HomeMy WebLinkAbout07-7040
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7040
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:
7040
PARK MODEL
PARK MODEL SET-UP
MOBILE HOME PARK
Address: 39736 COG HILL LP LOT 162
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: MAJESTIC OAKS
Parcel Number: 24-26-21-0030-00000-1460
15,000.00
10/09/2007
175.00
175.00
10/09/2007
PARK MODEL SETUP
CRANDALL, RICHARD
BAHR'S PROPANE GAS & AlC, INC.
A
PARK MODEL PLUMBING
40.00 PARK MODEL MECHANICAL
35.00
~ n o.l.tL &
l2..-\ %-07
~
EL
PARK MODEL PLUMBING
PARK MODEL SET-UP
PARK MODEL ELECTRIC
REINSPECDON 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 1'ound 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."
~J.
CONTRACT SIGNATURE PERMIT OFF I
PE MIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
tfl,j- (VV-VVLV
\....lIlY UI L-C;pIIYIIIIII~ . ""I II In. I '''''''''''11_-'''_1'
Building Department
I
I
I
Loo LOT# I /0'Z I
PARCELlD#12L/-2Co -21 -00 30-()O()OO~ I
(OBTAINED FROM PROPERTY TAX NOTICE) \ (p "2-0
o SIGN D MOVE D DEMOLISH
[2J
o
Date Received
11111111111
Owner's Name
JOB ADDRESS
Owner Phone Number -7 ~3 ,)t./ 7 7
Owner Phone Number I
Owner Phone Number I
Fee Simple Titleholder Address
Et
PROPOSED USE 0
TYPE OF CONSTRUCTION 0
0o./,{ fY7oc1e~
BUILDING SIZE /3 '13 8sQ FOOTAGE I HEIGHT I
11111111111"111111111111111111111111111111111"'11111111111......11..1..1.11..'1.11....1..............111111111.1111.1111111..111111..11111111111
1$ /5,000,GO
1$ 500,00
1$ 2);0. 0 (,
1$ 7S0. 0,')
D
FINISHED FLOOR ELEVATIONS I
I
I
I
I VALUATION OF MECHANICAL INSTALLATION s\ ~
. P:J~ / rJCf'(\1l-
D SPECIALTY 0 OTHER Po (00 c.- /
I FLOOD ZONE AREA DYES QNo
SUBDIVISION
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
ADD/ALT
REPAIR
COMM
FRAME
D
ElUILDING
D
D
D
D
AMP SERVICE 150
VALUATION OF TOTAL CONSTRUCTION
cz6
WR.E.C
ELECTRICAL
PLUMBING
MECHANICAL
GAS
ROOFING
III t I .. I " I
BUILDER
SIGNA TUHE
Addmss
ELECTRICIAN
SIGNATUHE
Addmss
PLUMBER:
SIGNATURE
Addmss
MECHANIGAL
SIGNATURE
COMPANY
REGISTERED
Addn~ss
OTHER
SIGNATURE
COMPANY
REGISTERED
PROGRESS ENERGY D
Ct7YVY" - O~
'T\~ - D~
(20L - ../
18u-f-fe/1feJ d fI HS
I Y / N I FEE CURRENT . I Y / N I
License # 1/11 0 600 () fO
1,8u-f1e/ f,t.rd uo.l1c!e/ /
1 Y / N J FEE CURRENT I Y / N I
License # I {; R 60/2 q /0
16u-f-le r-[e.Jd fIJ /"1\
I Y / N I FEE CURRENT --==r Y / N I
License # IIJ-!()OOOO ~O
I ~tthr 'J
Y / N I
FEE CURRENT I Y / N I
License # I tA CO Lf3 9tj~
Y / N
Y/N
FEE CURRENT
Addn~ss License #
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111111111111111
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 (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 w/ 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.
111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111II1111 i 11I111II1I111111I11111
Directions,:
Fill out application completely_
Owner & Contractor sign back of application, notarized
If ove!r $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 Ale 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 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 buiidings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco CoLinty 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, vVetlandAreas 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 isslled 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCiNG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOVR NOTICE OF COMMENCEMENT,
FLORIDA JURAT (F.S. 117.03)
. CONTRACTOR~
s...v1scriPed and sworn to or ~rmed) ~r~ q this
'1 2-IID7 by--r:er1 lA-t'"fu ,~
Who Is/~ known to me or haslhave produced
as Identification.
- ,
~'6"""" ~~" \t.
Notary Public
~<l-""",,,
'-~~
Notary Public
Commission No.
l~~~Karen L. Mille
Name of Nota - t. , DD609664
~~~~.~ .res October 29 2010
Ir". ........ TtQ)' Fa.. '1MUr .
_a. Ine 800-385-7019
Commission No.
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-'~~----
REVIEW DATE '1-)-./ rO/
CITY OF ZEPHYRHILLS -
PLANS EXAMINER r. ~
7:;'
Ittri
ALL WORK SHALL COMPLY WIEIALL
PREVAILING CODES, FLORIDA BUILDIF3
CODE, NATIONAL ELECTRIC CODE AN'~'
Cf:Y OF ZEPHYRHILLS ORDINANCES
State of
Flor-I dill-
NOTICE OF COMMENCEMENT
f CA.5;,co
County of
111111111111 1111I 11m 11111 1111I111111111I111111111111111111
2007158752
Rcpt : 1130527 Rec: 10.00
DS: 0.00 IT: 0.00
09/21/07 Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement:
/1. Description of Property: parceINo.2'1- 2Co"21-eJo3Q-QO(XJO - /'-/~O
3973(0 Go I-I,JI Loo .2 L f ,Ils L /01.:11 b2
(Legal desaiption of the pro and street ~,si.lf ilabl'PJ' 2 .s Cl<.~ - r Cu'l a ~ 2., e C>.. ~+ I'Y. ~l C Ou +1.
0... S5~ssed ("1 S ~(!t,on ZLf iTO J~.7S "IJ il"ll J ~ I r--- 0 . "'f~ CN"' 40<-
-- 2. General Description of Improvement fJ10v f.nO/J7e Da/t...rYJ6deJ <;ei'!..t()
, I
~g92~J~~~:sr~C01COUNT~CLERK
OR BK 7631 PGoi553
--- 3.
Owner Information: Name N tI c..- F L 1/5 I LL C
fOqq/ E. c'a.rndha.J:... f:. d ~31D .sCo ttscJ.~ l.t-
Address City
f}2 gSZ51
Stale
Interest in Property:
Name of Fee Simple Titleholder:
(If other than owner)
R
Address
Contractor: Name
5"/31 Clo I
Address
Slate
fl~3~l.J2
Stale
5. Surety: Name
Address
City
Stale
Amount of Bond: $
6. Lender: Name
City
State
Address
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by Section 713.13(1)(a)(7), Florida Statutes:
Name
City
Stale
Address
8.
In addition to himself, Owner designates
of
Notice as provided in Section 713.13(1)(b), Florida Statutes.
to receive a copy of the Uenor's
9. Expiration date of Notice of Commencement is one year from the date of recording unless a different date is
specified.
.-~..--
_/:~hn/a
L/';<c/ t. ~c/ /
9/20/0-;
Date '
~/!. P;:/J'/]/;.
Signliturli of "/V
STATE OF FLORIDA //0 j {O
COUNTY OF
CJ /20/ {)7
Seal:
))"\,L-
~.,.y I>tt.t TONI-uulDT NOTA Y
~ ....... ~" \1\IflIII
*.~ * MYCOMMISSION#DD616391
~~,.. EXPIRES: November 20,2010
.,~~ OF F\.O~'" Bonded Thru Budget Notary SeMca&
dv/pc05304B
State of
Flol-' d~
NOTICE OF COMMENCEMENT
County of f elSe 0
1/111/11/1/111/111111111111111111/11111111111111111111111111
2007158752
Rcpl : 1130527 Rec: 10.00
os: 0. 00 IT: 0. 00
09/21/07 Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement:
/1. Description of Property: ParceINo.2L/- 2(0"2/ -0030-00c.'Oo" 1'-/00
3973(0 Go I-It!/ Loo 2. 1L r' ,-115.L /01.:11 02
(Legal de.scription of the pro ..andSlreetacjcjre~if ailabl'll.. 2 SCl<.t{.. ,Cu11:l.e- 2/ eC<.~+ fY'.<. Ifl
O..:S5es:sed r'1"'/ S e'.C!.tron 2'1 J-,u '(]SYlj 11 J.. , ,~".;>( 0 COU....I-fJ 11ov; do<-
- 2. General Description of Improvement fJ1(JbJ /.e. nOme DCi/ J.jyJud tIs f f -cu)
{ I .
~~92~~~~~~:~A.SC01CO~~Tl CLERK
OR BK 76311' PG 1553
-- 3.
Owner Information: Name N H C-- F L 1/5 I LL C
0GJq/ E. f:A:'A..me.lha.J:.. ~ d.. S~3/D :SCo i-fsclc,; k
Address City
192 fJS2-5/
State
Interest in Property:
Name of Fee Simple Titleholder:
(If other than owner)
R
.~Gd
'2eDhc1 y h, llJ
City , V
f133tl/2
Stale
Address
Contractor: Name ~
5/31 C~ II
Address
State
5. Surety: Name
Address
City
State
Amount of Bond: $
6. Lender: Name
Address
City
State
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by Section 713.13(1)(a)(7), Florida Statutes:
Name
Address
State
City
8.
In addition to himself, Owner designates
of
Notice as provided in Section 713.13(1)(b), Florida Statutes.
to receive a copy of the Lienor's
9. Expiration date of Notice of Commencement is one year from the date of recording unless a different date is
specified.
..-~~.......'......,,-
~/)
/ .
--:I'" ~ "-;1 ./ /"
.,b;/'L/Z/.,;:,?(
STATE OF FLORIDA
COUNTY OF
//0 s ( 0
9 /20/0 '''1
Date .
The foregoing instrument was ackIJowledged before me the
--re y-rL fCtr (" (J {/ .
L'.L:
(date), by
(name of person acknowledging), who is personally
'_ '.J:;~ p~ O~idrr~liOn) ;;IS identification.
Ie, . .. fur
~.,.y PII.2 NOTA Y
+0 ..... ~0 TONI SCHMIDT
,..~. . * MY COMMISSION' DO 616391
'" EXPIRES: November 20, 2010
~"tOFF~O<f;'>" Bonded Thru Budg81 NolaIy S'Mca
9/20/07
known to me or who has produced
Seal:
dv/pc053048
09/24/2007 08:08
8137831374
BAHR'S PROPANE GAS
PAGE 01/03
.
.
}'
'Bahr's Propaqe ct AC,
~:813-782-S013
Fax: 813-713';1374
'.
.
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To:
flam:
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"'.~<<~"-'.~~, ,~ .h~ ~. -""~~~.1:"~~:;'~'T~"'''_G'~, ....~~'"
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09/:24/2007
08:08
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8137831374
BAHR'S PROPANE GAS
PAGE
02/03
-~~
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09/24/2007 08:08
8137831374
BAHR'S PROPANE GAS
PAGE 03/03
ACORD CERTIFICATE OF LIABILITY INSURANCE f I DA.TE (MMIDomYv)
--,., 0812212OO7
PRODUCER THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATfON
Jamerson McLean Corporalfon ONLY AND CONFERS NO RIGtrTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 621149 ALTER THE COVERAGE AFFORDED BY THE POUClES BELOW.
125 Executive DrIve
~~.~L 32782 .' INSURERS AFFORDING COVERAGE NAJCtI
INSURED Bahl1l Propane Gas & Air Condltfonlng, Inc.. INSURER Ie UNITED STATES FIRE IN~URANCE CO, 21113
4441 Allen Road INSURER B: Zenith In,.,rance Companv 00984
INSURER C:
Zephyrhllls FL 33541. INSURER D:
INSURER E:
COVERAGeS
THE POlIOIES OF INSUAANCE LISTED BELOW I4AVE BEEN ISSUED TO THE INSURED NAMED ABOve FOR THE POucY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIReMENT. TERM. OR CONDmON OF ~y CONmACT OR OTHER DOCUMENT WITH RESPECT TO INHICH THIS CERTIACATE MAy BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO All THE TERMS. EXCLUSIONs AND CONOmONS OF SUCH
POLICIES. AGGREGATE UMITS SHOVVN MAY HAVE BEEN REDUCED BY PAlD CLAIMS.
_ POUCY~ER POUCYBFFeCl1VE POlJCY~TlON UMITS
~ LlAIlJuTy EACH OCCURRENCE .1,000.000
A X COMMeRCIAL GENERAl LIABILITY 506-863612-8 09/01/2007 09/0112008 2~~;ro REffl'EO .100.000
- -1 ClAIMS MADE fKJ OCCUR MED EXP (Anv 0119 1IIlIWVl\ $ 5,000 . ..
PeRSONAl & ADV INJURY $ 1 000,000
GENERALAGGftE~Te . 2.000,000
.giAG~nUMrr Al'MPER: PROIlUM'C:: - COMPIOP AGG S 2,000,000
POUCY ':..Rg: lOC
..!!1:roM08IlE lIA8IUlY COMBINeo SINGlE UMrr $1,000,000
A ~. ANY AlITO 506-863612-8 01/01/2007 09/0112008 (ea 1tCDdIInI)
r-- All OWNED AUTOS BODIL y IN.t\J~
$
SCHEDULED AUTOS ~ (Pl!I' pat$On)
rx HIftB) AlITOS BOOIL Y INJURY
-'-'- $
~ HON-OWNEo AUTOS (PeIr"""""",)
~ COMP OED $1,000 ~OPER1Y DAMAGe
X COLL DED $ 2.000 (Per 8Cddetlij $
qAAGE UUftJTY AUTO ONLY - ~ACCIDENT $
ANY AUTO OTHeR THAN EAACC Is
AlITO ONLY: A.GG .
EXCESStuII8REI.W\ LIA8IUTY EACH OCCURRENCE $
~:J'oecUR 0 CLAIMS MADE AGGREGI\TE $
S
R ,IPEOUCTl8LE .
RETENTlON $ $
.WORICelw COMPENSATION AND we STATU-, I 10J:-
B EMPLOYER$" LlA8ILnY Z'3&554805 0511112007 0511112001 $ 100,000
ANY PI<<lPR/ETOAIP~'tNeRIEXeClIT1VI< E.L ~ACCIDENT
OFFICERlMEMBER EXCLUDED? E.L OISEAS~. EA ~0YEf I s 100,000
~~,~~
s SroNS ...._ E.L OISEASE - POLICY UMIT $ 500,000
OTNER
0ESalIPTl0N OF OPIiRATIONe, LOCATlON$' WHlCLES I elCCI.U$IONS ADDED In' ENDORSEMENT' J SPECIAl PROVISIONS
CERTIFICATE HOLDER
City of Zophyhlll5
CANCELLATION
SHOUlD AI<< OFTNEA.8OVE DelICRlBEDPOI.ICIEsBli CANCELLeD 8I!FORETHEEXPtRA'nON
DATl! THEREoF, TNE ISSUING INSURER WIU. ENO&AVOR TO MAL ~ DAYS WR/T'n;N
NOTICE TO THe CER11FJcAn fIOLDEfl NAMED TO TttE lEFT. BUT FAILURE TO 00 $0 8HAu.
IMPOSE NO 08UGA.TlON Ok UAIIltJTY OF /4H'( lOND UJION ntE INSU~ ~ AGIltml OR
REPRESENTATIVES.
AUTNOllIIil:eD REPIU!leHTAl1YE
-
FAX. 813-7811-0021
'CORD 25 (2001(08)
.. ._...._~ ..:~.~..___ ._.._"w... _..~~_.~._....~~..._.~_...~_...__._~.. ....... :.
-
fJV
City of Zephyr bills .
BUllDING PLAN REVIEW CO:tvnvIENTS
'Contractor/Homeowner:
~~d).
Date Recdved:
. ,
1
. .
~-2-l-07. .
:3Q'73f () {J C>~ l-\-,' t LIp ..\!- I~.z...
()().Ak:- vn cd, e...\
Site:
. Jlemrit Type:
ApProv~ wino cOOm.cots:D Appro~erl~1the below cmmnents: p Demerl ~Ithe below =cots: ..... D.
./9//
-r~1 C
.11c:> />2-/2 -ry . d1/t~/QE~\J?Z'
& p;= . . ~.RE'C'_:rZ-:-~~
~
_. Tbis C07.t ~e . sha? be kept: with~ep~t and/or plans. .
. ( . . .. ?pJ/.tTj ~.~
Date . .. ContractorROrll Homeowner .
. . (RequiTed when comments are presemt)