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HomeMy WebLinkAbout08-8489 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8489 BUILDING PERMIT mrii Permit Number: 8489 Address: 5935 GALL BLVD Permit Type: TEMPORARY SALES ZEPHYRHILLS, FL. Class of Work: SPECIAL EVENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 10-26-21-0020-00000-0050 Improv. Cost: Date Issued: 11/05/2008 Name: ZEPHYR PLAZA Total Fees: 527.00 Address: 5935 GALL BLVD Amount Paid: 527.00 ZEPHYRHILLS, FL 3542 Date Paid: 11/05/2008 Phone: Work Desc: TEMPORARY SALES FIRE WORKS- DECEMBER 10TH 2008 THRU JAN 2ND 2009 UNIVERSE NOVELTY&FIREWORKS CO. TEMPORARY SALES 5.00 SPECIAL EVENT 22.00 FIRE PERMIT FEES 500.00 cJQc( FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one 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 R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER TempOra1Y s Checklist , etfárs City of Zephyrhilis S 5335,8U'Street V / Zepbyrh1I1s,Fi.33542 �7 Phone:813-780-0020 I Fax:813-780-0021 j/Plot Plan Showing setup of location. "Notarized letter from property owner stating their IP advised this review of plans submitted is a gimory review to assist the contractor in compliance w qW"is not intended (/J If tent is involved, a flame retardant certificate i bbeafinalapprovalofthesubmitted plans It is the is erected. OontraCt s Sole responsibitey to ensure that the plans are in complete con0ance with ail applicable NFPA codes acid ✓Approved certified fire extinguishers per NFP ordinances. In the event that further examination or she inspection reveals areas of non-compliance,it shall be _} 'No Smoking signs must be placed outside entr is sole responsibility,at their sole expense tD s la GRo s-Adw9s no �/✓If there is a wire fence or chain link fencing ity contractor's failure to be in compliance 2 exits. with allPp4iCabis NFPA Codes and local ordinances. i If tent has sides,the sides shall be in the up position unless there is inclement weather, then 2 sides must be,in the up position. If fireworks are involved,the following is required: SUBMITTED PLAN(S)HAVE BEEN REVIEWED BY ZEPHYRHII-LS • SHAL'S OFFICE ✓ Proof of State License. Date: VProof of Liability insurance Reviewer: City Registration free of$2900 . 3"°' List of items to be sold at site. Fire Department fee of$25.00. `� o vers icense and Social Security Number of. 1 ersonnel.dealing with the sale of fireworks at the tent location. TO The o owing fees are app ice e: Temporary sales permit: $5.00 for the 1`�two days and$1.00 per day for each consecutive day thereafter,not to exceed duration of 30 consecutive days and no more than one occurrence per calendar year per Ordinance#408. Tent permit(if applicable): $35.00+$15.00 Fire Department=$50.00 Electrical permit(if applicable):$35.00 Property Owner: 0 cAS�"R O Applicant: U N' VEI cF 1'.io Phone Contact: $ 3 '1 $ 5 (.yAL - Bt f , 2E PNY1 R4 rLL5 Address Site: Date of Sale: �C. 10+P' X008 ^ 5AIV, o9 Nd `� Zephyrhills Fire Rescue 6907 Dairy Road,Zephyrhills,FL 33542 Fire Marshal Bus (813)780-0041 Kerry Barnett Fax(813)780-0044 E-mail: kbamett@fire.zephyrhills.fl.us Plan Review#: 08-139 Project: Universe Novelty&Fireworks Number of Pages: 17 Date: October 30,2008 1 have reviewed the package for retail sales of fireworks under a tent located at 5935 Gall Blvd therefore allowing this project to move forward. Paying for the permit acknowledges the contractor agrees to the items below. Should anyone have any questions,please do not hesitate to contact the Fire Marshal's office. 1. Certified fire extinguishers shall be an ABC and pressurized water. 2. Follow attached tent/vendor guidelines/checklist. Inspections to be conduct: 1. The tent and stand shall be inspected prior to opening. Failure to have the inspection will result in additional fees. ERR Y TT, FIRE MARSHAL ***Please be advised this review of plans submitted is a cursory review to assist the contractor in compliance with applicable fire safety codes.This review is not intended to be a final approval of the submitted plans.It is the contractor's sole responsibility to ensure that the plans are in complete compliance with all applicable NFPA codes and local ordinances.In the event that further examination or site inspection reveals areas of non-compliance,it shall be the contractor's sole responsibility,at their sole expense to bring those areas in compliance.The City assumes no responsibility for the contractor's failure to be in compliance with all applicable NFPA codes and local ordinances. ZEPHYRHLLS FIRE DEPARTMENT 6907 Dairy Road, Zepphyrhills, FL. 33544.° Fire Chief Keith fl l€Hams Bs ?. ,v0O4 Fall. (8i3730-0044 FIRE SERVICE USER FEES Occupancy No.: Plan No.: (' —/ Contractor. 1flI e Business Name: Billing Address: J Z. Business Address: 35— -s- 1 Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE Site Plan N/C Annual N/C Sp*dder $50 1st Alarm WC " am rneroia� .06 sf 1st Re-Inspection N/C Standpipes $50 2nd Alarm WC Cage 2nd Re-inspection $100 Fine Pump $50 3rd Alarm N/C DBL 3rd Re-inspection $250 Floods $50 4th Alarm $100 4th Re-Inspection $500 Fee Alarm 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200 8 0-25 Heads $50 violations corrected) Natual Gas $50 NON COMP NICE $150 26 plus Heads $100 SPRNCL.ER SYSTEMS Fuel Tardy per $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Spadders Per Riser $50 Hydrostatic Test $65 puslHoodwDlucl: Fie Works FIRE Pty Aocq*mceTest $45 p C Fire $25 0 Per Pus p $100 Hydrant Flow $75 Cattroied Burn $100 FIRE ALARM SYSTEM $50 [10-25 Devices $50 FOE ALARM SYSTEM Pieoe of Aee.- t ► $50 Arrant 25 plus Dolim $100 [1 Sys$u n $50 Aeceptence Fire Paileclion $25 SlIPPR DMSYS7EMS RecallAcoeptmu�ce $5550 Afar.aaua $50 Annual Wet $50 OT} Tee cage $50 Arne Dry $50 FieWassmciwwaK $15 per..e G.. '<KW $100 CO2 $50 LP Gas $25 pr» Generator>30KW 150 Otter $50 Nabsal Gas $?5 pern Bio•-Hard Waste $100 Annual K[it EId EXHAUST Fwftmtion Tenfg $50 ElHood $50 T or greater i5 tent Torch PdlAppied $50 OTHER Fire Pui4 Hat trials $100 Amrral LP kawatiorr per tank $50 F. so Fuel Tank lr $50 Sysm Acceptance (Per Tank) $50 Exteust Hood/Duct $30 Natural Gas k a5on $50 Re-inspection DBL (Per System) ^(other than annual) Spray Booth $50 E]inspection scledcded DBL and cancelled less t l 24 hours Cow kp Nc V Ac FALSE ALARM PLANS TOTAL T1ON TOTAL PERMIT TOTAL1V TOTAL ��' 11111 GRAND TOTAL I 0 Comm Date: /D lns ctor: c' 7 TENT/VENDOR CHECKLIST The AHJ shall be permitted to regulate all outdoor events such as carnivals and fairs as it pertains to access for emergency vehicles; access to fire protection equipment; placement of stands, concession booths, and exhibits; and the control of hazardous conditions dangerous to life and property. NFPA 1, Section 10.15.2 Event coordinator(s) shall provide the vendors a checklist of what is expected of them at the event. However, individual vendors within the special event shall be held responsible for their individual vending space. Those that do not comply with the guidelines of this checklist for their vending arrangement are subject to immediate denial within participation of the permitted event. ✓ Plot Plan showing setup. If part of an overall event, this shall be supplied by the event coordinator. ✓ Notarized letter from property owner stating their approval. ✓ Proof of liability insurance. If tent is greater than 10 x 10, flame retardant certification is required. If multiple 10 x 10 tents are placed together to create one large space under canopy, than a flame retardant certification shall be required on all tents. No smoking signs must be placed outside entrances(tents 20' x 20' or greater) If there is to be wire fencing or chain link fencing, this fence shall be set back from the tent at least 5 feet and have at least 2 exits. If tent has sides, the sides shall be in the up position unless there is inclement weather,than 2 sides must be in the up position. Adjacent tents shall be spaced a minimum of five(5) feet to provide an area to be used as a means of emergency egress. If stake lines are used to secure the tent,than the five(5)feet shall be measured from the stake line. The ground enclosed by any tent and ground not less than 120" outside the tent shall be cleared of all flammable or combustible material or vegetation that is not used for necessary support equipment. If lighting is installed in tent, it shall be in the way that bulbs are not in direct contact with the tent. Bulb/lamp cages shall be used. If power is supplied by generator, generator shall be a minimum of 5 feet from the tent and shall be isolated front contact with the public by either physical guards, fencing, or an enclosure. Fuel containers shall not be stored within close proximity of any ignition source. Any extension cords used shall be placed or positioned to not cause a trip/fall hazard. A minimum of one portable fire extinguisher with a rating of not,less than 2-A:10-B:C shall be provided if there is any type of ignition source present within or associated with the tent. (See note at bottom) If an LP (propane)tank is used by the vendor it shall be positioned outside the footprint of the tent. If cooking is involved: A minimum of one Class K portable fa4inguisher shall be provided for each concession scan at utilizes vegetable or animal grease cooking oils or other process that produces grease laden vapors. (See a at bottom) Concession stands utili for cooking shall have a minimum of 10 ft (3 m) of cleara a on two sides and shall not be located within 10 ft(3 m f amusement rides or devices. If cooking is tng place under any tent, a flame retardant certificatio s required. Any ap ance used for cooking that utilizes a vent,that applipfce shall be positioned to vent outside the tent. Copling equipment used in fixed, mobile, or temporary ncessions, such as trucks, buses,trailers, pavilions, tents, or any form of roofed enclosure, shall comply with this standard unless all or part of the installation is exempted by the AH7. NFPA 1, Section 50.2.9 NOTE: State of Florida requires all extinguishers to be certified by an authorized and licensed fire extinguisher company. Pasco County Parcel: 10-26-21-0020-00000-0050 001 Page 1 of 2 Search Again Show Map Generalized Building Schematic Estimate Taxes Frequently Asked Questions Other Parcel Cards: 1 1 2 1 3 Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: Weekly Archive - Saturday, November 01, 2008 Parcel ID 10-26-21-0020-00000-0050 (Card: 001 of 003) Classification II 16 - Shopping Center Community Mailing Address Property Value JOHN-MARY ENTERPRISES LTD Ag Land $0 C/O CINDY GRECO Land $273,389 PO BOX 17072 Building $255,804 TAMPA, FL 336827072 Physical Address - See All 3 addresses (First Shown) Extra Features $3,130 5931 GALL BLVD Market Value $532,323 ZEPHYRHILLS, FL 33542-3464 Assessed (Save Our Homes) $0 Legal Description (First 4 Lines) PINE GROVE PB 2 PG 15 COM AT Taxable Value $532,323 SW COR OF LOT 10 TH N02DG 02' 12"W 172 FT ALG WEST LINE OF LOTS 10&7 FOR POB TH N02DG Land Detail (Card: 001 of 003) Line Use IlDescriptionhl Zoning Units Type Price Condition Value* 1 1600 SHOP G 00C2 12,000.00 SF $7.32 1.00 $87,840 �� SHOPNG O SF $2.87 2 1600 00C2 38,000.00 SF $2.87 1.00 $109,060 3 1600 SHOPNG 00C2 27,814.00 SF $2.75 1.00 $76,489 Additional Land Information Acres 1.79 Tax Area II 0ZH II FEMA Code Commercial Codell M3012AO Building Information - Use 16 - Shopping Center Local (Card: 001 of 003) Year Built 1969 Stories 1.0 Exterior Wall 1 Concrete Block Stucco Exterior Wall 2 None Roof Structure Rigid Frame w/Bar Joist Roof Cover Built-Up Tar and Gravel Interior Wall 1 Plywood Panel Interior Wall 2 Drywall Flooring 1 Terrazzo Monolithic Flooring 2 None Fuel Electric Heat Forced Air- Ducted A/C Central Baths 4.0 Line Description Sq. Feet Repl. Cost New 1 CAN 703 $17,218 2 SPA 22,846 $1,584,590 3 EPEP 2,115 $103,550 Extra Features (Card: 001 of 003) Line Description Year II Units Value 1 PAV ASP 1969 12,000 $2,430 2 DOCK LD 1982 II 1 $700 Sales History Previous Owner FIRST NATIONAL BANK Year Month Book/Page Type Amount H I II II http://appraiser.pascogov.com/search/parcel.aspx?sec=10&twn=26&rng=21&sbb=0020&b... 11/3/2008 APR 11 1996 O5: Ø FR TO 7800021 P.01/03 l0'3oud 10101 DATE ----- Gry,pEIL ISSION TO. OWEN YOUNG UNIVERSE NOVELTY&FIREWORKS COMPANY.INC. POST OMPICE BOX 1662 Tu VERVIFW.FLORIDA 33566 (g13-)61 _1874 TO'SET LIP AND.OPERATE A TEMPORARY STAND ON MY PROPERTY LOCATED AT: E p N V K +its Ft; • LOT# BLOCK SUBbJViSION#. -- O0 NT.SIGNA'riRE STATE Or- Pt COUNTY OF HTLLSBOROUON SWORN TO AND SUBSCR1DED BEFORE.ME THIS Y OFc IS PERSONAL . • p R HAS PRODUCED __________.., N. NOTARY DATE(MMIDDNYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10/01/08 PRODUCER Allied Specialty Insurance, Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 10451 Gulf Blvd. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Treasure Island, FL 33706 800/237-3355 INSURERS AFFORDING COVERAGE NAIC# INSURED Universe Novelty & Fireworks INSURERA: T.H.E. Insurance Company Company, Inc . INSURER B. P.O. Box 1862 INSURER C: Riverview FL 33568 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 nl X COMMERCIAL GENERAL LIABILITY M8MF6580 02/17/08 02/17/09 DAMAGE TO RENTED $ 50, 000 CLAIMS MADE X OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY fl PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea a-dent) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIRED AUTOS . BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA IJABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I_. $ DEDUCTIBLE $ RETENTION $ $ WC STATU- 0TH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS FIREWORKS STAND SITUATED AT 5935 GALL BLVD. , ZEPHYRHILLS, FL FOR THE DATES OF 12/10/08 THROUGH 1/02/09 ADDITIONAL INSURED AS RESPECTS TO THE OPERATION OF THE NAMED INSURED ONLY: CITY OF ZEPHYRHILLS CERTIFICATE HOLDER CANCELLATION CITY OF Z E PHYRH ILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 533 5 8TH ST DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _1Q DAYS WRITTEN Z E PHYRH ILLS FL 33 542 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBUOATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRES ATIVES. AU RE ESE TIVY ' W ACORD 25(2001/08) ©ACORD CORPORATION 1988 MICHIGAN OPERATOR UCENSE• , A 450 149 189 425 �ALDr�M Ails ppIflMI r.r�w...ry �/III►., p7M� Vch -i I MhRWIW � ; 1v�1U110 Y ` C I � • z - -- co '$ • .g E ? fir► o ¢ ec O z o � 0 0 r w � c•1 �� a 1 o a � t0 E , yr- !cam rd m• ,�; ►-r:� I U) '. .c b a -iii r . . t H 4.U . JH1 -{ ell: •� ro N Z u G aH � ro 0 m , .fir.., c C 'O� oC LL- LL y 'b Rt C 0 V C -)s r = I- ___ = 1 I } it 1. I a 1 ro 1 ; 9 N C '7c-0 i 100 1 Cf f�* In Case of Fire Notes: The following instructions are of a general nature, intended to familiarize users with basic fire extinguisher operating techniques. Since extinguishers differ, the. extinguisher nameplate should be consulted for specific operating instructions and starting distances. Protective clothing and breathing apparatus should be worn to fight a fire whenever possible. Building occupants should attempt to extinguish only small tires in the incipient stage, large fires should only be fought by trained professionals. Be prepared to evacuate if the fire cannot be immediately controlled. Before any attempt is made to fight a fire with a portable fire extinguisher, the following steps should be taken: 1, Immediately evacuate the area. 2. Call the fire department, even in the case of a small fire. Small fires can quickly get out of control. The fire department phone number should be posted at every phone. 3. Activate the building fire alarm by using a pull station. Refer to your building fire alann manual for specific operating instructions 4. Evaluate whether the fire should be fought with a portable fire extinguisher, and if the person attempting to do so is physically capable of handling the fire extinguisher and quickly evacuating if the fire cannot be immediately controlled. Only small fires in the initial stage should be attempted to be fought with a portable fire extinguisher. Larger fires should be fought by the fire department. 5. Be sure you have a clear escape path. 6. Be sure that the fire extinguisher on hand is designed to fight the type of fire that you have encountered. This information can be found on the nameplate of the fir! extinguisher. The basic types of fire are as follows: Class A - Ordinary Combustibles: Burning wood, paper, or trash are examples c�i this type of fire. Class B - Flammable and combustible Liquids: Burning gasoline, oil, paint, solvents, and flammable gasses are examples of this type of fire. It is important toy shut off the fuel supply before trying to fight this type of fire. DEPARTMENT OF FINANCIA DIVISION OF STATE FIRE MARSHAL TALLAHASSEE,FLORIDA CERTIFICATE SOL RETAILER REGISTRATION SEASONAL tHIS CERTIFIES THAT UNIVERSE NOVELTY&FIREWORKS Co.,INC. 5935 GALL BLVD ZEPHYRI�ILLS, FL 33599 1 iAS REGISTERED TO THE PROVISIONS OF FLORIDA STATUTES TO ENGAGE iN THE BUSINESS OF SELLING SPARKLERS AT RETAIL. TUNE 20'f1IROUGH JULY 5 AND DECEMBER 10 THROUGH JANUARY 2 At THE FOLLOWING LOCA'f1O. FROM. CIC&T1ON. 5935 Oa11 Blvd. Zephyrhills,FL 33599 Pasco' Chief Ftna}ticiai Officer 83999800062002 0165960001 200.00 01 312009 07 63 Taxes&Fees Expire Date 1 02 0 l 2008) k ber Application Issue pnte Type Class Count Y License/permit Num UNIVEM€NffiELTY & FIREWORKS COMPANY, 1 1C. 8820 U.S. Hwy. 301 • Riverview, FL 33569 Official Licensed Phone (813) 677-1874 • Fax (813) 671-1790 NASCAR NFL, NBA, ML B. Fair- Festivals •Special Events E-mail: FireworksFlorida@aol.com Wholesale•Retail• Direct Importers Narnc_ — ��� ? `� --- � — -- — — Date / [ Address —__--- QUANTITY DESCRIPTION PRICE EACH AMOUNT w r -H r ' cl-7 er ______ Y of 9350 3nccp PopS E tiler I ,-S - T)r 1 , b J , 0 ________ 1ak1' 3h iLs L°) i . ________ _______ JOUCD cc. _S% oc _______ lf;oiin Cindk 5- 00 e , ©O______ ( ) L) I� � � r �, 6 I ! L - Q Cc iO 3 kp - ) . 0 O ______ f,. a r- ! n i he Ci, I Above items received on consignment from UNIVERSE OVELTY& FIRVORKS CO.. INC. I understand payment or return of merchandise is to take place within 20 days from above date. (Signature) __ C�l Q QO ___ UNIVERSE.NOVELTY & FIREWORKS COMPANY, INC. 8820 U.S. Hwy. 301 • Riverview, FL 33569 official Licensed Phone (813) 677-1874 • Fax (813) 671-1790 NASCAR NFL. NBA. M.LB. Fair• Festivals Special Events IE-mail. Fir eworksHorida@aolcorn Wholesale•Retail•Direct Importers Name __4j . _Q ___t t Date _i - .S ' Oa Address QUANTITY DESCRIPTION PRICE EACH AMOUNT 4t 'in 1C ≤ �W t ,G�10 IL t b I . 0 O • ç - c Pn I r)9 C- orS 3 r . c _________ 5rnc 1be . '3 C (Sfl( IC ut4 9c ______ hi nc [ 0d H1 " r rd 10 ( J 1 , o o J - ) ' @C 1g100 ______ 7. 0 SSkt Jvjc, k Z. r q ?,q , s" r_________ ç tc Ii . T U , c ç ________ r ______ Ce\ i T C C1 _______ k"7 �� N� ( l ✓ t______ I1r() rL 1-r 3g . c ______ ' J Vii - II R V Above items received on consignment from UNIVERSE NOVELTY& FIREWORKS Co., INC. I understand payment or return of merchandise is to take place within 20 days from above date. (Signature) ____________________ ' — UNIVERSE NOVELTY & FIREWORKS COMPANY, INC. 8820 U.S. Hwy. 301 • Riverview, FL 33569 Official Licensed Phone (813) 677-1874 • Fax (813) 671-1790 NASCAR NFL, NBA, M.L.B. Fair• Festivals • Special Events F-mail: FireworksFlorida@aol.com Wholesale•Retail•Direct Importers 11 Name _ ap_ _ —- — Date 1 .SR -- Address -- — QUANTITY DESCRIPTION PRICE EACH AMOUNT L C. u c Wc 0 ThtQ RrO jqg1cjç' c c Leucc& r25'ho + c.j o' m bs UJ ci.i ut � ______ id J-jj4-L TrucEc 3çç; ç ______ kA 4-p . -j q, q c ________ s / c1, qç _____ COrAA ____ ____ Li 1br'ic\€ r-Io g , qç ________ ç2, 3 Vtr) 15k _______ _______ 5rne S 4rrio cS 20 Sc' er , Y) cts yck ± 18 95 _______ +1 ' Pac IC c Above items received on consignment from UNIVERSE NOVELTY& FIREWORKS CO , INC. I understand payment or return of merchandise is to take place within 20 days from above date. (Signature) UNIVERSE NOVELTY a FIREWORKS COMPANY, INC. 8820 U.S. Hwy. 301 • Riverview, FL 33569 Official Licensed Phone (813) 677-1874 • Fax (813) 671-1790 NASCAR NFL, NBA, M.L.B. Fair• Festivals• Special Events h�F E-mail: FireworksFlorida©aol.com Wholesale•Retail• Direct Importers Name .-�r�(n x rj _ ___ _ Date , _/ (� Address-- ---- "- ------- QUANTITY DESCRIPTION PRICE EACH AMOUNT -______ 1)3 çç J C ç _________ d I - it S Ser cxI i z \i d-g rj/ iss a r- / oO _______ ,..Exptoer hoc ` ' ) -i cc ________ Spot flc,r -Q o . Above items received on consignment from UNIVERSE NOVELTY& FIREWORKS CO., INC. I understand payment or ret (n of merchandise is to take place within 20 days from above date. (Signature) APR 11 1996 05:10 FR TO 7800021 P.03/03 AGENT AFFIDAVIT 1. PURSUANT TO THE ATTACHED AGREEMENT, I ACKNOWLEDGE THAT ALL•MONIES COLLECTED,RECEIVED AND DUE FROM THE OPERATION AND SALES OF MERCHANDISE AT MY LOCATION MUST BE DELIVERED AND RECEIVED ON OR BY JULY 7, 20 NON COMPLIANCE WITH THIS STIPULATION TO THE CONTRACT COULD BE CAUSE.FOR GROUND FOR DEFAULT ON THE AGREEMENT. 2. I AM IN FULL AGREEANCE WITH THIS STIPULATION AND WILL COMPLY. FURTHER AFFIANT SAYETH NOT. 1 Signature Name: Connie t� Ile� Address: 5 l6,g r . r.C- C\✓r .TCG P S S# - (5y1 STATE-OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this of 7SUr1v 20C by He/She is personally known to me or has produced as identification. Signature Name (typed,printed or stamped) My Commission Expires: ** TOTAL PAGE.03 ** APR 16 1996 01:33 FR TO 7800021 P.01/01 OPERATOR LICENSE a c A 450 122 385 007 CONNIE JEAN ALLEN .. .. �; R33-F#ONYST PALO.MI I8170 tiffihl THIS NUMBED:MAt OEV 76NE0 FOR wass A son NsBM "m UGT"s EdJr�wMMe 1111: flat-1e�i a �2 wiz o Iwo t CONNI + ALLE • U...;A Cci r+ww�ri..wk�w+«k ATtlR6 - :f. .�+0`• "4 •lam I� ... ..:';.'.:. ;:„ ..�::. .li.: ..,:'.4.: N.•/80F10b1'?04S4i Je.M l.-a.._...,I,r Y•fl b Mni�.:+7a+.-:�s., C`p.dli.en JII n 1,1,1lJR+,M � All ���e ** TOTAL PAGE.01 **