HomeMy WebLinkAbout06-6245
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6245
Permit Number: 6245
Permit Type: RE-ROOF
Class of Work: ROOF REPLACEMENT
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost: 12,800.00
Date Issued: 11/14/2006
Total Fees: 95.00
Amount Paid: 95.00
Date Paid: 11/14/2006
Work Desc: TEAR OFF REROOF
Address: 5240 19TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-17600-0080
Name: NORRIS, LEE
Address: 5240 19TH ST
ZEPHYRHILLS, FL. 33542
Phone:
\9~
/ U: ~
'y l '\'ff ~
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
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 permits required from other governmental
entities such as water management, state agencies or federal agencies.
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."
NO OCCUPANCY BEFORE C.O.
~~
RACTOR SIG ATURE PERMIT OFFI
',,__ CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Date Received
tZ- iLl J
If~ S'I'.
Fax-813-780-0021
-k1 ~ ~l\5
c ~
Owner's Address I J-;;;2. YO
Fee Simple Titleholder Namel
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Owner's Name
I
I
~ J&3 / p'L. JI.]
I I /7/.[) . .off
BUILDING SIZE I ISQ FOOTAGE HEIGHT .
0~<::""""""'" .............................................."..................................,.....................................
BUILDING 1$ /~, y~ (!) o..f I VALUATION OF TOTAL CONSTRUCTION
D ELECTRICAL 1$ I
D PLUMBING 1$ I
D MECHANICAL 1$ I
D GAS D ROOFING D
FINISHED FLOOR ELEVATIONS I I
Fee Simple Titleholder Address I
I 5'';< YO 1'l-:Y-51
ION! e r- Z tI'll- 'j/llh'LV I
T 1~78'
E3 NEW CONSTR D ADD/ALT
INSTALL D REPAIR
PROPOSED USE D SFR D COMM
TYPE OF CONSTRUCTION D BLOCK D FRAME
T~ oq: -1(~IlOO;:; td/17-f
JOB ADDRESS
LOT #
SUBDIVISION
PARCELlD#1 II - ~ -.}-/ - 00/0 --17000 - 100dO
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
WORK PROPOSED
DEMOLISH
DESCRIPTION OF WORK
OTHER I
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C.
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D
FLOOD ZONE AREA
OTHER
DYES
DNO
BUILDER
SIGNATURE
~
M E..J/"1 / /UJ V.
Y I N FEE CURRENT
Address
License #
COMPANY
REGISTERED
ELECTRICIAN
SIGt.!ATURE
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y I N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
111111111111111 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
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 onslte, Construction Plans, Stormwater Plans wI Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge projects
COMMERCIAL Attach (3) 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 wI 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.
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000)
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 (Front of Application Only)
Reroofs Sewers Service Upgrades NC Fences (PloVSurvey/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 violatioh
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 Sectioh 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 "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 Officia~ for a period not t~ exceed nin~ty (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 NOilCE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03) .f, .
,/'
OWNER OR AGENT
Subscribed and swom to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
Notary Public
n-~ ~ ~ Notary Public
,,~IJ'JfJ. K
Commission No. ~~~ are" L. MII;~
€;: i..: CommiSSion # DD609664
~~. '~E' 0
-~.~ Xpll'M ctober 29, 2919
Name of Notary typed, pri 11 strllilllllWJ,. FOIn .In.ur.ne.. In<. 800-385-7019
Commission No.
Name of Notary typed, printed or stamped
Permit Num6er:
PIN:' 1!--cX(,-d.( -00/0.... (7(~DLJ-{)c80
111111111111 1111I11111111111111111111111111111111111 11111111
2006226711
Folio Number:
Rcpl: 1048834
DS: 0.00
11/13/06
Rec: 10.00
IT: 0.00
Dpty Clerk
>1/
NOTICE OF COMMENCEMENT
JED PITTMANJ PASCO COUNTY CLERK
11/13/06 01:19pm 1 of 1
OR BK 7263 PG 1387
State of Florida ~ _
County of .1:11 Sc 0
The undersigned hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13
of the Florida Statutes, the foUowing information is provided in the NOTICE OF COMMENCEMENT.
L Legal Description of property (street address required): h. I II
13 to . Wf 'i'J.- (-
<10 I ,-
2. General description 00 improvements: ~f06 F
3a.
Owner Name, L ee ~ n 1 ~ 1 <<J. AJ"f f ~
Owner Address: .~~ if .)... -Sf it y" it) ( 1/ s
Owner's interest in site: OW ~
FJ
c~_ 3..r; 'It;;2
3b.
3c.
4..
Fee Simple Title holder (of otber than owner)
Contractor Name: HOME IMPROVEMENT SERVICES
Address: J4377 US HlGl-IWAY]9 N CLEARWATER FL 33764
Amount of bond:
Pbon., 727-530-04] 2---B:
5.
Surety Name:
Address:
Lender Name:
Address:
6.
Phone:
Contact:
Phone:
7. Person with tbe State of Florida designated by owner upon whom notices or other documents may be served as provided by
Section 7. 13. 13(1)(a)1. Florida Statutes.
Name: Address:
Phone Number:
8. 10 addition to himself, Owner designates the following person to receive a copy ofthe Lienor's Notice as provided in Section 7.
]3. 13(])(b), Florida Statutes.
Name:
Address:
Phone Number:
9. Expiration date of Notice of Commencement (expiration date is one (1) year from date of recording unless a different date is
specified)
;11;;:: a. }~
STATE OF FLORIDA ~.J
COUNTY OF I Ii Sc()
Signature of Owner
The foregoing instrument was acknowledge before me this
by ! (.:> e IJ n e)/'/::" t{,1 A)..:J/i/; :"',
N~e~
date of /tJO(/(24?ll) er~ ,20 06 ,
, who (is) (are) personally known to me or produced
as identification, who did / did not take an oath.
/1
BRENT LLOYD
Notary Public. State 01 Florida
My Comm. Expires Oct. 9. 2010
No. 00603585
/)
1.11 . ;,7...;1 .,/.'
LI~'
/ ~.111Y ( : (1 .Vi
I Signatu _ Notary Public
H a IMPBOVEMENT 81 .VICES
14377 U.S. Hwy. 11N .C......., FL 33784 1951 PorlIIr L.-Ro.d, SuIeIA...... Flarlda34240
Phone: 727~12. Toll me 1.a77-84H880 Phone: 941477.100. Toll FNl1-177474-t771
Fa: 727~12 Fa: M1417.'13
lie. No. CCCOU227
SALES CONTRACT
Home 'mpl'OYtment ServIces .~ III flIonls/l II' m"'l8 Iftd IIbor ......, to do IItIllOdlrnlr.lllo work It tile following ......:
NIme Lp.p.. ; f11€b/IS5f1 JJOf("S Phone ~/3.7g3-7'1~~ Phone(wt 8'I3-Y69-:388-2
Add,.. ..5 ~ "i 0 J <1 Tl sf DIll II hI / o~
CIty;;;;. z e. jOlt, y V' J, I" 1/ '!; ..... F L ZIp -::s 364 .J
~E~ with Ihe IfIICIftcIIaons gIvIn below:
~~~~~ ~
t. REMOVE OlD ROOf TO SUlXml WllRKAIlLE ~
2; FlEPv.ce AHr ROTTED WIXlO WITH ST~.~TItNG. $7.00 PER FOOr AND SlID.oo PER SHEET OF PLYWOOD, F NfY. L
3. INSTAll FIWVA EAves DRIP. COlOl''-...1AU4...l.t.e . .
4. INSTAWlRY II Far OYER ROOF.
S. INSTAU NeW VAU.EY 1lETN.. AND FlASHINGs AS NECESSARY.
6. INST:t-~ IIOOTS OYER VENT PIP!S MIl RESEAl. VENT'S. J
7. INSl YEAR FIIIEROws SHNGlES. COlOR i/Jrnllf>' r:. ~1"e. .
8. INSt FEET 01' RIDGe VENT AT _PER IiOOf. . t ~ ) .
9. C\.EAN.UP JOB SITE OF AU. WORK DeIIRlS /1M) HAUL NJlfl'( AU. RElA1ED DEBRIS All) JClll SIrE ClEAN.
10. CClNTRAC'IOA WILL COOflDtNATE REMOVAl. AND RElHSTAlUmON OF ROOF RELATED PERI'HEIW.S SUCH AS 11M NOT I.MTED TOl SOINl UNrrs,lIK'tI.JGHT$, n DISH
AND AIR OONDITlONERS, ETC. AEMOYE /1M) REINSTAll EXISTING SOFFIT AND FACIA . $4.25 PER FOOr IN ADDITION TO CONTRACT PRICE. IF RElUIlED. TIE COST FOR
SUCH WORK WU BE II ADlll1'lON TO CONTRACT PRICE 11m HEAEtN APPAOYED BY HOMEOWNER.
B.1 PlYROOFSYSTEM
1, REMOVE OlD ROOF TO SMOOTH WOllIWlI.C SUAF'lICE.
2. R~E Nf'( ROTTED \IIIOOll WITH STANDNlD SlEATHING. 57.00 PER FOOr AND 180.00 PER SHEET' OF PI.YWOOO, F ANY.
3. 1NS'TAUA3l.B.1WlE FaT OVER ROOF.
4. INS'1llU. NEW lEAD BOOTS. IB '!
s. INSTAll FlWVA EAVES D111P. COlDR uJ e.
6. INSTAU. 1 PLY ROOF.SVSTEM. cotOR ,'.) P
7. ClEAN-UP JOB ~ OF AU WORK DEllAlS AND HAUl NIIItf AU RElATED DE8IlIS MIl LeAVE JOB BITE CLEAN.
1. CcnI~ llocuINnls. 1NI CDnIrIcl CllllIiIls III'" ~, ... ~ IUIIIllluIana.I ~, IIld, W,.,..,.,.
twllundlr... lolIe linn:IId. -1irWlCiIg dDanIInII. No jIlIIlIi.-........... ~.._ ft 1Ilt 00IlWIa
claanInls ...1Ie IllaIgIiz8d by etI1er JlIl\Y. TllI....1IlIIIrDdng end ___ 1111Ilt IlIIlIIs Is conlIIled h the
-~
2. his II'IdnlaacI end IllNICl N Ilis _"'1lCII1IIcame bIrdrv I4lGll Home ~ SIMIa... . iI cluIy
IIpIlnMCI, IICCIPled.Iipd IIld ~ by In albr lit IlIlcIls III" SIIIt. $"'"
3. WvdlCll111ltJab~~lIloddlla.meruwl_CII1~ /9-,.., IIld 1Ie~
... ~" . TIle 18GIod.... _O'O'....IIld.. 10 1lihIIlAinG.... 01
SIller. -.... ,_ 01 Qod IIld chr _1lCII__1II' 8* SIller _ the rWt III
......, ~ ~for"ClllIIIIIIIIOn 01.... _~ In'" 00IlWIa dDanIInII.
4. Home ~ SIMIa _.. ~ Ill.......... 01__11(' ~VIIue 1Ildldnd. ,..,...,
1MMll1UCh. t..1I\IIllIrt ~ lIIngUa 1Ild.- baI/d, lie. wille bII8d CII1 8time IIld ~ bills. .-._
d1I/9lI /BqIRl by NIw~ CodlI ~ '-s 1llIY'" ft adIIianII d1IfOIL
S. IrlMslIlIIIt 11II 01 tIgIteen (18%) per CIIl\ per _ wi lie cNrgea on II ~ IlCII peld U per lhelllmllp8Cled
IIxNe. "-'IDle 1IIlIrney'I_"'1Ie c:n.ged 10 1Ie~'. is r-..y 10... till 00IlWIa in 1Ilt hIIldI alln
aaney fat CllIIdian. IIld IIliIliIlIlgt...... 8 PM alllis 00IlWIa IIld alIIIgIIM ar.. PIlra- lo pay.
6. P8riIIagl8eIhll"'..,..,.. h1111e CIDIWIIUId IlDIIlIhg 10.. '- 1111Ilt S. III FIoIiCIIIIIld ~ aclion blaIght
1henIon 1llIY'" braught in 1Ilt SIIIt III AoridL VerMl is,.., lIDIIId to lie ft PinIIII CaIny, FOtdI.
7. BUYERS RIGIfT 10 CANCEL. . yalllD 1lCII........ ggodIor....., jQl IllIY CInIIIl....,..,..1ll' ~.....
llCIIioeto ........In .......1ll'1IIIgIIm, 1It1ll'1IIIil. TIIiI_ -lIIIICMIhIljQl llDllCII_1Ilt gacldllIt_1nll
IlIUII De -..eel 01' IIClIIIllIItlId DtIarlIIllilhutl III" third ~ cIIy 1IIIr)'IIU IIgn IlI5 ..._.
8. IlGlh -. comper1aIIon IIld puIllIc IiIIIiIy __ .... C>>IllIllIII'1Ilt Slllerllld1llty IIIIj1pl1c1b1e 10 !he _ 10 lie
perlormecl.
9. n is utlCleIIIoad IIld __1IlIl1he buyIr haId hIrmIIa, HIlma __ s.w.. lor an, llImIIII8'" ",.,_to
ilIlIIqe(B ~llblnglll8 dIMry aI.....lI1dfar..1IIlllMII GI_IIiIIIcl__... ",.,1Ie,...,1o
peIlalm...1aM ___ connd. I'urI1ermcn. 1Ilt bu,eI hIlIin gil'IIlIIIIllIIIIon tor .. dIIMly *** IIld
1YPICII .... IIIlllMII wllldlllo "aId~) tor1llt puIlIGII aI.......llI5... conlnIc:l.
10. CarCnIaor..COClIlIInIIIIlIlfnClllllIlld....., alroaI'*-l~ 1UCh.~1lCII Medlo) ...lIIIS......,.
T.V, dIIhes, Inllair CIIll'IlfIicNI.IIC. The lllIIllorlUdl_..DeIn....IO_primllld IIlIPIIMdby'-.
11. Home ~ SemaIs shIIlllClllIe lleIcl......lardMllge 10 IIIClllCIIlhII, lIlIIerlnel,.... ... 11('
llIIIer IIIICIIIncIl ClllllpIlnrdI", MMIlIen in1DIaPeIIY n1IIIId _1IIllI ~ IIld Il1Iy lie CIWnIQIcl wIliIlI ~
inIlIIIIian 0/ ~__.
12. CorwM:Ian ftllo.-iot AIcMIy I'tnI pa,nwa IIlIf De MIIIIII film ... CRF . JCllIoIe IlllIIl8r 111 . prIIjea peIbmed
--.cr. ....1Ilt... __......, WoIIIIiano 0/ 1'lDIIdII.... by. ___ _. For
AlI1naIIan - ... ~l1nIlIldtllno. -. _ IN FIondI ~ InlIlIlry I-.g IIDtnlIl ...
following __""'*' and ---= 7IIlO MngIDn ~ SuIIll3llO,........... FL lE211-7487 or... (1041
727~.
13. Cllepter 688, FbIda SIIIUlIs CDnbtIns irnpcJrlaIt lIIlUinllIIllIllIl VOU IIIlIlIDlbw ~ VOU IIlIY bIq lIlY'"
acllon lor III aIIIgId aJIlItuellon d*:l in yQI' home. SIllty _ befcIe ,ou blq lIlY IIgIl adIon, )'IIU lIIlIt
de., Ill.. alhIrP8IIYIlI'" COlIIICIall1lllln nolIc8 rtrIrmg III a., _ oIl1/1'f aIeged CGnIIrUClIIln_
IIIldlDCOlIIldermlllling an _10 IIpIJr or PlY forllle IIIged IlIItIftuclIon dIlIcII. You.. not ClIJIigIIIaIlDaalIPl
lI/I'follll'wIIIcIlllllYlle 1I1Ide. Ther8_ 5lIIct dHdIlrwundllrthiB Flartda LawwlllclllllUllbe ,,*1IIld IillIowIcIIo
prolICt,our imInsIs.
Executed In trIp11cete, one copy or which WlIS delivered to, and receipt I. herby ecknowledged by Buyw, IIIIs II
day of -1'j)0II4Im bu- ,20 f'J "
Approved end Acoepted:
NOnCE TO OWNER
e. Do not e!an IIIIs home Improvement contract In bIlInk..
b. You are entitled to a copy of the conlrect at the time you elgn. Keep It to PI'Dtect your rt......
kt:? ~~
(Pul'llhae8l' n H8nt)
11~
(Pu~r Sign He..)
(Seal)
(X)
(De8IlIr-8eller)
BY
(X)
~~
G,C}-'-l5
~
L~
~
CanInlct PrtcI s-12. ~OO ~
,
hrmlt $-~~
ToIII d. 00
1 J I 80"
..<:1
113 D.poeIt s_~JJOO ~
$......., $
8ALANCE DUE S
(plus Total from 118m No. 2 above)
UPON COIIPLEnON
(Sell')
(SeIII)
..* --