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HomeMy WebLinkAbout10-10010 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 10010 BUILDING PERMIT :411 W,-- ,. :a Permit Number: 10010 Address: 37603 LORENA AVE LOT 114 Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: NC CHANGEOUT Township: Range: Book: Proposed Use: MOBILE HOME SUBDIVISION Lot(s): Block: Section: Square Feet: Subdivision: GRAND HORIZONS Est. Value: Parcel Number: 34- 25 -21- 0090 - 00000 -1140 Improv. Cost: 6,395.00 r Date Issued: 1/19/2010 Name: LEITZKE, JAMES & JUDITH Total Fees: 65.00 Address: 37603 LORENA AVE LOT 114 Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542 Date Paid: 1/19/2010 Phone: Work Desc: A/C CHANGE OUT 4 TON SU 'Is' H A & SILIN HAN *UT ' 65.00 C lk D IN ALL D DUCTS INSULA ED 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." CONT R T SIGNATURE PERMIT OFFI �R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813 -780 -0020 City of Zephyrhills Permit Application Fax -813 -780 -0021 Building Department -IF j Qo 1(0 Date Received Phone Contact for Permitting -- Owner's Name — 3 — /r34. 1,....t try 7 kg Owner Phone Number / / � i' a Y.f Owner's Address S? 6 £Gft (pig is' t.' Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 3 /� 6 3 '' (... 4./w� x - z. 0f' -I LOT # SUBDIVISION PARCEL ID# 3 7 4J" 1 6'°94 O //V ° (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN I I MOVE I I DEMOLISH INSTALL REPAIR PROPOSED USE I I SFR 1 1 COMM 1 1 OTHER 1 I TYPE OF CONSTRUCTION I I BLOCK I I FRAME 1 p I PA-9- I ( OTHER I I DESCRIPTION OF WORK Z �k/A 'ee4�' R-S.r 0 )T - ,u /¢ // PA-9- G'/'17 .S „ //JJ1"L BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING $ VALUATION OF TOTAL CONSTRUCTION I I ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I I W.R.E.C. C. I I PLUMBING $ ''. jA)L ' 1‹ i MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION `e� (✓ �,/- �1 I I GAS 1 1 ROOFING 1 1 SPECIALTY 1 1 OTHER it j T % FLOOD ZONE AREA Y NO e 3 - , r FINISHED FLOOR ELEVATIONS FLO N I I 1 I , . BUILDER COMPANY I SIGNATURE REGISTERED I Y/ N I FEE CURRENT 1 Y/ N I Address License # ELECTRICIAN COMPANY SIGNATURE REGISTERED 1 Y/ N I FEE CURRENT I Y/ N I Address License # PLUMBER COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N 1 Address License # MECHANICAL / a , (fii)t4/ COMPANY S v�5/'f`�'t'' /1177 i z' L. /� SIGNATURE �/ // REGISTERED I Y/ N 1 FEE CURRENT 1 Y/ N I Address I License # e4 t J /S / 1 OTHER COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N 1 Address License # 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. Directions: FiII out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C 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 A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW ,...---- e f- - /3 - e f -- 7 V q 3 7 V 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, 1 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 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 IMPR N AM ATTORNEY BEFORE FINANCING, CONSULT WITH YOUR LENDER OR AN FORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR Subscribed and sworn to (or affirmed) before me this Subscribed and sworn to (or affirmed) before me this b by by Who is /are personally known to me or has/have produced Who Is /are personally known to me as identl/fcationroduced as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped Jan 15 2010 10:36AM HP LRSERJET FAX p.1 JAN /13/2009 /TUB 04;06 PM ZEPHYRHILLS BUILDING FAX No, 813 P,002 . 1 1 ,../awuIjTu %Ay or q,o y11Nla Yannt Palm Uaa.Ae • MA Y e ,w.. WI. . elM./D01,IDM11 , • Eau R.e.hred • Can V MN — . • Ownals Mama t• rY Owner Phaa Na11Mr ' Owner '. Add... '37 `a3' ',rld,rv» X.; 1 . o...r PhD* N.MB *I • F.a .Nlp..TNMNNN Nsm4 I Own., Phase *Mb* I Pau *nuns /11/0411 Address • 1 JOSAMNON 3 6 3 ' C M >a &' ' r grtijx•.� Le/ ' • ' LAY 1 , • eue01VNIICN 1 —r . • J PAWL. 3 • PA IDAI Y# / a•* • // • . . �, • 4glima■ POW POMPOM 1411101109 • WORK PROPcBCO 8 , /A"6TR e EPA [] T IION MOVe 0 DEMOLNIN RIN • 'Maot*OlID USN' • Q t)FR 0 • COMM (=I mom' ) • .1 • '7YPi or co.sn.ucno,1 EZZI Kam ee'� Q IMAMS ' ,Q VAAL CO WI ER ( • 1 DNCNIPTIONOPWINK 'C i w ooeff . •7 /V n% • J •q T $ 4 # %ff t.# 0 suLDNIC ilia 1 I dgPOOTAOS I . • • 1 Iletallr I' 1 • . Q BUILDING IS . , • 1 . YAW ATKMI GP TOTAL CONSTRUCTION [] •tiI. wIRICAL It • , 1 AMP SERVlt:e Q PROOiirddMARCY [3 W.RB•C 4,4 ,.. 0 Pummel 1 A i kl1/4, 1 ' LW . M • , NeCIN►aCAL hillpfc JIMMIIIH v . TION OP MECNANI0A61NBTALLATION • =. oils . Q MOP • • © CPEDIAI.TY = OT111:R /9i ) / E PINIONED 'LOON !L!vAT)ON! I 1 .. !AA !Loot:zo DA , []Yie QNO U dIL PM 1- CO I atiMAlURe , I pas»n.ae I YI N J PLIBUOle1T 1 YIN 1 ` . ti Addleli I , ' ' • LIanNP - I eLeOYAICNUI I , , . • . cow AIN . ____ - J ' • , BIDNATUI ItWr b • Y/ N I •AGCulUGNI 1 YIN 1 AN** 1 • LMdNIi 1 I SIGNATURE • • 010e nilo 1 1 Y 1 N I NICUMIMY .1 YIN ( 1 **Ras I (� .. I ' IJ.anea N MiolwlteAL ( ! , L1 „I•v DOMPANY 1 S id/t' ' I 1i'4! 1 6 ,04 I OS , a110NATURA I aer�at{Na 1 'VI N I r ®C1IN11AT • I YIN 1 Adamu 1 J .Ueunw1• I &vox /4- /I I DTMlI1 • : 7. 7 COMPANY ' DIGMATURU J • Pamala.a. )' Yr N I ram was* I Y /N 1 MM.* I Limn 11 I _____1 R E S I D E i m A L . Au t 12) PIN Ma 311 t!) OMEN SutIalro P(init (1) sal WEAN* Fame: R•OO.W Pe* I far now eanSIMI1011. . ..w.nw len(IO)wc.Idnd arm ./tar auRrnllrl dmM. Roan aw*Cal.auebn PNrr SNP*MIar PM.a w! WI Fell* .NWIad. Aenll.y PsWde. i 1 dampolan Ili. WGO !moll fir *male launerra prd.vb COMMe110AL • MIAMI aemPMM Mg of IIM InG Ptenn lima a UP. tl P.D.: (t) .M al Know Pans- A•p•W Penult fer man wrouueIen MlNMvnl ten (10) 10111111110•111 MIN dpi O * d.M. Raluhsd. AIM. Co.awellan Nana Baweww Plans* am Pane. D INM.d, 0ana.y 14611411•116 1 6110001110. Nis wars P..mtlw aN new I.•ta&a. Al eammarelnN aParoa da num mw1 e.Mplanr+ ' aleN rYkMIT Alladn (1) aka oranononnd Ilan.. , ^^rAwr61YV BURyIY *BMW rat 111(IW ernwur»n• . • . e MN Dui eppllal.. camp IP*N, • • • Dam a cepi.aeler baba pi @FA GUon. no *IIsd • . II aver e2UM, a 11111.. at Dgee.aee.m .g Is N gulfs 1Al0 upgraded ever 11001) • " Agent lam" **War) in Potter NAINNaiy Ilar Ma rim) lauld IN ION** PIIR nolatlyna lofts Inn avow WIWI** 011mq • • OVwr T1 CUUNTMJ1 rIitrini (II M ApNI.uU1t+ O . Rw.Ok e 9wvlc.U IJC pause Dllv.wIye -Nat ever Comte, 1 i Ice.dw.rh.ee NOW . ' unt a w r,6,. , 12 of" Y 4 7 1 y . Jan 15 2010 10:36RM HP LRSERJET FAX p,2 JAN /13 /2009 /TUE 04:07 PM ZEPHYRHILLS BUILDING FAX ?).313-780-0021 P. 003 • • NOTICE OF peep RE5TRICTION8: The undersigned undersesnds 1het Rib permit may be nublsot to 'deed' restriction■" whkh may be more monkeys than County regulations. The undersigned assures responsibility for oempllenoe Wherry • egollebbe dead reabklon.. UNLICENSED CONTRACTORS AND CONTRACTon .RlePONBIBILITIES: If the owner bee bred s conV.alor or centrectora to undertake work, they rimy be r.qUked to be Ibe ssd h eoeordetse with stets old local regulations, 11 the emareoler te not licensed as required by Isw, both IM ewer arid contrab err may be awe fore misdemeanor violation under .lets law. 1Ins owner or blended contactor are uncertain se to what Ooenelng regulretfhe,* may'Spp»y for the Intended work, they are advised 10 *omelet the Pasco County Bulldlnp Inepeohon Division- 1.1coneing B.Wlon el 727.147. e0 oa Furthermore. . Nhermore. M the owner has b s hired contrives err eenlreciors, he l advised to have 1 eoMrecle►(e) sign portions of the "contractor Moak' of this applosUon for which they will be rmeeeneible, M you, as the owner sign as the contactor, tees may be an Nldtoalon (het he Is not properly eosneed end Is not 'Milled to permeling privilege' In Peso, yftetepOlefATION IMpACTWTILITIEa IMPACT AND RESOURCE REMOVERY PEES: Th. undsrel d u nd o ' that Traneporldio en n Imouel Fees d Rewires R'oov6 m the may apply to e ooneIruetan of new bust ktge. change use In extent; buildings, or errpenelon of sx10bng buildings. tee specified In Polio County Ordinance number 00.07 and 00.1T, es emended. The undersigned oleo understands, Ihel Such fuse. es may be due, will be banned et the erne of permitting. It Is further understood lhet T10n. artellon Impact Pees end Resource Recovery pees must be paid prior to receiving . 'oerNnaele of occupancy' or Inc (l power mime, K Ise prolate doss not trWolvs e esNlleole e1 occupancy or Aral poops, pewees, the bee must be paid prior 10 penwi heUenoa Funhe more.1 Peeeo county Weterla.wer Impact teas ere due, they must be pelts prior lo permit issuance In ecooreencs with appNoeble PU.D Courtly ordinances. CONSTRUCTION LIEN I.AW (Chapter T1/, Mori& Statutes, as emended): If valuation of Work le 12,100.00 or more, I certify %het 1. the applicant. have been provided v4lh . copy of the 'Maeda Corokuopdn Llen Lerr— Homeownees Proleatlon Oulde prepared by the Florida Department of Ate Ioulkee and, Conutmer "Ire. N the 'maimed b Someone other Nun the 'owner, 1 wiry Mal 1 nave Obtained a copy of W. above described document end Wombs In good Lehi to deliver It to Ihe.'owner prior to commencement. CONTRACTOR'UOWNER'S AFFIDAVIT: 1 oertP , IhM se the NNorm.tlon In We s pltoallon Is accurate end Met all work WN be done In compliers* wen ail applicable Mee regulating eonotruceon. zoning one lend development Application Is hereby made le obtain a web 1a de work see lnelellseon es Indicsl'o. I osrltfy that no work or Instillation hoe oommenoed prior to issuance of a gem* and that all wok will be notional to meet stenderde of 111 laws regulating • construction, County end Chy codes, zoning regulellon.. end land development regulations In the $urledlelon. 1 elbo cerey that 1 understand Met the regulations of other government agencies may amply le the Weeded walk, and that N is ' my response:E f to Ideally whir bollone !must take to be In compliant*. Such agencies Include but we not limited Ios Department of Erprbefen.nlel Protection- 00rsee Daytonds, Webend Arcs and Envbon ertedy 9.taleve Lends. WeteI WWNew.ter Trsslmgnl. • 8outllweet FPc Water Management Dialed-Web, Cypress towheads. Welland Areas, ' Altering Ar Arrmy Corp. of 6ngbnsbrs•Bew ells, Docks. NsvPOoM. W.uewuye. • • • D.eellment of Health 1 RehabNNWve Sirvi000M vbonnrenlsl Health Unu --Wdh, Weobwde Trealm.nt, Who Yank.. • US Environments' Prd1oeon Agorloy..Aebwlw ebalsmsnt• Federal AviNlon Aulhorlly%Runw.Y.. I understand Mel the fallowing reetriellons apply to Meuse 01111. . Use of fill le not meowed In Plood Zone 'V' unless emereesiy permitted. If the 111 materiel la to be used In Mood Zone "A', 11 Is understood tlest a dreelege pion eddreesing e 'oompenseeng volume' we be submitted al Ums of permitting whloh te prepared by • professions' engineer Deemed by the 81s1e of Florida. If Me 111 mele1N Is le be used in Flood Zone 'A In cemeollon with . ptrml1ted Wilding using stem wail oonetrudeon,1 certify Mat IN Me be used only 10 IN Ina area Whin one lies well, 11. I11 rndbdSl le to be used In any .yea 1 witty Met u.w of such ft wit not adversely offset .dfeowl1 • propedlee. 11.use of fill is found to adversely ailed ed)eoallt ptope1Pe. Inc owner may be ailed far vloleling the conditions of nho bulldbng psrmll issued under the uric reed panne sppllc.Uon. for lots less then ens (1) we welch lie stewed by 1111, en engineered dreknegu ohm* required N 1.m the AGENT FOR THE OWNER; 1 promise in good Mb to Inform the owner of the permitting candsbns sit forth In We affidavit prior to oom nsnodng oombuollon, I understand list • separate p.rme may be required for Wedded work, plumbing, etgns, wells, pools, sir oondntonbtp, ode, or other InsPNdtions not .pec$bmby Inoluded In 10..ppl,oaUor, A permit issued dieN'be ooasuued to be s license to proceed with the work end riot as authority b•Wclal', ounce aster, or e►M set aside any prlone Of the learaslod nodes, nor end is r issuance of e pet prevent the Guiding 0011311 frees molter requiring e weree0on el wore In pierns, oonshuallon or vloWlone of cry codes, Every permit Issued shall become Irwilld unless the work aumarlssd try such permit le commenced within sbc menthe of permit Issuance, wit work adlhol7ad by I permit le subsended or ebenden.d for e ported of six (a) menthe sear the Ilms the work Is commenced. An extension may be requested, In writing, tom the Bolding 011dd for period not to .ewed ninety (so) drys end w!N demon.Mete• Iuslleable souse for the extension. If work o.essi for nine* 100) oonsecunve day., trek b Is considered abandoned. PAWN* T MYMhMYMrR0VE1Al f TO YOUR PROPERTY. Er YOU I T DETAIN FINANCING, CONSULT ameninularnamis • 1MRH YOUR FLORIDA JURATII , l7rAa � s omen Demeter • f 1 aoITe.sevo I) j ed il:': IiJ� Ii'i- l�'� ►'.l,iT: t;. �r.4' ". i:�"� /ii " /J a':...., ,"a.; �,►.. .. a ,.rr'r.T7717771 ' nude pm• as Iden'l.lto. as Ida eweeM1 polo 14/ /! Al4h_i_HNarPubgo commeeeereh 1 5 /9" raendreen • D ill ¢' s � • ed. pen eta or Notary ,r1 err s tip' FORTUNA R. MUSINSKI FORTUNA R. MUSINSKI MY c%IMIOSION #DD8'11747 MY COMMISSION #D0551747 "' EXPIRES: MAR 18, 2011 EXPIRES: MAR 19, 2011 7 17- - •• , , . d b 1 et Sit! Insurance �' Bonded by 1st Stele Insurance I • .•r ,. ._ •_ _ ......... .... • • taunIVNUI.0 1 = ^ • , , , , , , • in i r'.1:11Cr ... .. . , . .■ . . . ,.... 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M. iit 1 e, I. ,.. ,... r . . . ... ...' - , _, • , . XEJJ 13CH3SU1 dH W1J96:01 0102 ST ue e . d Jan 15 2010 10:39AM HP LRSERJET FRX p,4 01/13/2010 10:41 7273443261 INSLRANCE RESOURCES PAGE 02/03 ■ j .. o ATI nP4rDShvvvJ t AC_M/A ADDITIONAL INTEREST = 2• . AeaNCY ( e, (727)345-0242 APPIICANTpINN 01' I , (1131 054 3449 " 1 Superior Nesting and Cooling Management Inc ``• —•--' Insurance sources, LLC X 705 Dunbar Ave 6620 sat Avenue Mouth Oldsmar 9'L 34677 8t. Petersburg FL 33'707 iPPICTtVa0ATI IPIRAT0NOATt 00A COM T WIVOII: 1/0/2030 1 a1 1/8/2011 First, HsrcurF AM6- AoeNcv cu4roMeN m P4ILIC4 NUMUb lmnewal _af F?*B►001709 -2 09009330 AeoOUNTN1NIaaR+ - 7INlaT `RANI(: NMII AND AOOREIe 1 Rat l INCl MI I X RI01NPIO OMA1IT IN XXIN NUMaiR 000111011A6 aeuulD M1C RIp kory N. Mobil• Nose Part LEMMA: jJItaNBt - LeuPAwa 3.601 Josephine It Mu: 1101171 MON GIMM Lakeland, FL 33 915 I CNsoULeD Rs1 swam onus , Lawman lMPL0 !eAILI4em , Pax:772- 207 -1827 A, aersieieat a I1•34se ITEM OIIOaIPloWl , Wins 1IANR• i Naga ANDADOMIS 1IeNe4411004: 1 A 1 caalmcallneunistl oraRaaT INITEMNIIIMR ADOmONALINEM O City of Plant City LocanoNI LCUILC•Net _., LORI MN 302 W Meynolds It VINNCL1 I MT. mummer Plant City, PL 33563 mum D ITaeNUMIIIN OTNIR LIENNOLaIR e$PLavatASLIIU011 9'4x: B13 609 - 4227 h i_ es. tandem Bold•r rfaMCls0NP41011: Wimp 1 RANRi NAMa AND WAIN LRaIININCa 1 x 1 DIRTIII'J1'11 noun, steam MRIMNINMIlA igloo NAL PNIUNao City of Oldsmar 1.00ATINA w1LDIMa: koss AATIe 100 State 8t W VlNIGLet MI: MORTOAats Oldsmar, rt. 3467/ SDIXDULBD MX NUM/e111 OTHIX ...0 LIINNOLOIR INPLOVat e aLIIIO R Fax: 813 -8S8 -2730 r.— r az II Ta ole tille se a �• t t N I AN N D A Pf101�k M/Rp i Matt NAM4 AO ADORIM FRIFIRaNCe X ERrnCATa Na�aNlO INTaRE0TN11TIMNUNaaN _ AopTIOI(Al N1$ti eo bun City Center Commu•Aaty Association ►o0ATR7N: ∎ MAMA Lon PAM Mtn Susan VIDINst sOATI -- MOaTtIAOIC 1009 N Pebble Beach Blvd IOINOUt1D UINNOLDIR Bum o st City Cnte FL 93573 +ODOR sePLOTee AD LIMOS Fax: 613-634-3406 ILS2WI !vato Delfts WW1 0111131111p: II•TIMR }1144111 NRMt AND AOOt1Iaa rNeASINNNCI A 1 x 1 CIRTIROA11 RIcumi0 s u TIN ITIM NUM MI ADOIONALINIUND sunbelt Santdal LOCAI1CNt lessusis; Lae PAWS 125 Forest Lake mlvd VIIMOL& T' MOI1TOAIe4 Oldsmar, LF 34677 SC NOM CD MIX NYMNR: OTNIN Lawmen IMPLOTIi Al Leese lPS : 819 -854 -3915 , X Corti! I.=to Helder ITMal10BICPI I10NI: INNIIT LAI N NAME AND ANSON 1 MOPMINOIS: -..-- 77 . 0 — XSTIPICAls 4041411101 I14121NTw weal* ADDlnemAi.Paulen city of Brooksville Building Division 1.0044111h ?LOO LON PATS! 201 MOMa11 A►ve ��• IO WORT0A04E Brooksville, FL 34601 I0Il011LEO MANNA A Wniel LwNNOLDfl winCroll A4leSsoR _Fax: 352 -544 -8306 X , CereiILwta Midair 11IM 01114140110111 mutes, 1 NAM NAYI £ND AMMO I'MINIMS It I i cawni10ATI RIOIRRIO IN1IRa M ITC A NUMUt _ ADCRIONALaalNtaN • LOCATIONt mN1.0tN0: VINICLII OW. -- LOea►AYai IONIOULeD INN N{AMM MORTOAOaa 'OT es LaNNOLO/R IIMO'fII AS LU XOR �• „ OIIaNaP is ACORO Al (2001104) •ACORO CORPORATION 180: IN0049 Iol040 a € � �� ���� 2w %of' City of Zephyrhills: 46 Pt Building Department Phone: (813)- 780 -0020 Fax: (813)- 780 -0021 TO:BOB FROM: JACKIE FAX #: 813 - 814 -9374 FAX #: DATE: # OF PAGES including cover sheet:* 3 3 E i t [ I d I ! t i t MESSAGE: Hello, I have a application that was left for a a/c change out. What I will need to process this for payment is: 1. Business liability insurance 2. Business workmans comp r E 3. A contract for the job 4. Please sign the back of application and have notarized. 5. Need to fill in the valuation of the job in the mechanical dollar space. i t 8 { ! E All this need to be done before I can process the application for payment for a permit. If you have any additional question call me at 813 - 780 -0020 ext. 3513 9 ; Thank you s E E E € E E t Jackie 3 g S ; 1 # I E E E