HomeMy WebLinkAbout06-6246
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6246
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
6246
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 6013 17TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
6,425.00
11/14/2006
65.00
65.00
11/14/2006
TEAR OFF REROOF
CHERYL
6013 17TH ST
ZEPHYRHILLS, FL. 33542
Phone:
~\df
< ('O'\?p L9"
\. '" ~
,
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. n
NO OCCUPANCY BEFORE C.O.
~ ~~
NTRACTORSI NATURE PERMIT OFFI
ALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
81:3-780-0020
City of Zephyrhills Permit Application
Building Department
Date Received
EO<rt...
I 7 - Sr.
Fax-813-780-0021
4 ~v*~
Owner's Address
Fee Simple Titleholder Namel
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Owner's Name
Fee Simple Titleholder Address
SUBDIVISION
I ~ 0 { 3 17 ~ .fr.
I j?AIf..A IfJU- Jug
LOT #
JOB ADDRESS
PROPOSED USE
TYPE OF CONSTRUCTION
NEW CONSTR
INSTALL
SFR
BLOCK
PARCEL ID#I ();t - ..l.' ..,,)/ _ oj Yo - 00000 - o6J-o
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
I
D ADD/ALT D
D REPAIR
c==J COMM c=J OTHER
D FRAME D STEEL D
D pF .. It E.fUJ(JF WI 77-f- IS" .rd.} 30 ~.!Jt 41 S/fr.( 6.tL f
BUILDING SIZE I ISQ FOOTAGE I I HEIGHT I I MoO'?, 'Iff
~ .....(.,....""""..""",....",..."",..",..,.,.....,......,.............................................,.......,.....,..., ....,......
~ BUILDING 1$" I <I;). s-: 00 I VALUATION OF TOTAL CONSTRUCTION
D ELECTRICAL 1$ I
D PLUMBING 1$ I
D MECHANICAL 1$ I
D GAS D ROOFING D
FINISHED FLOOR ELEVATIONS I I
WORK PROPOSED
E1
D
D
DEMOLISH
OTHER
DESCRIPTION OF WORK
AMP SERVICE
D
PROGRESS ENERGY
D
W.R.E.C
VALUATION OF MECHANICAL INSTALLATION
SPECIAL TV D
FLOOD ZONE AREA
OTHER
DYES
DNO
111"'11'111111"""1.1.1""...111"""1'1.111..111.."".111.'1'..11.......".111..11'.1111.."".......","111'111'1.1'11'111"'."111"'111
=:::~~~RE~ cS~~
Address _
J 'C/C. VIe EJ
I Y IN I
COMPANY
REGISTERED
1/h,/1tc ~/~oy.
Y', Y I N I FEE CURRENT
License # I
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/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
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
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 wI Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large 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.
1111111111I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111
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 ~ewers ~ervice Upgrades AlC Fences (PloUSurvey/Footage)
Driveways-Not over Counter if on public roadwaysuneeds ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" re'str1ctions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with a'ny
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 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: Theundersigned 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 humber 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 hot specifically included in the application. A
permit issued shall be construed to be a license to proce~d with the work a~d not as authori~y !o violat:, 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 violat~o~s o~ any codes. Eve~ ~ermit issued. shall become. invali~
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 th~ work is commenced: An extension
may be requested, in writing, from the Building Officia~ for a period not t~ exceed mn~ty (.90) da~s 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 N CE OF COMMENCEMENT.
FLORIDA JURAT (F,S. 117,03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who islare personally known to me or has/have produced
as identification.
Notary Public
\
~~ d.~ Notary Public
,'~l.,~I',,- Karen L. Miller
Commission No. ~A""f, C I' II- f)D669~~
:.. :._ OOlm ~OI1
~,." rl Expires October 29, 2010
Name of Notary typed, prlntef.,; nij!leIl!IlTIOyFam-ln&Ufanco.lnc IlUU-Jll~IU1~
Commission No.
Name of Notary typed, printed or stamped
Permit Numb~r:
PIN: '0.1- ,),6-.)-1 -0/ )10- 0 0 ~ CJ \J ~ (/ b LO
~~~~~~I~ lW' 11111 11111 11111 11111111I111111 111/111I
Folio Number:
Rcpt.: 1048834
DS: 0.00
11/13/06
Rec: 10.00
IT: 0.00
Opty Clerk
~v
NOTICE OF COMMENCEMENT
State of Florida
County of
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 following infonnation is provided in the NOTICE OF COMMENCEMENT. '
I. Legal Description of p'operty (......t address ""IuD-ed): ~'f ~~jf Sf %;;.t ~ 1h f ~ ~ ~ 0 (., f-b ,
or t(,;..r) pG- /590 60/~ _~'el___e.-~ --yr ,___ _ ~ _~~
{/aJ6>
JED PITTMAN PASCO COUNTYfCLlRK
11/13/06 0i: 19pm 1 10388
OR BK 7263 PG
2.
General description of improvements:
3a.
~oF
Owner Name: C~~J) Jf c)5 p
Owner Address: _ o:z) r n ::5:;
Owner's interest in site: ()Lu 1lD~
Fee Simple Title holder (of other than owner)
Contractor Name: HOME lMPROVEMENT SERVICES
Address: 14377 US IDGHWAY 19 N CLEARWATER FL 33764
7P~Jhev'lA I lIs
,
I- L- ~3 -59,'9
3b.
3c.
4.
Phone: 727-530-0412
B
5.
Surety Name:
Address:
Lender Name:
Address:
Amount of bond:
Phone:
6.
Contact:
Phone:
7. Person with the State of Florida designated by owner upon whom notices or other documents may be served as provided by
Section 7. 13. 13(1)(a)7, Florida Statutes.
Name:
Address:
Phone Number:
8. In addition to himself, Owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 7.
13. 13(1)(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)
STATE OF FLORIDA
COUNTY OF
1 ~Qq'1.D f ~/)j 0_
gna ure of Owner
, JPCU'Co
../ c.
The foregoing instrument was acknowledge before me this 7 date of NO iJ e??1 h BY' , 20 c.7 G ,
by C. h ev V I t: d5 e , who (is) (are) personally known to me or produced
E .)(fo-oq- '[6 ,-510' 0 as identification, who did / did not take an oath.
~~~:~~~~~:::_~
BRENT LLOYD
MNotary Public. Stare at Florida
y Comm, Expires Oct. 9, 2010
No, 00603585
/ ,~/.0
iIi1~" A~ j:r;>
/ L/"'''''{/ t-//
Il
J'" ,/
H( E IMPROVEMENT BE - :ICES
14377 U.S. Hwy.11N .~.I'L33764 1851 PorIIr~AoId, SunlAos..oe., ~3G40
Phone: 721~12 . TaU F,. 10C7-14H68O PIlone: 84'~7NI1ao. Tal FNl1.f77037M771
Fu:: 721-53H912 Fa: 841"'71"'33
Uc. No. CCCOII227
SALES CONTRACT
Home IIIlprOnment ServbIs ... 10 fumJlItt a111l181e1ta1s Ind labor ,...." to do 1he IIICldImIIIIIon work. ... faIawing __:
Name 2: ~~:r I e:d't3 e. Phone ~/~~ 7~- ?~Phane (II) 'TF.3 ~97.3- /I II
Acldrtu ~('"I/3 / 7 ;. ,<; +- DIll
CIty. ~SJP~,v J/' h, 1/.:5 .. FL. ZIp 33.:5 7','<.
In IOCG.... the 8peclbllane given below:
REROOF:
A. SHINGLE ROOF
" REMOVE OlD ROOF TO 8MOOTK Y<<lRKA8LE~. .
~: ~=~=s~~:~j~~.1 S7,lXIPERFOOTANl~lXIPEASHEETa:PI.YWOOO.FANV. t9 ~ l'-l
4, INSTAUDRY IN FElT OYEII ROOF,
5. INSTAll. NEW VAllEY METAl. AND R.A5HlNGS AS NECESSAIlv.
6. lNSTALl NEW lEAD IlOOTS 0\IEIl VENT PIPES NID RESeAL~ ~
7. lNS1:~l YEAR FIIlI!FlGlASS SHINOlES. COlOR ) t ~~ y .
8, INlt FEET a: IlIlOE VENT AT ~ FOOt _ !_ _'
9, CUAN-uP sm: OF AU. WORI( DEBRJS NfO HAUl. Miff ALl RElATED lEAVE JOe SIrE ClEAN,
10. COHTIlACTtlR WU COOAoINA'IE FIEMOVAI. ANl RElNSTAI.LATION OF ROOF RElATED PERIPHERALS SUCH AS IBUT NOT lIlTED 1OI11OlNl UNITS. SKYLIOHTB. tv. 0I8H
AND NR CONIlITQfERs, m:, RBlOYE AND REINSTALl EXISTING SOFFIT AND FACIA. k2S PER FOOT IN ADDrTlON TO lXlNTAICT PRICE. F 1lEQUIlEo. TJE COST FOR
SUCH WORK WU BE IN AIXlITlON TO CONTRACT PAlCE ANl HER9l AI'PROYED BY HOIlEOWNEIl.
B.1 PLYROOFSYSTEII
1. REMOVE OLD ROOF It) SMOOTH WOIlKABLE lUlFACE. c..' ,
2. REPLACe INf ROT'IED WOOD wm4 STANDNlD SIEATHlNG. $7,00 PeR FOOT ANl SlIO.110 PER SHEET OF PI.YWOOO. F 1Nf. 9 i-_ ~
3, INSTAU.43 LB.1lASe FaT OVER ROOF.
4. INSTALl NEW lEAD BOOTS. I. .' L
:: :: ~~=.~ I.{) fR::el-P :
7. CLEAliI-UP JOe SITE a: All. WCflI( lIEBIlIS AND HAUl. NNIff AU. RElATED DE8IlIS AND lEAVE JOIl M'E aEAN.
(p0'-\ {p
,. Coma~. ll1iI ~ anIIII aI" -'1Ib ~ UlOIlzlIIcn, w .,...1IIlI, IIlIl'NIlII
~"IO belllllr'Clld, Illllnn:lno llaaInerts. No P!1lIIiIeIllIlIIr.."...IIJIdIc:IIIl'''1OIIII in",__
~ ... be NCOgrliDd by ..,., l*lY- The lI1linl undnIIndng MCl....... aI.. '*'* It 0lIIlIIined In'"
CftIct ~
2, · ISlIIdIIIlDod and IlOnlId IhIIIhIt cam.:t... nar beI:amI bIndng upon Home hSeMces.... iI II cUr
iPOfMCl .....Iipclllld ~ by.. aIIcor Iff.... aI DlI Seler.p
3, Wvdlon"Jcl&lIIIcIlMdiJ1.___wl_CIlIlilllaimllely__... belllllllllllf*l
CIlIllll'll1lllinl U F> . The IlIdlId cities nllllPftlldo.__... IN Mjed 10 IdlecUIno dIlGlIIea aI PermIt
Seller, --- . -alGaaIlld,**_noc,-> bySlllt. SIIot-..lfIt1llO
.......,. fIff ~Ior" ~ or.....llIIailIId In lie CIllb:I ~
4, Home ~~ -.......10..............01_ or...,... IIldIllnd. Mt/lqlllll(j
r-.1Udl. hllllnllr( pIrMJad, Illngue IIld QIllM DolIIII. ell:. wi belllld CIl lime IIld I1IIIIdII bill&. AI '**
dlonges NqUlred by Nlor oMiIIiaIanIl CcIde Enl-... a. may "lIlldillni nv-, TOIlII
5, 1nI... lithe lilt or....., (18%1 per.... per _lIlIbe dllIgId CIl..... nar lIIld. per the IImlIII*ified
IIbowe. Ae.lnUltIllOlllel"l_lIiIblcNlVldlOfIe ~Wilis'-YIO_1IIIICllIlIlIll.in "l1IIldIor..
IIIomIyforCllllleClian.IIld" CMIIe ~ ._or iii CIllb:IIIld... aI.. Pl.u- 11I_.
6. PWIiII aoree..... ..-..... be -..cl1Cl1llldng 10.. .... or lie SIIIe aI FbtdIIIld.,..1llllIn IIIa/GI'l
1hefellI\ may be brougIilln I/le - aI FlorIclI. Yne is henIIy"'-lII be In PInellI ~. RDridL 11.1 Depollt
7, BUYERS RIGHT TOCANCEl. I ~ clIInot....ggodI or.... ~ may _.. ~ byprvoldng wrIlIn
IlClIicIeIO .......in peqon. bylllillt1lfn. ~ llliI_1lIlII 1IllICIIII.... jllUclII nar.....ggodIor_1Ild
..... be deMnldlff~beIanl alllelHnl~ day .....~IiDn'*.-.
8, IlclIl WOo1lel's ~ IIlIl P*c iIIlIily iwIMlI1C1e lie CIIlied by" 9IiIIr nllley ... applcabIo 10.. _ Ia be
PI/lCIImecl, SubIDlIIl
9, lis undeIIIooclllld IgIllIdlharllle/lu)1lr hoIcI /lIIINII$, HaIIII ~ SeMele. lor .,...,...... ny_1o
"'Ou,er's ~ llJing .. cIIIMty aI n-.1Illl'ot DlII'IlllOVII or WllIk IIIIIId dIIIliI traI maybe.....1O
per\lNm iii '- ~ ClII'Oll ~. ... buyer henin Ili* JIIIIliIIIan lor \)llIcII dIlIlMry wHdMlIld
1ypicIIw.-1IlI1OVIIl VIhidlllIIIl...,1Ild cInvIwIIyl.) far the IUlDI d 1lIIIIlIIrG....... ClII'Oll
10, ConlrIaurwl ~ IIftIMIIIld teilIIIIIliGnd AlllI,..., ~ 1uCll.. tlluI notlillilldlO) IlIlIr UIliII, IkyIftI
tv, dna, nl lit concIIOnIoI,llc. The COlt 1ar1Udl...... be Inldlllon to CIllb:I priot n IPPI\lIlIIlI by~
11. Iion1e ~ SINlcIIhI not be hIId /IIllO'lIIIlft lor clImIgIlO IIIclrIe* IinII, ....-...... _ or
OlI1er"*,- ClllllIIOI*llIIIlIt '- been ~ iIWIed_1'lIOI dIclina IIld maybe CIImIOId...... paIIclInq
......... .. oaGIno -.IlIa.
12, ConoIIuc:Ion ~ ~ Fund p8JnlInIlIIIIJ De MlIIlIlI fnlrn" CRF . jIIU _ -.y CII1a plljIa peIIeImed
U/llllt~........1ou NMllnlm IIldIdvialaliClnl..FlOIlCIl....lly allllltlllned ___ For
~ 1Ilad... ~ UllIIIld ling a dIim, CllIIIIIl:I... FIDIlGI CclniIodol-.y UcnIrIg IlaIIIIII ..
1cllIoIIing__1UIIIIer and__7S MinGIllIl ~ S. 300, JacbanoAIe, Fl :m11.74G7lffcd (904)
727~,
13. CI1apl8r.. FIaI1de bUes contam ~ ~,au IIIUIl foIgw 1lIIaIe,au may~ Iny IIp/
ac:lIon for an IlIeged CXlllIIIuClIon dIIIcl in ,aul home. Slldy days ~ ,au blfng Illy lIgIl ac:lIon, ,au IIIlIl
d8liier1O'" OIlIer I*IY 10 !his cannd. WIlIIlln ncllce ~ 10 l:IlI/llIIr 588 01.", *11m anIIudIan cleIeds
8IldID llOllIIderlltllllilg III *1Il..... or peylor"'lIIIgId lDIRucIIan dIlIcls. You 1ft IIOl ~ IOlICCIpI
Iny .rwltil may be..... '"- nltrld dIdnes Ullderlltls FIcrtcla Law which 11IIII belllll and ~ to
p"*t,aur irlIenlela.
Executed In trlplk:8te, one copy of whIch was delivered to, end receIpt Is herbyecknowleclged by Buyer, this ~
day of J1kJ V ,200 {.
Approved end AccepI8d:
ConIrIet Price
c',JcJ 5 ~
s_ ,
s
200.00
6 ...c
$ G I '-);J ___
I
s__
.
BALANCE DUE $
(Plus To/aJ from It8m No. 21bow1
UPON COIIPlETION
NOTICE TO OWNER
.. Do not sign Ihs. home Impravement contrwct In blenlc.
b. You ere entitled tD . copy of the contnlct at the tlm. you .'8n. Keep It tD protect your rtghla.
(X)t.Op L~ ~~ 0
, ( SIgn .......
(Dealer-Seller)
(Seel)
(Seal)
BY
~~
(X)
(Puft:huer SIgn ....)
(....)
....-