address Property Value
STEBBINS MADALEINE C TRUST Ag Land $0.
STEBBINS MADALEINE C TRUSTEE Land $16,800
5051 5TH ST Building $59,107
ZEPHYRHILLS, FL 33542-4925 Extra Features $419
Physical Address
5051 5TH STREET, .lust Value $76;326
ZEPHYRHILLS, R ET, - Assessed (Non-School Amendment 1) $46,560
Homestead -$25,000
Legal Description (First 200 characters) Additional Homestead -$0
See Plat for this Subdivision
CITY OF ZEPHYRHILLS PB 1 PG 54 LOTS Non-School Taxable Value $21,560
4 &5 BLOCK 187 OR 5085 PG 1028 OR School District Taxable Value $11,560
9392.PG 1507 Warning: A significant taxable value increase may occur when
3urisdiction sold.
CITY OF ZEPHYRHILLS Click here for details and info. regarding the posting of
exemptions.
Land Detail (Card: 1 of 1)
Line Use Code Description Zoning Units Type Price Condition Value
1 0100R LP2-1 SFR 0OR3 8,400.00 SF $2.00 1.00 $16,800
Additional Land Information
Acres Tax Area FEMA Code Neighborhood Code(s)
0.19 30ZC -- ZHLH
View Sketch Building Information - Use 0100-Single Family Residential (Card: 1 of 1)
Year Built 1930 Stories 1.0
Exterior Wall 1 Average Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Min Roof(Corr. or Sh M)
Interior Wall 1 Wall Board or Wood Wall Interior Wall 2 None
Flooring 1 Pine,or Soft Wood Flooring 2 None
Fuel Electric Heat Forced Air- Ducted
/C Central Baths 1.0
Line Code Description Sq. Feet Value_
1 BAS01 LIVING AREA 1,169 $51,565
2 USP01 UNFINISHED SCREENED PORCH 353 $4,676
3 UEP01 UNFINISHED ENCL PORCH 130 $2,867
Extra Features (Card: 1 of 1)
Line Code Description Year Units Value
1 RUDU-M UNFIN DETACH UTIL MT 1987 1 $294
2 RWDFENCE WOODEN FENCE 1990 320 $125
Sales History
Previous Owner: STEBBINS MADELINE
Month/Year Book/Page Type, DOR Code Condition Amount
06/2016 9392 / 1507 Warranty Deed 11 Improved $0
09/2002 5085 / 1028 Warranty Deed Improved $87,000
05/1993 3152 / 1956 Warranty Deed Improved $48,500
06/1989 1815 / 1284 Warranty Deed Improved $37,900
12/1983 1303 1 0208 Warranty Deed Improved $0
04/1980 1063 / 1271 Improved $18,900
Gall or text wL& with as�.r� +L stions
.(727) 842-2247
* '� ''' � '�' AWNC. SYSTEM
owww.balancedair.com
Air Conditionina a Heating
8009 Applesix Dr. Port Richey, FL 34668 PROPOSAL
State Licensed CAC039633
PROPOSAL SUBMITTEDT DATE
o,1 eih e
ADDRESS JOB/TENET NAME
SOS/ 5
CITY,STATE.ZIP JOB ADDRESS'(f different)-- ---
t ils FC 33YYZ
TELEPHONE V CITY,STATE,ZIP
13 7T2 - Z-'/
E-MAIL
We propose to furnish, install and service under warranty(stated below)products or related equipment for your home
or business in accordance with the conditions and specifications set forth in this proposal.
EQUIPMENTNEW • - •
❑Air conditioner Model pigital;Thermcstat
Heat pump Model ❑:Digita'FPr6grammable Thermostat
,Air handler Model C 37 Cl - ❑Touch-screen Programmable Thermostat
❑ Coil Model ❑Humidistat
❑ Furnace Model ❑Outdoor thermostat
❑ Heat recovery unit Model ❑.Install new` amp electric service and panel
Heat strip Model S' 'tf/' ❑ Upgrade existing electrical service
Tons'.3--- SEER rating-�4� HSPF from to
❑ New all copper, insulated, electric circuit(s)with disconnect
Other ;��ghkhh �' �Q q switch box(es),circuit breaker(s)and weatherproof conduit
❑ Other �! and connectors at outside unit.
❑Other ❑ Other
PIPING MISCELLANEOUS
40_Condensate drain hook-up %-Primary ,Secondary All work done in accordance with existing codes -
❑ Refrigerant copper liquid line All required permits
❑ Refrigerant copper suction line with insulation s ¢it Removal of the existing equipment from the premises
❑ Condensate pump Pump to ❑ Weather'resistant_vibration,-proof isolation pads
❑ Gas pipe from ❑ Mounting stand for outside unit
Other Pad for outside unit
- DISTRIBUTION II work to be performed in a neat and professional manner
Modifications of supply plenum V return 79G y:skilled technicians. Sweeping, dusting, and vacuuming will
` New supply s)ceiling sidewall be accomplished at the conclusion of each day's work and
Floor ' )e debris removed from the premises
)I-N,ew return �. ceiling 'si
all dewall ❑Other
Sidew witimc�cess door floor o Other
❑ New transfer grille(s) doorgrille(s) WARRANTIES
❑ Rust resistant anodized aluminum ❑24-hour emergency service
❑White baked enamel ❑ Beige baked enamel ❑ 1 year warranty warranty��►'
❑ Rigid fiberglass duct system with reinforced rip-guard Warranty-other
vapor barrier maintruck and flexible branch and return ductUpon receipt at our offi a of your signed Premier
❑ Sheetmetal insulated duct system Service Agreement , we will provide two complete
❑ Pressed aluminum perma-guard stapled and taped joints maintenance tune-ups and professional cleanings
❑ Optional perma-flex mastic seal weatherproof duct joints annually during the first year free of charge
❑ Balance system for uniform air distribution Manufacturer warranty on Compressor years
❑ 1" Fiberglass disposable filter(s) Manufacturer warranty on Outdoor Coil= years
❑ Electrostatic air cleaner Model ❑ Manufacturer warranty on Heat Exchanger years
❑ Electronic air cleaner Model ❑ Other
KvIedia air cleaner Model J I e- Free ❑ Other
❑Other Lt• k Free ❑Other
,.W&,propose'to,furnish:complete;6 'above specified; for.the'investment:of'(taz,included):-. -,:.dollars $
100%Financing Available _ ,$ minimum monthly payment.
Sublectao lender,acceptance. $ down paymetit:
',Bl1Y;ER'S:RIG HT'TO.CANCEL:,you;the Buyer;:may.cancel;this;transaction withotat-penalty•or obligation,anytime priorao
midnight of_the'third business day-after the'date•of thisatransaction",by•proper.notification:
Final payment to installers:in full upon;completion'of installation..This proposal valid'until % = /
The above prices,specifications and conditions Approval Date 7/ �G• 1
are satisfactory and are hereby accepted.You are r� Om p nY,)4r
authorized to do the work as specified.Payment ]
will be made as outlined above. Approval'
IfINC.
Air Conditioning Et Heati •
_ _
PH.(727)842-2247 F(:727)842-2245
8009 Applesix Drive
Port Richey- FL:34668
www.balancedair.com.,
January. 8- 2021
Contractor Authorization
The.following are-authorized signers to record-license,sign.for; and-obtain permits for.license
'CAC039633'.forlicense holder Gary:L.Shari-of 9204=Bearcat Rd; New Port Richey, FL 34655
and Balanced Air; Inc at 8009 Applesix,Dr, Port Richey; FL.34668.., .
-
Person: Ben Shari.: : . .
:Person-..Jared Shari
Person:- Naomi Shari.. . :
Person: Sharma Wright
License Holder: i - . License Holder-Signature: -
STATE OF FLORIDA
COUNTY OF PASCO,
Sworn fo.(or affirmed)and subscribed before me this _day of: ,20 Z� .
. . .
Signature.o Not Public .
Printed*Name.ofNotary.,Public L. (NOTARY SEAL)
Personally:Known: .OR Produced Identification: `fir Sharma C Wright
Type:of Identification Produced-
NOTARY PUBLIC.: .
=STATE OF FLORIDA
0/2
a Comm#GG312762
� � Ep' s4 02: . :
f I
A�/VY CERTIFICATE OF LIABILITY INSURANCE 7E(MM1DDNYYY)
/08/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTANAME: Livio Gasparini
Safeguard Insurance Pros,Inc. PHON o E (727)841-7080 (FAX No): (727)841-7068
8106 US HWY 19 N ADDRESS: Livio@safeguardinsurancepros.com
INSURERS AFFORDING COVERAGE NAIC#
Port Richey FL 34668 INSURER A: HUDSON SPECIALTY INS CO 37079
INSURED INSURERB: AMGUARD INS CO 42390
BALANCED AIR INC. INSURER C:
8009 Apple Six Dr INSURER D:
INSURER E:
Port Richey FL 34668 INSURERF:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE'AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUBRTYPE OF INSURANCE INSO WVD POLICY NUMBER MOL pY EFF MMIPOLICYEXP
LTR / LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RETED
CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
A HBD 10039112 05/13/2020 05/13/2021 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑jE LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED BAAU943808 06/26/2020 06/26/2021 BODILY INJURY(Per accident) $
AUTOS ONLY X AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
HVAC SALES,INSTALLATION,SERVICE AND REPAIR
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CITY OF ZEPHYRHILLS-BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
5535 8TH ST AUTHORIZED REPRESENTATIVE
ZEPHYRHILLS FL 33542
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD