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Home My WebLink About05-5267 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5267 5267 COMMERCIAL ADD/AL T COMMERCIAL COMMERCIAL Address: 38303 N RTH A V ZEPHYRHILLS, FL. Township: Range: Book: Lot{s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 02-26-21-0080-00K06-0080 4,500.00 12/20/2005 553.15 553.15 , I R PLUMBING SOLUTIONS OF TAMPA BAY PLUMBING FEE FIRE PLAN REVIEW FEES A 75.00 MECHANICAL FEE 285.60 70.00 ~ ~\ 0\VAD~/ DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED LINTEL PRE-METER WATER SHEATHING FRAME MISC SEWER MISC INSULATION WALL MISC MISC. MISC. INSULATION CEILING MISC. MISC. MISC. DRIVEWAY MISC. MISC. REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade: (a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when inspection called (d) Work not ready for inspection when called (e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before recording your notice of commencement." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~, ~. NTRACTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER , , CI~Y OF ZEPHYRHILLS PERMIT APPLICATION BUI;LDING DEPARTMENT 53~5 8TH St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 '(6~~ DATE RECEIVED \ d. - <6 - OS ->r &0.."'1 ~'3&~ PHONE CONTACT FOR PERMITTING '8l1-r~lf-/)P' 7 JOB ADDRESS c.e-/?Jt?-l/ I J ?'J ~ J L, /hp s R' 1.,-/" f/;7:,., Lt Jyp~7l. LLL. PHONE . , /11 'If. r /..J /f r ~ 2q IIy /flit LL. <j ;: L ~/,-'t '-1-1 5 V' ~ J35"'t P' OWNER'S NAME LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL 10 # P ~-7"- ;lJ- (/Qj-O -gi7,fQF Qt7 'r 0 (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: DNEW CONSTRUCTION o ADDITION ~ALTERATION o REPAIR o INSTALL OSIGN o MOVE 0 DEMOLISH PROPOSED USE: OSGL FAMILY DWELLING OMULTI-FAMILY 0# OF UNITS o MOBILE HOMI ~MERCIAL o INDUSTRIAL o SWIMMING POOL o OTHER c:J RESTAURANT & HEALTH DEPARTMENT APpROVAL DESCRIPTION OF WORK /V7F7H-'- r1:=?V-c-e-- +- ;).. /3A-1"H Ie~t?' ~ j (Pe("l~Cd , BUILDING SIZE f$ ~ <; {., I SQUARE FOOTAGE 4~o V HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. & (1) SET ENERGY FORMS. r u -- &rf1t FORMS. ~BUILDING o ELECTRICAL ~LUMBING o MECHANICAL G}15d1, CO PERMITS REQUESTED VALUATION OF TOTAL CONSTRUCTION AMP SERVICE ~ Progress Energy 0 W.R.E.C. $ litl? .- VALUATION OF MECHANCIAL INSTALLATION o OTHER o GAS o ROOFING o SPECIALTY TYPE OF CONSTRUCTION:~BLOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES ~O (ce.tl 350. - a.o~.. 4~ q~ N\ "5 ( K~A -::s "" BUILDER t2 COMPANY-L:-~ ~ ~ e . I U'<\ \0 0( SIGNA;URE . ~~y STATE CERT OR REGIST i Ckr;r?.,3t') ~ ii> I 4/ d-r/",,-J>'" ~ ****************************************************************~~~~~ ,., IJ';'O< ELECTRICIAN COMPANY ~~ d<~ ************************************************************ * (.-~ PLUMBER / / ~ COMPANY ':2..'1f::1I/'4-.flL"7J~>JJ. F ,<u/;,s,'1 rJ... SIGNATURE /~ ~ . STATE CERT OR REGIST # epClr2SZt9 ~ ****************************************************************** SIGNATURE - STATE CERT OR REGIST # MECHANICAL COMPANY SIGNATURE STATE CERT OR REGIST * ***************************************************************** OTHER COMPANY SIGNATURE STATE CERT OR REGIST * A. NOTI~E OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed restrictions" which may be more restrictive than City regulations. The undersigned assumes responsibility f)r compliance with any applicable deed restrictions. B. 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 l~cal 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 City of Zephyrhills Building Department, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign po~tions of the "C;oi1tractor sections" of this application for which they will be responsible. If you, as the owner signs 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 may be an indica~ion that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION 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 _ Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the "owner", I cerify 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. E. 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. . Appli~ation 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 wiil be performed to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental 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 Regulation-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 *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan addressing a "compensating volume" will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. 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 code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for ia period of six months after the time. the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to'the Building Official. An approved inspection must be logged during each six month 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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATURE: CONTRACTOR SIGNATURE: OWNER OR AGENT acknowledged , 2~ STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _day of by STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _ day of by acknowledged ,20_ (name of person acknowledged) Dwho is personally known to me, or (name of person acknowledged) C1ho is personally known to me, or D who has produced (type and wrioD did D did not of identification) take an oath. Dwho has produced (type of identification) and who Ddid [):iid not take an oath Signature of person taking acknowledgment Signature of person taking acknowledgement Name typed, printed or stamped Name typed, printed or stamped JOB LOCATION CITY OF ZEPIIYRHILLS BUILDING DEPARTHENT & ;:7:'T fA- ;VPi:1e- L-t.- '- / Cc /( ,R(/ L 11<<05&/ '-V- / I /1/t~/erfr /lvlE '3 t J~ 3 . OWNE'R PARCEL I.D.' # () ~-;JlC- 7-1 -e7c"''g"(} - (Yt7A CJC' C1 0 ~CJ SIIOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS. I' 'J.. i 0, . V i 1V~t.- ---- C-/....-- 'tv '\ c. ! ~:2. , ')7 "" j///tIJL.. ......... -- 'J5~ :;..'1 UTILITY BUILDINGS MUST SHOW SIZE & FOUNDATION INFOR- MATION. FRONT PROPERTY LINE (NOTE EXAMPLES 1 & 2) STREET )/1 J ft'3t/ } /II Nt r H /11/ t:F 1. SETBACKS FOR Rl, 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 FAM 30'DUPLEX 1 0' FRONT PROPERTY LINE FRONT PROPERTY LINE FLA. 1977 LAWS FS 713.13 NOTICE OF COMMENCEMENT SEMINOLE FORM 408 'PREPARE IN DUPLICATE' State of Florida } County of \ The undersigned hereby informs all concerned that improvements will be made to certain real property, and in accordance with section 713.13 of the Florida Statutes. the following information is stated in thi~ NOTICE OF COMMENCEMENT. Description of property . .flf:,:o./~. .1.41. ?1?1.i1--':J. .l-:f'. ~~ !~rA:.7?. /r.[. . . ~. r.1.~ /f . . JJ!. ~'.;r.1 (r. /1:1(. .~ . . . . . . . . . 7.~7.!ljI.1e. .Ii~!-:-~.. .f.?;. 3.lr~1. .c.:.... .4/.'.(.,~~. .'#.:.. P. 2.-:.?r;,.::. ./.... ).77 .~~ .':.?.i;}.~. .c?,'?/f. ef?. P'.c:.?,O ........... ......0.. .0... '.' ..0 ..... .0...0 .......0 ..... ...........0... ....... ...... .0.... '."...0.0.. ..0. ..0...."......... 0'.0...... . 74- .., ,(,1, . ,/t&"',u..'j' -e-;t-c;;. iF !/f/iFVPP :~~ :;; General deSCriptIOn of Improvements .. .. .?Arl!. . . . . . . . . . . . ./. . . . . . '.' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . n' . . . . . . . . . . . . 'C, _ . . t/~f'C;J--;fP /,vc. Fiowner.? tkP.. .k~/?A?{.. if.:...0.. /.. .k.f;~:1(1'.7' .0: .11'1'.,,~~~'.~!~. . if. r.r.~ g.~~/,!::? .c./I..I(.'.f.r.~~ Address .7. If. It. 'J.. /f{;, 1:::71. . If</.. . jJ./.t~i':, ?i.tJ:y. Ft.-I...1. //?: ~ . If/{' /r)."(i. Y.r. .h;l:.#Y ~ jA~~~:. P..~. . Owner's interest in site of the improvement. .. . . . . . . . . . . . . . . . . . . . . . . .. . ... . . . . . . . . . . . Fee Simple Title holder (if other than owner) 11111111111111111111111111111111111111111111111111111111I11I 2005259972 Rcpl: 949655 Rec: 10.00 DS: 0.00 IT: 0.00 Address ........................ ~ . .. . . .. . .. .. .. .. . .. . .. .. . . .. . .. . .. .. . .. .. . .. . . .. . . .. 12/08/05 Dpty Clerk .~ ContractorflJ-!.8..\~.. ..m..\)5.~~............................................................;...................... Address . .~. (':{PtJ... &: .~.~... .M..... J)tf..~... 411:" .Ft.... .?.!..~~.~~.................... Name ............................................................................... Surety (if any) ................................................:.................................................................. Address .:.;.................................................................:................ Amount of bond $ . . . . . . . . . . . . . . . Any person making a loan for the construction of the improvements: Name ... .-.. . . ... . .. .'. ... . . IV: ~.f!-:: K..... .. .., . .. .. . .. ,. .. . ... .. ~... ... .. .... ., . .. JED PITTMAN~ PASCO COUNTY CLERK 12/08/05 11: 18am 1 of 1 OR BK 6734 PG 1810 Address ......................................................................................................................... Per~on within the State of Florida designated by owner upon whom notices or other documents may be served: ,A/?~ /v ; . Name ..................................1::............................................... ......... ................................ Address ........................................................................................................................ In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section --- 713.13 (1) (h). Florida Statutes. (Fill in at Owner's option). - \;1' - . Nam.e ............... -..........; ............................0-._.----.................................................................................. Address ............... . . ./ :// . . ./. . . THIS SPACE FOR ~~~.~~~.~~'~. ~~.~ ~.~~~. . . . . . . . . . .. . . . .. . . . .. .. . . . './1: ..... '.?/~' . .. . . . . . . . . . . . . . .. . . . . . /.~.................:............................... ~ l.,. ~ '0.;) s - ~ "1 d - "i--G-vyrJJlr .;). 5 -:s -- 0 Sworn to and SUbscri~before me this. . .U. . . . ; . . . . . . . . . . . . . . . mr"J V ...:~m":mmm~S ~~~.{.L.~~......... Notary Public I...... ........... ........ II' .... ...... .... it.... "'11" .... : ~#"~':"'''- PATRICIA E. REED : i jg'.l!. .~~ Commission" 000127862 ~ : i. j Expires 612012006 : i ;f", fl""'~'" Bonded through ~ : (800-4 12-4254) Florida Notary Assn., In'-_ : .."..................... ...~... ...... ...... ....... ,.. ~"r !~, rJr' ~LORIDA OF PASCO . '. TH:') is TO CERTIFY THAT THE F r PU' ;,:1." ;~')QRr'T "~) .' ,OREGOlrvG IS A C'r~ :]f l'ij',:.:C ';'~~O~vf y OF ::~E DOCUiViF:.oj ON FILE ,,, , _ . u.1) iN THiel OCFI~. W. !:\I'''~~ MY c....l;f,)[ I . ,:r' t,' , .. _1_....,) , . ,'..",1..1."1 .,f,F.,r.,r., """., T'. - Ili C ",i'Kl ",.. >'1" L.I U r> _ ~.' - .....t_.'iL < ,.1 V :' ;-\r :lr" ~~ ,.cI"'Uf' Jf=L' f)iTTf'JlAAf" '. 2 _00 S'. . -'ill' .1. "\LGLHji<CJf."(ic';i'iiT""~T B\: / :~i~.'.:e~ht.~~E:~~f~~r CLERI( Musser, Ronald Jr 38303 North Ave Little Peoples Christian Day care SQ. FEET PRICE MAIN OR LIVING: - $ 50.00 OTHER AREA UNDER ROOF: $ 50.00 OTHER: $ - VALUATION $ 4,500.00 FEE SHEET $ 55.00 ADDRESS $ - DRIVEWAY $ - BUILDING: $ 82.50 CREDIT: $ - BUILDING LESS CREDIT: $ 82.50 ELECTRICAL: $ 40.05 PLUMBING: $ 75.00 MECHANICAL: $ 70.00 SUB-TOTAL $ 267.55 RADON: $ - TOTAL $ 267.55 v ./ ./ / SEWER: $ - WATER: $ - IRRIGATION: $ - TOTAL: $ - WATER METER:I $ IRRIGATION METER $ - I 267.55 I I SUB-TOTAL $ PARK IMPACT FEES I $ PUBLIC SAFETY IMPACT FEES POLICE $ - FIRE $ - 5% $ - TOTAL: $ - SIF'S: $ - 100.0% $ - 1.0% $ - TOTAL: $ - : I I I TI F 'S 'I $ 99% $ 1% $ TOTAL: $ 267.55 I Fire Chief Robert Hartwig ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 FIRE SERVICE USER FEES/ Occupanc~~o.: Owner: "'Jf~ ~A"c/~ 7vn;P"-- Pla~ No.: OS -o~m ~~~. Billing Address: I Business Name:~ _ _~0. ~ Business Address: Business Phone No.: Billing Phone NO.~ 3~;)ob-l./ftP Business Fax No.: Billing Fax No.: Contact: Contact: GREASENENTILATION GREASENENTILATION o Hood/Ducts $35 0 Hood/Ducts $15 ~ 0 KltchenSuppression $15 . r---l FALSE ALARM I PLANS TOTAL'" INSPECTION TOTA~ PERMIT TOTAL! TOTAL Com~"" ~d r~ Cee- -C-Gvk~AL ~~~ PLAN REVIEW FEES B Site Plan N/C 7/'/0 Building Plans .04 sf Revision .06 sf STANDPIPE SYSTEM o Per Riser $25 SPRINKLER SYSTEMS o 0 - 25 Heads $30 o 26 plus Heads $60 FIRE PUMP o Per Pump $100 FIRE ALARM SYSTEM o 0 - 25 Devices $30 026 plus Devices $60 SUPPRESSION SYSTEMS ~ Wet $35 Dry $35 C02 $35 Other $35 INSPECTION FEES Annual N/C 1 st Re-inspection $25 2nd Re-inspection $50 3rd Re-inspection $125 4th Re-inspection $250 5th Re-Inspection $500 Construction $15 Commercial $25 SPINKLER SYSTEMS Hydro Undergrounds $45 Hydrostatic System $45 Wet Acceptance $30 Dry Acceptance $45 Hydrant Flow $25 Hood 1 Booth $30 Grease Duct $15 FIRE ALARM SYSTEM o System Acceptance $50 o Recall Acceptance $50 OTHER Fire Wall/Smoke Wall $15 LP Gas $25 Natural Gas $25 Fuel Tanks $25 Tent $15 PERMIT FEE FALSE ALARM FEE 1 st Alarm N/C 2nd Alarm N/C 3rd Alarm N/C 4th Alarm $25 5th Alarm $50 6th Alarm $75 7th Alarm $100 8th Alarm $150 9th Alarm $200 10th Alarm $250 SPINKLER SYSTEMS o Automatic $15 FIRE PUMP o Fire Pump $15 FIRE ALARM SYSTEM o Detection $15 OTHER ~ LP Gas Natural Gas Fire Works Fuel Tanks $45 $45 $25 $45 :::&I",.lt~~~~_ ~'- --"-- C!T"I"V L")I;" "ZJI;l'DUVDUTI T C QIITII\TIIIt':!. nJl;l'DIlD.....IR'....... ~ ~ CI~Y OF ZEPHYRHILLS PERMIT APPLICATION BUIILDING DEPARTMENT 533.5 80rB St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 PHONE CONTACT FOR DATE RECEIVED \d.-~-05 (SO'-~ ~ PERMITTING 1j17~, 'f -/ $", 7 OWNER'S NAME Ce-/i'Jt?-1./ J ~Jt7 J Lf Ihps, ~/t r~L..r( /.t},/JI:7f. LLL PHONE . , //I ,.If. rf-l II- ~ ~2 tq:' /Iy /( /Iz Li.- S ;: L ft/, -~ ~ 1 -I ~ V' ~ J3S't P' . JOB ADDRESS LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # 1J;l-;1 ,,- ~J- tJ" 'to - (It' A- (l F e;t7 1 0 (OBTAIN FROM PROPERTY TAX NOTICEl WORK PROPSED: [JNEW CONSTRUCTION [J ADDITION ~ALTERATION [JREPAIR [J INSTALL o SIGN [JMOVE 0 DEMOLISH PROPOSED USE: [JSGL FAMILY DWELLING [JMULTI-FAMILY [J# OF UNITS [J MOBILE HOMI ~MERCIAL [J INDUSTRIAL [J SWIMMING POOL [JOTHER c=J RESTAURANT & HEALTH DEPARTMENT APrROVAL DESCRIPTIO~ OF WORK !),N;r7H-t- rt=7'Vc.-~ +- ;)... /3/t"TH ,r~p ~j{Pe~~~ , I BUILDING SIZE f5 ~ ?' SQUARE FOOTAGE 4~O(; HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. IF SIGN PERM~T ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ~BUILDING o ELECTRICAL ~LUMBING [] MECHANICAL (;)4501. CCJ PERMiTS REQUESTED VALUATION OF TOTAL CONSTRUCTION AMP SERVICE ~ Progress Energy [J W.R.E.C. $ 7icJ?~- VALUATION OF MECHANCIAL INSTALLATION [J OTHER [] GAS [J ROOFING [J SPECIALTY TYPE OF CONSTRUCTION:~BLOCK [J FRAME [J STEEL [J OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONEAREA[J YES J3ilNO (ce-il 35.3 - a.Dw - 4~ q-g- . Q ti:S r/ BUILDER ~ COMPANY::.ffi" sSe.-, ~.. ""'" l< SIGNA;URE, '~~.L . STATE CERT OR REGIST t CklYr?~~:1 . ****************t***********************************************~~~z,r- ~... ELECTRICIAN COMPANY SIGNATURE STATE CERT OR REGIST # ************************************************.***********~~<?~~ PLllHBER // ~ COMPANY ::2/'1f1I4J1""TI6~.tJFl;;;J/ttij rI.... SIGNATURE /~ . . STATE CERT OR REGIST # ef'CIY2~~ 9 ~ ****************************************************************** MECHANICAL COMPANY SIGNATURE STATE CERT OR REGIST * ********************************************~******************** OTHER COMPANY SIGl'lATURE STATE CERT OR REGIST *