HomeMy WebLinkAbout07-7072
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7072
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:
7072
SLAB PERMIT
SLAB
COMMERCIAL
Address: 4330 20TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: N/A
Parcel Number: 13-26-21-0070-07400-0000
200,000.00
10/03/2007
780.00
780.00
10/03/2007 Phone:
FOUNDATIONS, TILE PANELS-EXISTING IMPERVIOUS
Name: P HILL ORP.
Address: 777 W. PUTNAM AVE
GREENWICH, CT 068305091
SLAB
FINAL
FRAME
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."
~
CONTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
-
813-780-D020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-D021
~"7
Owner's Name
Owner PhDne Number
Owner PhDne Number I
Owner PhDne Number I
Date Received
Fee Simple TItlehDlder Address I
4330 2oTI-J 51 ~~A7I-1ILLf"lrtoT#
PARCEL 10# I f3
JOB ADDRESS
12Ef'JH Y~HIL.LS A./VT
I I
B
CJ
CJ
SUBDIVISION
PROPOSED USE
"TYPE OF CONSTRUCTION
ADDIAL T
REPAIR
COMM
FRAME
-26- Z/-cc7t.? - 07'-/00
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN 0 MOVE 0
._ cLcC.'o>Q
WORK PROPOSED
B
o
o
NEW CONSTR
INSTALL
SFR
BLOCK
o
o
o
DEMOLISH
OTHER
STEEL
I
o
OTHER I
I
I
IEx/sTIP? 1A/l~6 vIOc,....$
BUILDING SIZE
I~,,-
[jA/t?/i'Tlo~ 7/'-/ /!1,4-'.€'LS A-II~, t.--u~1<
I~H SQFQOTAGE /{.;,csO t lna~ HEIGHT I
A-
VALUATION OF TOTAL CONSTRUCTION
DESCRIPTION OF WORK
o
BUILDING
1$ ~~.J~
ROOFING
I
I
I
I
CJ
I
AMP SERVICE
D
PROGRESS ENERGY
o
12tc.L.& h-
i-'=: ~
~
o ELECTRICAL 1$
o PLUMBING 1$
o MECHANICAL 1$
D GAS 0
FINISHED FLOOR ELEVATIONS I
WRE.C.
VALUATION OF MECHANICAL INSTALLATION
SPECIALTY 0
FLOOD ZONE AREA
OTHER
DYES
ONO
'1~.:;)'U BUILDER I ---=. '-~2 I I
/"U/v SIGNATURE ~6 ~ ) ;::.~~:e~ !jl~ FEE CURRENT Ui!:U
Addrese 1111 t<fVE::~S/Oc .-1//t=;.. )JK/<:~A1v/peJA.. 32.)02- License# IcG::::. L:D337S-1
ELECTRICIAN II COMPANY I I
SIGNATURE . . REGISTERED l.....:!:.!...! FEE CURRENT Ui!:U
Address I License # .~ ~ c.-L/ ~::::> -'=>/
PLUMBER I COMPANY I
SIGNATURE . REGISTERED l.....:!:.!...! FEE CURRENT Ui!:U
I License # I
I
I
I
I
Address
MECHANICAL I
SIGNATURE .
Addr... I
OTHER I
SIGNATURE
Addl'llllll I
COMPANY
REGISTERED
l.....:!:.!...!
FEE CURRENT
Ui!:U
License #
COMPANY
REGISTERED
l.....:!:.!...!
FEE CURRENT
Ui!:U
License #
RESIDENTIAL
Attach (2) PIDt Plans; (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans. Sanitary Facilities & 1 dumpster
Attach (3) sets of Building Plans; (1) set of Energy Forms.
Minimum ten (10) working days after submittal date. Required onsite, ConstructiDn Pians, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance.
Attach (2) sets of Engineered Plans.
'-PROPERTY SURVEY required fDr all NEW construction.
COMMERCIAL
SIGN PERMIT
Directions:
Fill out application completely.
Owner & ContraCtDr sign back of applicatlDn. notarized
If over $2500, a Notice of Commencement Is required. (AlC upgredH over $5000)
Agent (for the contractDr) or Power of Attomey (for the owner) wDuld be someone with nDtarized letter fram Dwner authorizing same
OVER THE COUNTER PERMITTING (Front Df Application Only)
ReroDfs Sewers Service Upgrades AlC
Fences (PloUSurveyIFoDtage)
Driveweys-NDt over Counter if Dn 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 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 govemment 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, WaterlWastewater 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 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 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 lWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER ORAN ATTORN FORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F. .117.0
Notary Public
Notary Public
J.\.
Name of Notary typed, pr1ed or stamped
G).. NlYMlCHELEHOGE
: : MY COMMISSION I DO 389241
EXPIRES: February 26, 2Oll9
:. . Bonded Thru NotIuy NlIc ~
\~~~~
IWA.: ~~
. . . :
. . i
.ji,;dl
NIY MKHI.E HOGE
MY COMMISSION' DO 389241
EXPIRES: February 26, 2OQ9
Bonded Thru Notary PubIc iJnderMoIIen
- ----------'-----------.---- - NOTICE OF'COMMENCEMENT..
ZEPHYRHILLS COLONY COMPANY LANDS PB 1 PG 55 TRACTS 73,74,
87 & 88 EXC THE WEST 10 FT OF TRACTS 73 & 88
. Permit No. OR 4499 PG 1327
Property Identification No. 13> - ZG-;( I - eX;;"? O. -- 0"/ '-j oG1 ';.... c.(::x::x::..) .
. TIm UNDERSIGNED hereby give' informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the. Florida Statutes, the following informationis provided in this NOnCE. O~COMMENCEMENT;
l.Description of property (legal description:). ):3 ~ 2 G :-2/ ~cx:J 70 -- O?,-!oC:> -OCX:.:>C)
a) Street Address: ~A.d,h,'/Is,.. /A.:.vt-!- Y33~'2C>7H:s.7.: ?"'~hy"h://S rL. 5~.S</O
2.General description of improvements: r=C>'-'nc~~'- f;'-'Y):S../ 7:'/~ ~Y>c:7/ "-'C>Y'> ci ~,...."'o:::. h-~..&-o) 47.......) /,)..~
777 W. /V--I'/'7c\.m /IvE'. ,
6rE'01I/V(ch., c:::..,r L'6830.
~
3 . Owner Information . .. . .
a) Name and address: :Ale7l/e /../iJ... f~l's . 4Sr JI.,/fWle/-/-co..
b) Name and address offee. simple titleholder (if other than owner)
c) Interest in property
R4:c~ntra~;o~:~:~~es's1k Io.-skllt:o It kt'v r~~ dvp ~e-~c/C~nv/lie rL 3220Z-
b) Telephone No.: 1t.-'l..f - 3)7 -yetIs Fax No. (Opt.) ""',.-'-/7 .-?8YS;-: .
Q-5.Sure1y ~:::f='" . 44 .. "'ll!~"IIIIIIIIII"IIII"I"IIII""I""1
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
Rcpl: 1131930 Rec: 10.00
DS: 0.00 IT: 0.00
Phone No. 09/27/07 Dpty Clerk
7. Identity of person within the State of Florida desi~ted by owner upon whom notices or other documents may be served:
.. a) Name and addiess: tf2..1 eA ' . ~, .~~. ... ...... . .. . . ... .,
. b) Telephone No.: g, l'3 - 753 '- q .. ~.. . Fax No. (Opt.) 6/3. - 7g-z - )J~
8.In addition to hiinself, owner designates the following person to receive a copy of the ~ienor'sNotice' as provided in: Section
713.13(1~r~~~r:=:~ . ~n1 III ):{/U2f'-s/dQ ../ke. 5~.*5cnv,/le ~L ~:S22c72_
.b) Telephone No.: i?o't - '$5?- yq I ~ ,Fax No. (Opt.) _ '90<(":'" Y7 5"'- ;;(3 SI S-
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording. unless a di:ffei'ent date is
specified): . . .
A//f-
WARNING TO OWNER: ANY.PAYMENTS MADE BY THE OWNERAFfER 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 PAYIJ.'otG TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECI:ION.IF YOU INTEND TO OBTAIN FINANCING, CONSULT youR. LENDER OR AN ATTORNEY BEFORE
COMMENCING WO~ OR RECORDING YOuR NOTICE OF COMMENCEMENT~ . .
STATE OF FLORIDA n _ / " ~~
COUNTY OF PASCO ...v~ ~
JED PITTMAN PASCO COUNTY CLERK Signature of ~CJ'or Own 1..,Au liiized OfficcrlDircctorlPartncrlManagcr
09/27/07 11 : 29am 1 of 1 ,,~t1Lt:.. A. 6J BJfV . . ..
OR BK 7645 PG 245 Pnnt ame: ... .! . .
. The foregoing instrument was ack:nowl. ed before me this;;) 7 day Of& ~r)+eiY'\ 'o~~-. 20~ by~~ A \Sib b~ (
,- . as · . \ . (type or a~ority, e.g. officer, trustee, attorney j
fu fact) fur . .. oc 41"0.,, ofportyonbebalf of.!!!>"", ~ot.:"'.....~. '
P"",onally Known X OR lroducod Ideotification~. Notmy Si~,",:_~
T . .. Name (print)Am'-j 0:\, e ~QJf> ~ e
i*i MYCOMMISSION'DD389241~. "- _ ~
\ EXPIRES: February 26, 2009 t .
Ve . Ik'!*l , orida Statutes. Under penalties ofpeIjury, I declare that I have read the foregoing and that
the - ""red fu it "" """ tn the host ofmy knowledge ... belief --:!J.i. jj ~.
Signature of Natural Person ~gning "
FORMSlNOC,rvsd2007
STATE OF FLOR'DA
DEPARTMENT OF - JSINESS AND PROFESSIONAL FC,ULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
(850) 487-1395
~~Db.~i=~~~o~ANY
PO BOX 44100
JACKSONVILLE FL 32231-4100
. S'rA11:OF. FLORIDA AC# 2 ~ 27111
DEPAJt'1'MBN'l' OF BUSINESS AND
. PROFESSIONAL RBGULATION
CGC003375
06/23/06 058095836
CBRTIFIBD GBNERAL CONTRACTOR
GOOD, TIMOTHY A
THB HASltELL COMPANY
IS CERTIFIED under the provido... of ch.489 I'll
lIxpintion date, AUG 31, 2008 L06062301058
DETACH HERE
262711 0 STATE OF FLORIDA
DEPAR~NT OF BOSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L06062301058
SE NBR
0623 2006058095836 CGC003375
The GENERAL CON'l'RACTOR
Named below IS CERTIFIED
Onder the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2008
GOOD, TIMOTHY A
THE HASKELL COMPANY
~i~~sg~~~INE FL 32216
JEB BUSH
GOVERNOR
DISPLAY AS REQUIRED BY LAW
SIMONE MARS TILLER
SECRETARY
William A. Burgess
Building Official City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33540
September 26, 2007
Tom Osborne
Haskell
111 Riverside Ave.
Jacksonville, FL 32202
William,
'-, '-
, ! \, - .
At this time, I am submitting the Permit Application and tbreeO) signed and sealed sets
of the permit drawings for the foundations & tilt-up panels for the Zephyrhills Warehouse
Expansion to the existing Nestle Waters North America - Zephyrhills Natural Spring
Water Facility. The warehouse expansion will consist of approximately 165,000 SF of
additional warehouse space constructed by concrete tilt-up construction. Also included in
the improvements will be the addition of a new entrance drive for truck traffic. At this
time we are submitting and would like approval to start construction of the foundations
and tilt-up panels with the condition that work will be performed in the existing
impervious areas only. At a latter date we will submit for the overall building expansion.
Upon completion ofthe project, three (3) sets of the record drawings will be submitted to
you.
Please call if you have any questions or require additional information.
Thank: you,
.---
t.
. ^"'i2
t-:lUl o-t""tn,<S TIo..
Tom Oso
Project Manager
Haskell
Phone # 904-449-1101 or 904-357-4913
Fax # 904-475-7845
..:>ul e..Ir -W\' s \' . (Y\?
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner:
+\AS~e-~ \ r n
Date Received: q -'d.l-O'
Site: 43~('J ~D-\'tl 5+-
Permit Type: ~un<-h..In. U'r-.. } '"\; I -+ Po n~l S
Approved wino comments: 0 Approved withe below comments: ~enied withe below comments: 0
0~
of SU1g
I rf'5-rrJLlfJTl ~ ct'" ~~t< ~ ry
11M)) ~t{(" c5'f" llLT Vf r>M~L2.
c:; I ~ fL (7('/ (2)i VllLUJ t9No /JrffL~";'PIL / '>
~0 i t'tN) ym::lI)tiL ($ f2 (4:.e17,..( Is- W;9U.. 0 1}-1'I)i.L~
(
IV_{\uur\\cf\r,l ~~ I2t.YH;~ fy{~NT Or
-P~"-\I f17nS I)N') I~T h111'S LAJI\L ~
~ y(l.j(,)L 70 C~I'I'1I"'0f'1\ftii- 6y~Jfi6'
This comment sheet shall be kept with the permit and/or plans.
Date Contractor and/or Homeowner
(Required when comments are present)
CITY OF ~Il.LElDWAL COUNTY
IIIKEHO$AJlI, TAX CeUECTOR
231 E FORSYTH STREET ROOM 130 JACKSONViLLE, FL 32202-3370
PHONE: (~)_2080 FAX: (904) 630-1432
WE$$fTE: www.coj.netltc
Note - A penalty is imposed for faiture to~eep this "~~ed conSpicuously at your establishment of place of
business. This receipt is furnishedPUFS__Gfchapter 770-772 City ordinance codes.
2007-2008 BUSINESS TAX RECEIPT
HASKELL CO, T~
PRESTON HHASKELL
111 RIVERSIOEAV
JACKSONVILLE, FL 32202-4921
..
ACCOUNT NUMBER:
LOCATION ADDRESS:
168e48000
111 RIVERSIDE A V
JACKSONVILLE FL 32262-4921
DESCRIPTION:
CONTRACTOR- ALL TYPES
CONTRACTOR- ALL TYPES
MC 772.309
COUNTY TAX:
MUNICIPAL TAX:
TOTAL TAX PAID:
375.00
1,026.25
1,401.25
COUNTY RECEIPT DESC:
MUNICIPAL RECEIPT DESC:
VAUD FROM September 1,2007 TO September 30,2008
***ATTENTION***
THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY.
CERTAIN BUS1NESS MAY REQUIRE ADDITIONAL STATE LICENSING.
This is a business tax receipt only. It does not permit the receiptholder to violate any existing regulatory or zoning laws of
the County or City. Nor does it exempt the receiptholder from any other license or permit required by law. This is not a
certification of the licensee's quatifications.
*~
TAX COLLECTOR
THIS BECOMES A RECEIPT AFTER VALIDATION.
PAID-413232.0001-0001 M01 08/24/2007 1,401.25
THE HASIELL COMPANY
AMBIla's DESIGR-BUILD UADE
TO:
William Burgess
5335 Eighth Street
Zephyrhills, FL
Phone: 813-780-0020
Fax: 813-780-0021
DATE:
11/7/07
PROJECT:
Zephyrhills Warehouse Expansion
SUBJECT:
Field Order - Retaining Wall (Reference Permit #7072)
NUMBER
COPIES
the following documents on this project.
TITLE OR DESCRIPTION
PREPARED BY
Bill,
See the attached for two (2) signed and sealed copies of the retaining wall detail that has been added to the
project. At this time, I am transmitting this detail to you for your records and reference on upcoming
inspections. Haskell will incorporate this detail into the record drawings and submit a copy to the City of
Zephyrhills Building Department upon completion of the project.
Please call if you have any questions or comments.
Thanks,
Tom Osborne
Haskell
Project Manger
Cell 904-449-110 1
These documents are being submitted to you:
lit For your use.
e] For estimating purposes.
181 Approved.
o Approved as noted.
o For
REMARKS:
o Please sign and return both copies; one executed copy will be retumed to you
o For your approval. Please return ( ) copies "APPROVED" or, "APPROVED AS NOTED".
o Due to revisions. Please acknowledge receipt, advising if these revisions will affect the
contract price.
Should you have any questions on the enclosed, please call me at 904-791-4500 (direct) or 904-449-1101.
COPIES TO: THC File
Very truly yours,
THE HASKELL COMPANY
To~2~
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City of Zephyr bills
BUILDING PLAN REVIEW CO:rvnv.tENTS
Date Received:
Site:
Permit Type:
. Approved wino oomments:p
Approved withe below comments: 0 Denied withe below comments: 0
e kept with the permit and/or plans.
1/ ~ 0/
Date
Contractor and/or Homeowner
(Required when comments are present)
L~l~.