HomeMy WebLinkAbout08-8157
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
8157
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost: 4,745.00
Date Issued: 8/07/2008
Total Fees: 117.50
Amount Paid: 117.50
Date Paid: 8/07/2008 Phone:
Work Desc: INSTALL WALL SIGN W/ ELECTRIC EXIST
8157
SIGN
WALL SIGN
COMMERCIAL
Address: 7400 GA L BL V
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 35-25-21-0010-08800-0000
TOWN V W RETAIL LLC
725 CONSHOHOCKEN STATE RD
BALA CYNWYD, PA 190042102
R
ELECTRICAL ROUGH
FINAL
REINSPECTlON 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: Yo r failure to record a notice of commencement may result in your paying twice for
im vements to your perty. If you intend to obtain financing, consult with your lender or an attorney
recording your n tice of commencement. II
PERMIT OFF I
IT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
11111111111111I1111I11111111111111111111111111111111 11111111
2008115763
. .
Rcpt: 1196624
DS: 0.00
08/07/08
Rec: 18.50
IT: 0.00
Dpty Clerk
~'
~
Permit No.
NOTICE OF COMMENCEMENT
JED PITTMANA fASCO COUNTY CLERK
08/07/08 0~: 4am 1 of 2
OR BK 7900 PG 975
Property Identification No.35-25-21-0010-07200-0011/35-25-21-001O-08800-0000 /35-25-21-0010-05600-0000
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
7]3.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1. Description of property (legal description :) See attached
a) Street Address: 7252- 7400 Gall Boulevard. zeOhvrhills;L 33545
2. Genera] description of improvements: New signage - ,-l u av...o... 0...
.5 ~c. JS- ; u..J p J- ~ R" e... ~ IE
3. Owner Information: Townview Retail, L.L.C. c/o Stoltz Management of DE, Inc.
a) Name and address: 725 Conshohocken State Road. Bala Cynwvd. PA 19004
b) Name and address offee simple titleholder (if other than owner) N/A
c) Interest in property 0 w t\.~.r-
4. ContractorInformation hdeln'lo../'O'Y1a...f )'(q",\ tD€>s)CJ~ eoV'!\. (VC(? ( (It\...~C\.\ <;1. (o..."""CJ F..... ~s)) '?
a) Name and address: j;;iU'" v Dr~H 1 QRJ 1 Carlal ShGet. ~@lRi:RQII: FL'DR7
b) Te]ephone No.: (727) 545-9785 x1309/ (727) 4105128 Fax No. (Opt.)
5. Surety Information I
a) Name and address: " Q....
b) Amount of Bond:
c) Te]ephone No.: Fax No. (Opt.)
6. Lender
a) Name and address: Bear Stems Commercial Mortg.age. Inc. Servicer: Wells Fargo
1320 Willow Pass Road. Suite 210 Concord. CA 94520 Phone No. 800-986-9711
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: N/A
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. ]3(1) (b), Florida Statutes: N/A
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 COMMEN EMENT.
STATE OF FLORIDA
COUNTY OF PASCO
The foregoing instrument was acknowle~ed before me this L day of :::ft,,/y ,20H, by -r \T' JI-'l; I J~
as t'r"t>~ ~M4'~ (type of authority, e.g. officer, trustee, attorney
in fact) for ""'OI.O"'W~ <UA.) k~; I . . (nam of party on behalf of whom instrument was executed).
Personally Known ../ OR Produced Identification _
Notary Signature ~ '
~
Type of Identification Produced
Name (print)
6()~n\-k<4
~O!1j
Verification pursuant to Section 92.525, Florida Statutes. Under penalties ofperj ry, 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. ~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Sokunthea Thong, Notaty Public
Upper Mer~n Twp., Montgomety County
My Commission Expires Oct. 27, 2009
lv1embef, Pennsylvania Association of Notaries
FORMS/NOC,rvsd2007
OR BK 7900 PG 976
2 of 2
OR 8K 7642' PI 344
3 or 3
LEGAL DESCRIPTION
EXHIBIT "A"
A portion of the W 1/2 of the W 1/2 of the SW 114 of SectIon 35, Township 25 South, Range 21
East, being also a portion of Tracts 72, 73, 88 and 89 of ZEPHYRHILLS COLONY COMPANY
LANDS SUBDIVISION, as recorded In Plat Book 1, Page 55, public records of Pasco County,
Florida, being also a portion of Lot 8, PASCO MEDICAL ARTS CENTER, ,is recorded In Plat
Book 23, Page 24, public records of Pasco County, FlorIda, being more parttularly described as
follows: Commence at the Northwest corner of the SW 1/4 of said Section 35, thence along the
North line of said SW 1/4, S. 89 degrees 51'40" E., 663.35 feet to the East Ihe of the W 1/2 of the
W 1/2 of the SW 1/4 of said Section 35, thence along said line and along.;he East line of Tracts
72, 73, BB and 89, S. 00 degrees 09~03" W., 25'.00 feet to the South r1glt-of-way line of Pretty
Pond Road, for a point of beginning; thence continue S. 00 degrees at'03" w., 1004.84 feet,
thence leaving said line N. B9 degrees 55'34" W., 50.00 feet, thence S 00 l;fegrees 09'03" W.,
117.00 feet, thence N. 89 degrees 55'34" W., 200.00 feet, thence S.OO degrees 09'03" W.,
109.00 feet, thence N. 89 degrees 55'34" W., 259.00 feet, thence S 00 degrees 09'03" w.,
205.36 feet, to the North' right-of-way line of North Medical Avenue, the1ce along said line N. 89
degrees 56'33" w., 133:84 feet, to the East right-of-way line of U.S. HtJhway 301, thence along
said line and along a curve concave to the West with a radius of 57395.BO feet, chord bearing N.
00 degrees 04'19" W., 747.11 feet. thence leaving said right-of-way lin~ S. 89 degrees 50'57" E.,
171.18 feet, thence N. 00 degrees 09'03" E.. 197.00 feet. thence I,J, 89 degrees 50'57" W.,
173.54 fe'et, to the West line of Tract 73. thence along the West line::lf Tracts 72 and 73,' N. 00
degrees 0'7'20" E., 332.86 feet, thence leaving saId line S. 89 degr~es 51'40" E., 200.00 feet,
thence N. 00 degrees 07'20" E., 160.00 feet to the South right-of-way line of Pretty Pond Road,
thence along said line S. 89 degrees 51'40. E., 448.35 feet to the POII,JT OF BEGINNING.
AND
RETENTION POND:
The North 290.0 feet of the South 515.0 feet of the East 150.0 feet of the SW 1/4 of the SW 1/4 of
the NW 1/4 of Section 35, Township 25 South, Range 21 East; being a 'portion of Tracts 56 and
57, ZEPHYRHILLS COLONY COMPANY LANDS SUBDIVISION, as recorded in Plat Book 1,
Page 55, public records of Pasco County, Florida.
TOGETHER WITH an easement for ingress and egress and drainage purposes over the South
225.0 feet of the West 30.0 feet of the East 100.0 feet of the SW 1/4 of the SW 1/4 of the NW 1/4
of Section 35, Township 25 South, Range 21 East, Pasco County, Florida, LESS the South 15.0
feet.
AND
TOGETHER WITH the irrevocable right and easements as set forth In the Reciprocal Easement
Declaration recorded in Official Records Book 1801, Page 974, as amended In the First
Amendment to Reciprocal Easement Declaration, recorded in Official Records Book 1929, Page
576, Public Records of Pasco County, Florida.
AND
TOGETHER WITH that certain perpetual non-exclusive egress and Ingress easement as set forth
in Exhibit "0" to that certain Easements and Maintenance Agreement entered into by and
between Zephyrhills Retail LLC, a Delaware limited liability company and Concire, Inc., a Florida
corporation recorded In Official Records Book 7159, Page 758, of the Public Records of Pasco
County, Florida. ,
STATE OF FLORIDA
COUNTY OF PASCO
. THIS IS TO CERTIFY THA T THE FOREGOING IS A
TRUE AND CORRECT COpy OF THE DOCUMENT ON FilE
OR OF PUBLIC RECORD IN THIS OF2E.WITNESS MY
HAND AND OF~ICIA4 THIS '(h. DAY OF
~~.. 2 00
~~D PI ~MA lERK OF qRCiJii'COURT
~ 'L.,/~ DEPUTY CLERK
813-780-0020
City of Zephyrhills Permit Application Jt' B (S 1
Building Department - 11
Fax-813-780-0021
Date Received
ItIlllllllllllllttl!lllllllll
Owner's Name
Owner Phone Number
Owner Phone Number I
Owner Phone Number I
Fee Simple Titleholder Address I
\ IZ.hr/IS' "L.3 g540 LOH I
PARCELID#135-25-2/- (){)/o-offctJ- 00
(OBTAINED FROM PROPERTY TAX NOTICE)
SUBDIVISION
JOB ADDRESS
WORK PROPOSED
NEW CONSTR
INSTALL
SFR
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SIGN
D
MOVE D
DEMOLISH
PROPOSED USE
TYPE OF CONSTRUCTION
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D
D BLOCK D
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AD DIAL T
REPAIR
COMM
FRAME
DESCRIPTION OF WORK
~_J~~-~
D BUILDING ~ 145". <.JQ I VALUATION OF TOTAL CONSTRUCTION
OTHER
STEEL
I
D
.-l-o .e>li
OTHER I
D ELECTRICAL 1$
D PLUMBING 1$
D MECHANICAL 1$
D GAS D ROOFING
AMP SERVICE
D
PROGRESS ENERGY
D
WR.E,C,
I
I
I
D
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VALUATION OF MECHANICAL INSTALLATION
Address
SPECIALTY D OTHER
FLOOD ZONE AREA DYES DNO
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License # l-p OOCOtY)"2J I
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FINISHED FLOOR ELEVATIONS I
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BUILDER
SIGNATURE
Address
ELECTRICIAN
SIGNATURE
Y I N
FEE CURRENT
U;:5(X)mn:Q I
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I
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I
Y/N
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y I N
FEE CURRENT
Address
License #
MECHANICAL
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
COMPANY
REGISTERED
OTHER
SIGNATURE
Y/N
Address License #
llIlIflllllll!lll..........-;.__ 1lIlIII!Ill1lllllllllll1llllll!lll1lllllllllll1lllllllllll1llllll!lll1lllllllllll1llllll!lll1lllllllllll1lllllllllll__IlIlIII!IllIlllllllllll_-- 1lIlIII!Ill1lllllllllll__
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 wi Silt Fence installed.
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsllarge projects
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 wi Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans,
....PROPERTY SURVEY required for all NEW construction.
IIIIlIIlI
COMMERCIAL
SIGN PERMIT
mm~~!lIDIIlIDI~mmmm:mHR-WflillllllllimllllODllllllll~mD.IIm.mm!lllfili~~mDJl~mJlIftJ.IImI~lRmHIAlR:JIHR1JRmIIIlmmllllll:~rm-JHJJHrRmHrJHJrRlHrAlfJHHHHATmIIII~
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 Attomey (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 AlC
Driveways-Not over Counter if on public roadways..needs ROW
Fences (PloUSurvey/Footage)
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 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, 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 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 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 YO R TICE OF COM NC ENT,
FLORIDA JURAT (F,S, 117,03) ,
CONTRACTO
Subscribed and sworn to (0
by
Who is/are personally known to me or has/have produced
as identification,
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification,
Notary Public
Notary Public
Commission No,
Commission No,
Name of Notary typed, printed or stamped
Name of Notary typed, printed or stamped
.1 L\tr.. \.J~...."....,.A.
~'~V/~VVV ~,~~ rl'~
L.' vvv
TO:Unknown COMPANY:SIGN XPRESS
c;UI'PLlER
SIGN XPRESS
10821 CANAL STREET
LARGO, FL 33777
United States
Purchase Order .
PURCHASE ORDER NO r~~SION I PAG;
743315 THIS PURCHASE ORDER NUMBER MUST APPEAR ON ALL INVOICES.
PACKING LISTS. CARTONS AND CORRESPONDENCE RELATED TO THIS ORDER
SHIP TO
See Line Item (s) Below
for Actual Ship To Location
BILL TO
Humana Inc
Accounts Pa~able Deport
PO Box 7400 3
Louisville,KY 40201
United States
HUMANA@
G~idance when you need it most
500 West Main Street
Louisville, KY 40202
502-580-8880
CUSTOMER ACCT NO I SUfOlOR9908 DATE OF ORDERI8UYER REVISED DATElTIME
10-APR-08 C Brandenbur
F'AYMENT TERMS SHIP ~A DELIVERY TERMS
Net 45 UPS FOB Destination
FREI GHT TERMS REQUESTOR/DELIVER TO CONFIRM TOrrElEPHOr--l:
Prepaid and Add Johnson, Ms. Donna C DEROSE (727) 545-9785
ITEM PART NUMBER/DESCRIPTION DELIVERY DATE QUANTITY UNIT UNIT PRICE EXTENSION
This Purchase Order is issued for the est i me ted ollar Amoun for Goods or
Services (GIS), and Hun ana does nc t commit 1 o pa the stated amount except
as hereinafter set for h . Paymen (s) will ~ e re eased only e s GIS are
provided and correctly submitted nvo ices bE come payable. A ter all
anticipated invoices he ve been rec eived and baid against thi:~ PO, it will be
closed and any Dollar ~ mount rema ning will e c ncelled wi t no further
obligation by Humana.
All prices and amounts on this or er are eXI= "'essc d in US de llar
Please formally accept this order by:
1 NEEDED: 4 , 745 . 00 N
11-APR-08
Zephyrhills new sign
for front of building
Invoice #2255
o SHIP TO:
5401 W Kenned~ Blvd ~ 161
Tampa,FL 3360
United States
Total 4 ,745 . 00
THIS ORDER EXPRESSLY LIMITS ACCEPTANCE TO THIS FORM. THE ATTACHED TERMS AND CONDITIONS. AND ANY OTHER Ths Ptrchase Order has been electronically approved by:
HUMANA DOCUMENT YOU SIGN ANY ADDITIONAL TERMS SET FORTH IN ANY SUPPLIER COMMUNICATION ARE HEREBY
REJECTED ~~~.~
Chief Proct.rement Officer
'STOLTZ
725 Conshohocken State Road
Bala cynwyd, PA i9004
610.667.5800
fax 610.664.1976
www.stoltzusa.com
fiI
July 18, 2008
TO WHOM IT MAY CONCERN:
This letter authorizes INTERNATIONAL SIGN & DESIGN CORPORATION
To manufacture and install sign(s) and/or awnings at the following location:
Townview Retail, L.L.c.
Humana Medical
7400 Gall Boulevard
Zephyrhills, FL 33541
INTERNA TIONAL SIGN & DESIGN CORPORATION is authorized to secure
Permits required by the local governing body.
Sincerely,
SWORN TO AND SUBSCRIBED before me this J g#t day of ~, 2008 by
who is
as identification
1""0"
/ personally known to me OR
~; \ k.f"
produced
~iC~
(NOTARY PUBLIC
SEAL)
My Commission Expires:
It>/~7 /1>9
I .
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Sokunthea Thong, Notary Public
Upper Merion Twp., Montgomery County
My CommiSSion Expires Oct. 27, 2009
Member, Pennsylvania ASSOCiation of Notaries
PHILADELPHIA
NEW YORK
CHICAGO
LAS VEGAS
WILMINGTON
City of Zephyrhi1ls
BUILDING PLAN REVIEW, COMMENTS
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Site:
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7-,3/-05
7cJob ((;1+(I,b/fib
/A)tf.Q) J&- / w/''j (" ;., cc/r(~
ContractorlHomeowner:
Date Received:
Permit Type:
Approved wino comments~
Approved wIthe below cOIDnlents: 0 Denied wIthe below comments: 0
."~-
s all be kept with the permit and/or plans.
~w
Contractor ,and/or Homeowner
(Required when comments are present)
Kal
Date