HomeMy WebLinkAbout91-1497
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY
Permit N~
1497 E
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances.
BUILDING DEPARTMENT
1-813-788-6611 ..r- _ / _ o. /.
-.. . ' Date '-' b I'
/-5,.. 07J /~- OV,.~_ ~ ~?~ ' t9V
PLUMBING; GCH~ ']);;T.bt." LA.,A-. ;J.'{/Z) - t1'V
- - - }jd4.~~),% / / t-.S.... (J7)
prOperIYOWnersName-:JJ~ JJ1d:!f ~ ~~ ~Lt.f_1fl5~M(YP,.P
Job Address: :3 ~ 0 ~ yL .:L77:l3 ,~ cP ~3
Legal Description: Sub. Diy. Lo~ ~ h %' ~ '1 Blk~ L~ pi!;,tle
ZoningCI: /'f~ ~~ -d-I-{)~~:::;.tJO- Q.25!ZJ ----dr-tlt-'13
Description of Work )11 ~ ~~r_ _ -__
:;Z;:~LAA-dtf-",~"7 d;vl ~ \i--LR- ~ ~. / A :rfJ ,,:I~, 7/ LIt? j
Energy Code Readout: av:z
,()" ~-~t-7~
']<.1. V
Fee: 70. Ov /,
SIGNATURE 1-')1-'. l' ~... //;;~?<~-~
/' (
COMPANY
/S. trD
ELECTRICAL .
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost:
ADDRESS
Ftr. SLB
Pre SLB Tub Set
Lintel VVater
FRM. Sewer
Insul.CL Final /1 - Z -c;2-l5~
() " ~ WL
~~~ l'~!JD"'6\()$*-
Drrve..t.ay
Tp.Serv.
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final Jz. --1.,-411-- (JAg
Breakers r ) _
Ducts InsI.lJ-.3b -fj'WI1"fI"'"
Compressor
Final
Reinspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten (SIO.OO)
dollars shall be made for each trip.
(a) Wrong Address
(b) Condemned work resulting from faulty construction
(c) Repairs or corrections not made when inspection called for
(d) Work not ready for inspection when called.
The payment of reinspection fees shall be made before any further permits will be issued to the person owning same.
CITY OF ZEPHYRHILLS, FLORIDA
ELECTRICAL APPLICATION
Electrical Contractor
Owners Name
'. Job
...5"7 rf {/ 0 V
~730 -V
Certificate Number ~cr-
Date
Application is hereby made to make the following installation in accordance with the
City of Zephyrhills Electrical Codes.
MINIMUM PERMIT FEE - $ 15.;:,00
Description of Work Number , @ Fee
,
Minimum Permit-Standard
2 Bedroom, 2 Bath House $25.00
Mobile Home Services 15.00
Fixtures or Outlets
including switches. 110V .25
Fixtures or Outlets
including switches 220V 1.00
Alc Central Unit 5.00
Electric Signs 15.00
o through 100 amp service 5.00
Over 100 amp to and including
200 amp service 10.00
Over 200 amp to and including
400 amp service 20.00
Over 400 amp to 800 amp service 30.00
Over 800 amp service 80.00
TOTAL OF ALL ABOVE
Reinspections: When extra inspection trips are necessary due to anyone of the follow-
ing reasons, a charge of ten dollars ($10.00) shall be made for each trip: (a) Wrong
address, (b) Condemned work resulting from faulty construction. (c) Repairs or correc-
tions not made when inspection called for. (d) Work not ready for inspection when called.
The payment of reinspect ion fees shall be made before any further permits will be issued
to the person owing same.
...~
C.rt:l.f:l.cat. Numb,er'
Plumb:l.ng Contractor
Owner' 8 Name
Date
.3'7
c:tTY Of ZEPllYlUt:tLLS, FLI;m:tDA
PLUMD:tNG' 'APPL:tC'ATION,
". 3.bAdd.... )~~L,;"i 4LL
3 _#~ ~ ~~hL ;k-r
~3,O cf 16- -d '1 .
/'
Application is hereby made to make the following Plumbing inst~lJ.ation in accordance
with ,City of Zephyrhills Plumbing,Ordinance. '
MINIMUM PERMIT FEE . . . . . . . . . ... . . . . ... . . . . . . . . . . $ loS. 00
DESCRIPTION OF lVORK . , NO. @ FEE
t,
,
For lTObile he:X-re" i?lurt'il:)oing.~;- '" :,..,;.,:: . 15.00 ....
. .
For each plumbing fixture, floor drain or "'I" ",
trap .(including water and drainage piping) .' . 2.50
For each house sewer. . . . . . . . . . ~ . . . . . . . . .. . . . . . '. 5.00
For each house sewer having to be replaced or
repaired....................;..~.....~.~..... . ,5.00
each hea ter, and/or ve.n t . . . .' ..:~ . . . . . . r. ',' 2.50
For water "
"
For installation, alteration or repair of water
piping and/or water treating equipment....... 5.00
"
For repair or alteration of' drainage or vent
piping. . . . . . . . . . . . . . . . . . ,_ . . ~ . . . . . . . . . . . . . . . . . . , 5.00
, , , ,
For vacurrm breakers or backflow protective
devices installed subsequent' to the install-
ation of the piping or equipment served
One. to Five.. ~............... .".............._. , 2.50
..
Over Five. each. . . . . . . . . .". . . !' . . . . . . . . . . ; . . . . . " , 1.50 I
,
TOTAL FEE
Reinspections: When extra inspection trips are'necessary 9ue to anyone of the following
reasons, a charge of ten $10.00 doll~rs shall be.made for each trip.
<a)
(b)
(c)
(d)
. '
'Wrong address. ,
Condemned work resulting from faulty construction.
Repairs or corrections not made when inspection called. for.
Work not ready for inspection when called. '
The payment of reinspection
to the personow~ng same..
fee:I:::::~e O:~:P:::::,..nr::t:e"~~e~m"2}1~
""7
Cl:TY, OF ZEPH":{RHILLS
Perm~t Appl~cat~on
HEATING, VENTILATING,
A/C, REFRIGERATION SYSTEMS
30b Addr~..~e t' 0 i ~~t ~
,~~?o+~
~:::::::::. Nltt ~ .
Owner'. Name
Date
Air Conditioning Ventilation-Ductwork Heating
Refrigeration Repairs--Alterations Boiler
Other CONTRACT PRICE OF INSTALLATION $
,
MINI}IDM PERMIT FEE . . . . . . . . . . . . . $ :1-5 -. 00 FEE
Fee for Heating, Ventilating, Duet, AirConditioning and Refrigeration
Systems shall be Ten ($10.00) Dollars for the'first one thousand dollars
($1,000) of total valuation of installation PLUS two ($2.00) per each
additional one thousand ($1.000) dibllars or fraction thereof $10.00
Repairs, alt-erations aOnd addi dons to an existing system over $500 .00
shall"be $2.00 per each $1,000 or fraction thereof in valuation plus
five ($5.00) dollars. 5.00
Temporary Operation Inspection Fee: For inspecting a Heating,
Ventilation Refri~eration or Air Conditionin2 Svstem. 5.00
In all buildings except one and,two family dwellings using self-
contained A/C units less than two tons, the fee charged shall be
based on the valuation of total ,tonnage of all units comb i ned . Minimum
fee shall be $10.00 10.00
Boilers based on BTU Input:
33,000 BTU(1 BHP) to 165,000 (5 BHP) . . . . . .' . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00
165,001 BTU (5 BHP) to 330,000 ( 10 BHP)................................. 10.00
330,001 BTU (10 BHP) to 1,165,000 ( 5 2 B HP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.00
1,165,001 BTU (52 BHP) to 3,300,000 BTV (98 BHP)....................... 25.00
Over 3.300.000 BTU................ ~ ~ . . ~ .0 ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.00
Re-Inspection Fee, each trip 10.00
For m:>bile hare mechanical 15.00
, TOTAL FEE
Check one:
Re-Inspections: When extra inspection trips are necessary due to anyone of the following
reasons, a charge of ten ($10.00) dollars shall be made for each trip.
(a) Wrong address.
(b) Condemned work resulting from faulty construction.
(c) Repairs or corrections not made when inspection, called for.
(d) Work not ready for inspection when called.
payment of reinspection fees shall be made before any'further permits will be issued to
person owing .same.
The
the
,SIGNATURE OF APPLiCANT
'~
,
...:r,.,13771A
~,"
I
I
L-
1
SECTION /4, TW~ 265., RGE. 2/ E.
//2 Dtd 10 =44028'52"
,
Rod Ii./ 5 = 25, qo
ARC =- 3882 ...,.i
Tangent = 24. 55 .-.....
Cllord = 35,03' I
~ Bea rn 9= N 4501825" ,
~ :0 ~ ,l /-- _\ __ n~n_ 1____ --1- __. ~_,_ _
........ ~ / LselDoa1 l()
~ (/e I 1 0\
:--;;~'" - n 11 :
I L 3-- !f-~
,[l= i \ C-"1. ~
10' 1 I I I ~
-. -~ : 75' \'IJ
. 'r ~'
,..; ; cc-y 0 9 _ '" I I ~
h) 1 LO T 30 ,~ West //2 'I Eo 51 //2
.~ ~ 1 - - I LO T 29 U) T 29
~._ I -- ..1 t _ ---T-- ~lbo";1 -i - _un L__,';;'; - _
i ...."l ~ Ut'lit~J.~,_~raJnoge Eose1entj "I'~~I6\'>
LAWANDA LOOP
- - -n -- -----r----- - n___un t-- --
,,'" ~I r-~9
~ lr)i ~'(J e'
~ \0<) l\j' r-~~/()\'i
"Sr~ .,\\0 ~
V , " I~ vS
__ ~/prS.89047 /6 W. _.'J ~
3J ? 2 - .'..;-25-5~T --;:>
I
~
~
.....J
~'r ~
tt. "
r~ 25,00'
~ ,--'-----
21' ~
, ,t::
.......,. ~
~
I
1
I
I
I
SCALE /",:-20'
~._-. __ ___, _ ____...h__.___
~_.__._-_. - ---.----------
~
~
~
~
~
'-
I
I
'qi"
i
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT 11~, mJJ,J,. N~. -- qJ~ tL fY)m1..v~
ADDRESS .3 '1/'10 ~~ b l/ 2 It ,,0. - I~OL Ii. PHONE 783-loOg7
() v J.. ~ . 35'13
OWNER I...f SlAA^tf- Ii mno 1 D",-, ~^.
JOB LOCATION 3)]614 ~ 4
LEGAL DESCRIPTION: LOT(S)
LOT SIZE12LX 9.5 AREA SQ, FT ,
SDBD IVIS ION /,)ll "J~ ! l3JA d L.J...':d-..
PARCEL I.D,4F-1'1~ ~.,. ~J ---.allDe - OClDn() - O;J.5n
BLOCK
WORK PROPOSED:____New Construction _Addition _Alteration _Repair _Install
_Sign/Temp, _Sign _Move _Demolish
PROPOSED USE: -Lsingle Family _M/F _4F of Units .-LM/ H
_Commercial _Indust. _Swim, Pool Other
:~
_Restaurant & Health Department Approval
BuiLDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORI1S, ,',,',
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS,**
**COPY OF CONTRACT REQUIRED.
PERMITS REOUESTED
-1LBUILDING
-XELECTRICAL
\J ,,1
-A-.MECHANICAL
-2lPLUMBING
$ LIto pOO. OD
AMP Service
Valuation of Total Construction
X' Florida Power Corp,
_W,R,E,C,
$
Valuation of Mechanical Installation
GAS
ROOFING
SPECIALTY
m / l-t
I
Other
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
FINISHED FLOOR ELEVATIONS: FT,
SECTION
Company
State Cert, or Regist, #
Signature City License Registration 4F
i ******************************************
,:;
::::::~;:~_ _~/l(iA~L LOb-/. ~ Company -E H J?J/11l1J S'Is DoT rill "-
.,n State Cert, or Reg1st, iF E. ~ 0000 t/9/
. M _ _ _ City License Registration IF
******************************************
***********************************
1
~Yo~~"rr.u Company bl1/~l1I~t~ OA&.!).
~ ~ State Cert. or Regist. {f <!. F~ E> :::. 7', ,
Signature City License Registration #
***********~********~*******************
MF.CHANTCA~ "K..~~ ~~ !l. J Company ~V 1~~JAlE.&iTd:.J-
- ~ tJL') State Cert. or Reg'ist, j,!~'(!
Signature~ . \ r: .~ City License Registration IF
******************************************
PLL'MBER
~4' [&~
Company
State Cert, or Regist, #
City License Registration #
OTHER
Signature
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER,
CONDITIONS OF PERMIT~IDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to 'deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance Nith any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OMner has hired a contractor or contractors to undertake Nork, they lay 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 lay be
cited for a lisdeleanor violation under state law. If the owner Dr intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, (B131
7BB-6611.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor!sl sign portions of the
"Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - HOleoNner's Protection
Guide" prepared by the Florida Depart.ent of Agriculture and Consuler Affairs. If the applicant is soteone other than the
"owner", I certify that I have obtained a copy of the above described docu.ent and promise in good faith to deliver it to the
"owner" prior to cottencetent.
! E. CONTRACTOR'S/DWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cotpliance with all
I a~plicable laws regulating construction, zoning, and land developtent.
Application is hereby lade to obtain a pertit to do work and installation as indicated. I certify that no work or
installation has cOllenced prior to issuance of a pertit and that all work will be perforted to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies tay apply to the intended work, and that it is
ty responsibility to identify what actions I lust take to be in cotpliance. Such agencies include but are not litited to:
f Departtent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Water/Wastewater Treatlent
f Southwest Florida Water KanaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering WatercDurses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f De artlent of Health & Rehabilitative Services Environtental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f S Environlental Protection AQency - Asbestos abatetent
I also certify that, if fill .aterial is to be used in Flood Zone "A" Dr "A,etc.., it is understood that a drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to pertit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frot thereafter
requiring a correction of errors in plans, construction, or violations of any code., Every pertit issued shall becole invalid
unless the work authorized by such perlit is cOltenced within six lonths of issuance, or if work authorized by the per.it is
suspended or abandoned for a period of six lonths after the tile the work is cOI.enced. One 90 day extension of tite, tay be
allowed for the pertit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each six lonth period, or the project will be 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 DR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COM"ENCEMENT, JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER .or .ft~T{::"b~~*
SIGNATURE: tONTRACTOR
, . (l
STATE OF FLQRIDA /'
COUNTY OF . ~
The forego'ng 'nstl~ment
before me this 10 2~
\..'+,"'.'
'41~~~\
... .,.~ .... ~
was acknowledged
19 9 Ii!:- by
STATE OF FLORIDA
COUNTY OF
The foreg6ing in~~rument
befc'l-e me this
was'~ck~o~ledged
, 19_ by
. - H 'lYle ~s. 'S~
who is p rsonally known to me or who has
produced
as identification and who did/did not
take an oath.
(SignatU'F"<t~QQ_ ~
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
, : " .".
. : I :
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
(SignatLrre)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
Notary Public, State of Florida
.Robert Charles Ehrman, Jr.
1My. pommission Expires April 27, 1996
,Comm. No. CC 196771
~ ' CITY OF ZEPH~~~LLS BUILDING DEPARTMENT
OWNER llJ~ K ii~l.(U ,m~ )JClYY\JL ~~
, l crop n f ^-- _
JOB LOCATION 3g 0 J '-I ML JA ~ l.;-'.ULrT)
PARCEL 1.0. # J1-~~ - DJln() - 00000 - O~50
SHOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS.
.5/
f
l
/61;.
.'
\
\
....- - C3 ..
<- "1;1.:1, .
,~::7'" ~
.
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
, MATION.
-- - ~ - -
,
,
I,t)
.) -? x ~-G
F,/..i::Erw,;)o()
7-i
)b
9s: r20
, . f
I
,
,
-TJf
~ t) ..1.11"
FRONT PROP~RTY LINE
STREET _180/L/ fnJ.A~- ~#~5
(NOTE EXAMPLES 1 & 2)
1. SETBACKS FOR Rl, R2 ZONING
60'
10'
P E
R X
0 I
10' P S 10'
0 T 1 0'
S I
E N
D G
20'
FRONT PROPERTY LINE
2. SETBACKS FOR R3 ZONING
60'
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30'DUPLIX
1 O'
FRONT PROPERTY LINE
~ . CITY OF ZEPHY~~LLS BUILDING DEPARTMENT
OWNER Ll)~ i\ R"(VJ m~ JJ~ 3,~
JOB LOCATION 3g 0 J i../ LL1A~ irn-p 7
PARCEL I.D. # I~ -~- ~i - OllnD - 00000 - O~~O
SHOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS.
5/
/5'
~
,l
..J -? )( ~-G
F~~rTwooO
/~J;
?i
st
9s: c2.0
.'
(
.- - - rr::J -
~ ,:l-;2.{.
.
(
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
, MATI ON.
--- - -
,
;(1)
_ _ _ _ J_,
, -- -' -' I'
I
I
,
-rJi
.,2. l') .1. Jf-
FRONT PROP~RTY LINE
,
(NOTE EXAMPLES 1 & 2)
STREET
380/L{ ~LA~J. ~- ~#~5
1. SETBACKS FOR R1, R2 ZONING
60'
2. SETBACKS FOR R3 ZONING
60'
10'
...P E-
R X
0 I
10' P S 10'
0 T
S I
E N
D G
20'
1 0'
10'
10' EXISTING 10'
PROPOSED
20'SGL rAM 30'OUPLBX
1 O'
FRONT PROPERTY LINE
FRONT PROPERTY LINE
- - -'--','- _._._~ - -'--"-'~--~--'---- -- - --- - -- ---- ~
C E N T R ALP E R M I T T
PASCO COUNTY, FLORIDA
CONTRACTOR #:
NAME: GOLD KEYS MH SALES
ADDR: 38014 LAWANDA LOOP
C/ST: ZEPHYRHILLS FL 33540
FOR:
CHECK # 1040
RESOURCE FEE ON PERMIT 1497B
CITY OF ZEPHYRHILLS
?-)CCNT
114
TOTAL AI'10UNT:
COMPNY ACCOUNT CENTER
B450 - 363000 - 2
:3:3. :3(:,
::::~;. :3t.
At'IOUNT
\__/"\ .........-:::~\ . . ,. ,- " .'-'\.
RECE I VED BY ~-,-_;_~'::~:""~~~":'::':::;'\:..._}.__,__
\ \.
I N c.~
DATE: 03/26/9:3
P{~GE: 1 ()F 1
I :::::3UE OFF I CE: D
RECEIPT NUMBR: 00168410
OFFICE: DADE CITY
DESCRIPTION/PERMT DATA DRICR
****** 60
~
PASCO COUNTY, FLORIDA
Permit #
,
,
Date
Name/Owner
County Parcel #
Location
ClassifICation / Type of Use
lRANSPORTATION IMPACT FEE CALCULATION
Rate $
Zone #
Sq, Ft.1 Unit
Prepared by
Impact Fee Amount $
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the Board of
County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or authority to utilize the permitted
structure.
RESOURCE RECOVERY ASSESSMENT
RESIDENTIAL
NONRESIDENTIAL
# Units
Gross Sq, Ft (GSF)
Rate 1 ERU =
50,00 x 0,96'" 1 Year
or $0,13151 Day
ERU Assign #
Assessment =
(# Units) x ($0,1315)
x (# Days)
Assessment =
!Q.Sfl x (ERU) x (0,1315) x (# Days)
100
TOTAL FEE $
TOTAL FEE $
"'Discounted for Prepayment
The above assessment has been established pursuant to the Pasco County Ordinance No, 89-07 and Resolution No, 89-197, as commended.
TIm ASSESSMENT WILL BE CALCULATED AT TIm TIME OF ISSUANCE OF TIm CERTIFICATE OF OCCUPANCY,
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building permit
owner on notice of this assessment and the conditions of payment for same,
Date
Received By
......--...--------...---------;..------------------------......-----------------------------------------------...--------------------------------------------------------------
OFFICE USE ONLY
lRANSPORTATION REC, #
RESOURCE RECOVERY REC, #
DATE
DATE
BY
BY
White
Applicant
Canary
Trans 1 Finance
Canary
RR 1 Finance
Pink
Office
Green
Bldg IInsp