HomeMy WebLinkAbout08-7908
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7908
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:
7908
RE-ROOF
ROOF REPLACEMENT
NOT APPLICABLE
Address: 38750 H NRY DR
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot{s): Block: Section:
Subdivision: PARK HILL
Parcel Number: 02-26-21-0180-00000-0150
7,000.00
5/29/2008
65.00
65.00
5/29/2008 Phone:
REROOF 25 YR GAF ROYAL SOVERIGN
GALLUP,
38750 HENRY DR
ZEPHYRHILLS, FL. 33542
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IN
TAPE JOINTS ROOF INSP
FINAL
REINSPEcnON 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 pennits 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."
/ /. h---. 0:> __~u
~;. '..---c./-ry~
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Proposal/Contract
SC6tt ~~ 1i:~, 11tC.
P.O. Box 1188
33010 SR 52
San Antonio, FL 33576
(352) 588-ROOF (7663) · (813) 782-1330
Fax (352) 588-9763
email: blackmanroofing@aot.com
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'1",4-lelf,ett
Date j /If'/v V'
- /
PROPOSAL SUBMITTED TO
WORKED TO BE PERFORMED AT
Name (V, q V" II c" / ( v .<,
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Street 3 ~' 7 ~u Flu. / .'/
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Street/ /I..,{)f,b~'\.; ;,; ,I "",;I...
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City~S/~'Yf..,'l- 1)5'<;' i
City 2,L'j) Hj" \., ,'\ I)
State \- I Zip J 3 5 L/ J....
Phone Number 7 &' 2-- 2-S to .3 Fax
State
Zip
Owner of Property
Phone Number
Fax
We h~reby propose to furnish all the materials and perform alUhe labor necessary for the completion of:
crR~move existing shingle roof ~;;;Iace bad fascia boards at $ 2, 0 U per foot
o Remove existing built-up roof ~tall 8' U feet of ridge vents
O'6ry~in with 0 151b.EJ30 lb. rftP fHl'c 0 Install modified bitimen (granulated) torch down roofing
~'(""i Hi)
al~~tall new galvanized valley metal blagk;white or other color
c:flnstaU new lead boots a1nstall 25 yr. fungus resistant 3-tab shingles
OO'."?
cr(~~!all new exhaust ven~ 0 Install 30 yr, tung us resistant dimensionai shingles J I ~ I
Er(r;stall new drip edge, 'J In t./'/U {.< color 0 Sh~ manufacturer b II: F color b()lden~r
o Install new flashing as needed ~tall TPO, white rubberized roofing membrane" " -I } (.'f-"
Q-Replace plywood at $ -') s--- <' v' U per sheet 0Uther::' n,j-:;J/ ('. C) irt:. I /i (i" j.. \ ..' /" I. G Vi
0'1'le'pair rotten trusses at $ 2," v per foot v h1- \, t ( 'A. -( h " 'j 'c. ( J..) IT Iii .1 J
"'Woodwork is an additional charge, see pricing above J=f C",v "".'0.' ~ J \.-... L-~ ~).\:: \(
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(/v-l.C i I.,.........., 't,'/,<'<,,,,,-, 1~I/h);'1t..:..il~>t',{ ,; _ .
All material is guaranteed to be as specified, and the above work is to be performed is accordance Wit~ t.~e ~r~wi.~9,S~ specifica-
tions submitted for above work and completed in a substantial workmanlike manner for the sum of $ 5 if D 1-'. (. \.: I." 0 0
~
with payments to be made as follows. Payment due in full on completion, unless otherwise noted. Thank You.
Credit cards accepted, additional 2.8% charge.
Any alteration or deviation from above specifications involving extra costs will
be executed only upon written orders, and will become an extra charge over and
above the estimate. All agreements contingent upon strikes. accidents or delays
beyond our control. Owner to carry fire, tornado and other necessary insurance
upon above work. Workers' Compensation and Public liability insurance an above
work to be taken out by Roofing Contractor.
Client gives permission to drive on driveway to deliver materials.
/5; C~/-L>ry~_._
Officer/Agent Scott Blackman Roofing
Note: This p,rjOSal may be withdrawn by us if not accepted
within days.
","
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as
specified. I have read the back of this Proposal/Contract, which contains Florida Statues 713.001-713.37. Payment will be made as
outlinedagove. to (tI~
Acceptei' 7(l()~oOrJVP~ Signature ?:}h7 rT-_d~__,
Date r.....- 14--- tJ f1 Signature _~ ___
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Date Received
Owner's Name A. V' \A.
Owner's Address I 3 f) 7 rv fit n VV1 {J r
Fee Simple Titleholder Namel
JOB ADDRESS
Fee Simple Titleholder Address I
Is r 7.5l) !-ft-t\ vy jJ(
IPA ~k H-\'\ \
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
BLOCK
"2-( P J,. '? (1-1,' II J f-I
I PARCELlD#I02...-U-1..)-OI~ - 00000 -0/0
(OBTAINED FROM PROPERTY TAX NOTICE)
E3 ADD/AL T D SIGN D MOVE D
REPAIR
D COMM D
D FRAME D
LOT #
SUBDIVISION
DESCRIPTION OF WORK
B
D
D
t Yoo(
DEMOLISH
BUILDING SIZE
OTHER
STEEL
PROPOSED USE
TYPE OF CONSTRUCTION
OTHER I
1$ 70VO,OO
1$
1$
1$
o GAS ~ ROOFING
FINISHED FLOOR ELEVATIONS I
I
I
I
I
D
I
AMP SERVICE
D
PROGRESS ENERGY
o
W.R.E,C,
0 BUILDING
0 ELECTRICAL
D PLUMBING
D MECHANICAL
VALUATION OF TOTAL CONSTRUCTION
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY D OTHER
FLOOD ZONE AREA DYES
ONO
11'.111....'.....",,'.."'11'11..111'..111'...1111'1111........11..1111....111'......111'11.'1"'..""'.....111"'1""".""11"11'11111111111
BUILDER
SIGNATURE
COMPANY
REGISTERED
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
Y/N
Address
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
Address
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
License # I
IS~t!fC~~::T I Y/N I
) ~ License # let COr) 7' s- ')
Address
OTHER
SIGNATURE
Address
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111111111111111111111111111
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) complete sets of Building Plans plus a Life Safety Page; (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.
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 j
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 (PloUSurvey/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" rel?triction~"
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 accord~nce 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 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 offill 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 ~nstallations not specifically in?luded. in the application. A
permit issued shall be construed to be a license to proce~d With the work a~d not as authorl~y ~o vlolat~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~II~1n9 OffiCial from the~eaft~r
requiring a correction of errors in plans, c~n~truction or violat~o~s o~ any codes. Every ~ermlt Issued. shall become. invalid
unless the work authorized by such permit IS commenced Within SIX months of permit Issu~nce, 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 mnety (90) consecutive days, the)ob 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 NOTICE OF COMMENCEMENT,
FLORIDAJURAT(F.S.117,~ L ~ _ ./f ~
OWNER OR AGENT ~ CONTRACTOR/~~
Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) before me this
by by
Who is/are personally known to me or has/have produced Who Is/are personally known to me or has/have produced
as identification. as Identification,
Notary Public
Notary Public
Commission No,
Commission No.
Name of Notary typed. printed or stamped
Name of Notary typed, printed or stamped
STATE OF FLORIDA
. COUNTY OF PASCO FOREGOING IS A
THIS IS TO CERTIFY THAT T~6cUMENT ON FILE
TRUE AND CORREC6~gPI~ ~~i~~FFI~' ITNESS MY
OR OF PUBLIC REC THIS DAY OF
HAND m OFFICIAL SEAL 200-
~~~ITC~
JED D CLERK
BY ,
NOTICE OF COMMENCEMENT
II11II1 1111111///1111111111111111111111111111111111111111111
2008079746
Rcpl: 1183164 Rec: 10.00
DS: 0.00 IT: 0.00
OS/29/08u_,_,~____ Dpty Clerk
JED PITTMAN, PASCO COUNTY CLERK
OS/29/08 08: 41am 1 of 1
OR BK 7847 PG 523
Permit No.
Property Identification No. n 2.. -1... t:. ...;. "Ll- 0 i ~ {) ~ 00000 - () i 5 U
THE UNDERSIGNED hereby give infonns you that the improvement will be made to certain real property, and in accordance with
Section 713,13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
l.Description of property (lega! description:J(iLf kN,II .svb U", f I f6/1 Pb 70 LoT 11:)" S" 33 P(:"/O/Y
a) Street Address: 3SS7~O ~eh"'~ D.,- 2.<.pJ",,'~/llj F... ~3SYz...
2,General description ofimprovements:,~ ~. t'v,}"" tv) r, Is- u:;:; '" (-! hi 3 --/-<(..1.
; , ,
3.0wner Information M c;;... '1'- '.1
a) Name and address: l'/eW.,'t .3 J 7:> () I/c,w
b) Name and address of fee s mple titleholder (if other than owner
R'~'\ c) Interest in property 0 I.v (\ e v
Contractor Information '. , .
a)Nameandaddress:S(~~ CItM 001. /I 1]()/1J.J1!..$2.. At,
b) Telephone No.: 5 - Fax No. (Opt.)
5.Surety Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6,Lender
a) Name and address:
Phone No.
7, Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No,: Fax No. (Opt.)
8.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)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is
specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT,
STATE OF FLORIDA
COUNTY OF PASCO
-~~~
,/ Si~t~re of Owner or,o;mer's Authorized Officer/DirectorlParlnerlManager
<JlOtt /j/&1La~k~~
Prin'N... \!.
The fo,egoing imtrnment w", ac"""wle~d 'iffm "':' 4h* day of (Yla.!t ' 20/JL by ( 'CtJttt/u, ~fL.
as \. 'ti f I t2-L j,- e of authonty, e.g. officer, trustee, attorney
in fact) for f:r) CI /r!:J f!1 t:L.I i (:l (name of party on behalf ofw om ins~ent was executed).
Personally Known --;kC.OR Produced Identification ~ Notary Signature ~ ~
/J e t1 (lj h
Name (print) Or {. an t1
Type of Identification Produced
Verification pursuant to Section 92.525, Florida Statutes. Under penalties ofpeIjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
~~/
--- Signature of Natural Person Signing Above
FORMSINOC,rvsd2007
~t."'~"""'" CORI ANN KEOUGH
Im~ Nol8ty PubIc - SIIII 01 FIarIdII
:. . CclnIn*'bIErpbsAug '7.31'0
\If ~, DO 586503
.,Yr... Bonded By NdonII AIaa.
Pasco County Parcel: 02-26-21-0180-00000-0150001
Page 1 of2
Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions
other Agency Data: Tax Collector School Board Supervisor of Elections
Data Current as Of: Weekly Archive - Saturday, May 24, 2008
ParcelID 02-26-21-0180-00000-0150 (Card: 001 of 001)
Classification 01 - Single Family
Mailing Address Assessment (totals)
GALLUP EVERETI K & MARY L Ag Land $0
LIVING TRUST Land $37,271
GALLUP MARY L TRUSTEE Building $112,733
38750 HENRY DR
ZEPHYRHILLS, FL 335422681 Extra Features $1,163
Physical Address Total Assessment $151,167
38750 HENRY DR Save Our Homes $83,466
ZEPHYRHILLS, FL 33542-2681 Homestead Exemption - $25,000
Legal Description (First 4 Lines) Taxable Value $57,966
PARK HILL SUB UNIT 1 PB 14 PG Warning: A significant taxable value increase
70 LOT 15 may occur when sold. Click here for details
OR 5633 PG 1018 and info. regarding the posting of exemptions,
Land~ro: 0Ol~
I Line I~ Description Zon its Price ~n I Value* I
I 1 I 0100 SFR 00R2 7 930.00 SF $4.70 . I $37,271 I
Additional Land Information
~cres II 0.18 I Tax Area II 30ZH II FEMA Code II X IIResidential Codell PAHILP1 I
Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1978 Stories 1.0
Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Carpet Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
AIC Central Baths 2.0
I Line Description : Sq. Feet I Repl, Cost New
1 BAS 1,640 $123,541
2 FOP : 24 $452
3 FEA 112 $5,876
4 FCA I 196 $3,691
5 UGR 528 $11,902
Extra Features (Card: 001 of 001)
I Line I Description Year Units Value
I 1 I DWC I 1986 I 1,068 $988
2 UDU-M 1988 1 $175
Sales History
Previous Owner GALLUP MARY L
Year Month Book/Page Type Amount
2003 11 5633 / 1018 QC $0
1992 01 2087 / 0703 WD $59,000
1985 I 09 I 1444 / 0538 WD $56,500
http://appraiser.pascogov .comlsearchlparce1.aspx?sec=02&twn=26&mg=21 &sbb=O 180&b... 5/29/2008
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JURISDICTION OF YOUR CHOICE
BUILDING DEPARTMENT
HE: Permit # 2'l..lJK..___
'1117107
Inspection Affidavit
I .2~.Rl,It-.J)L4..~k 1"1.4 t"
IT"e=J~(~ )'Win. "lime and circle Lie. Type)
,_ ,licensed as a(n) Contrllctor"/Engineer/Architect,
FS 468 Building Inspector"
Lice"St~ #; {'CLO~7 C, 5 1
On or ahout.. h/ /3/, t?Y
(1)"le &. lime)
C;;;:;:;;li.ml..1Ln~r se~()ndarv waleI' barr.!~work at ,3g.J~.lic.~n( L/..p,(,
t CfC' rm. (Job Sile AdcJres.~) ;1-
2 eph1-[h, / (( ,-fL--. 'u__....,________,__.. _.. __., .._..
Based upon that examination I have determined the installation was done according to the
)Iurricant.' Mitigation Retrofit Manual (Based On 553,844 F.S.)
, I did personally inspect the ~!1[
~~-
Si,~"Atllrc
STATE OF FLOR.IDA
C()lINTY OF
",worn to a~d subscribed berore me thisL3._day of .Jld1L_,_...__. 2003
li:-- 0~~tF (0(Q.c.k ~"_'
N~li~' State of Florid~ ,
Pr ~-.."k~
( int, type or stamp name) - -./--
Personally knownL or
Produced IdentifieatiOtl
IYPe- ofidentil1cation produced"_n
Commission No,:
-..---- ----'.--.--.
~. (;cnc!"'JI, Kuildinl:l. fC.esid.enbll, or RCX1fing Conltactor c~r ~y indiVidual ccnitied under 46R F.S. (I,) rnk~e ,udl all
ln~"e~llon. In~lude fJ~lo8mph., o(eacb p~nc nfLhc: mo1 wnh Ute permit II ur addr'eh ~ clearly 5hcM'n mlJlkcd olllhe
:It'('k for each ,"~Cllon.
.~- COIII_ KEOlJOH
'" "*Y PulIIc . s.. III FIadiII
-. . c-.lIIIonEJ,noAllg 17.21110
· . CenInIIIolon , 110 _
· ........ Iy "- NIllIIy __.