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HomeMy WebLinkAbout10-10688 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780 -0020 10688 BUILDING PERMIT Permit Number: 10688 Address: 37 &, h*I R ' v Ai EY B� VD 3g 'alak Permit Type: PARK MODEL SETUP ZEPHYRHILLS, FL. Class of Work: PARK MODEL SET -UP Township: Range: Book: Proposed Use: RV PARK Lot(s): Block: Section: Square Feet: Subdivision: MAJESTI • K tj - 0690 Est. Value: Parcel Number: 24-26-21-3V" •-; , : i ; -otee Improv. Cost: 2,300.00 ; , s f �_�r , . Date Issued: 7/12/2010 Name: MAJESTIC OAKS LLC Total Fees: 175.00 Address: 8818 PC Amount Paid: 175.00 ZEPHYRHILLS, FL. 33542 -- Tru Date Paid: 7/12/2010 Phone: Work Desc: PARK MODEL REPLACEMENT 14 X 36 1111Z11° , `„A' . `' M t1 Cis ;, , 7 '.. - � : e t' w :- i P TER •N •N MH IN - A - KM•• LELE I 40.00 PA='M•DEL- U -ING 40.00 CRANDALL, RICHARD PARK MODEL MECHANICAL 35.00 PARK MODEL SETUP 60.00 PETERSON CONST & MH SET UP, INC BAHR'S PROPANE GAS & NC, INC. PkCt- (—) PA M•D L -UP PARK MODEL PLUMBING PARK MODEL ELECTRIC PARK MODEL MECHANICAL 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." - , CO TRAC •PSIG TURE PERMIT OFFI 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 Date Rued IINPTNIMIIIII Phone Carat for • , , , ...167/ 1 ' • - ■. CO # / 616 6 0..... N. Q �c (^ t� i Owner Phone Number I Owner's Address' (a 1 1 l Coi .S rk riff 3(�I (p 4h Owner Phone Number 1 Fee Simple Titleholder Name In / yi - i 4 O Owner Phone Number 1 'Y Fee Simple Titleholder Address l (� kO ( Q 0 / 2 a CA. a JOB ADDRESS - 1 ! � ! TX._ 1 •Iii /.7lyVIE , & LOT, 1 1)1 I h SUBDIVISION I Mq P ( (. ()I/CZ) 1 PARCEL ID, bar! j F - �_' AJ, l 7 " It� A L 2 (I - 26 - k (061M W FROal PROPERTY Tex NOTICE) 0 V n / 00 -6090 R ] WORK PROPOSED NEW CONSTR 8 ADD /ALT r ---, r ---, SIGN Q ri DEMOLISH INSTALL REPAIR 3/� � PROPOSED USE SFR COMM OTHER ✓ 'J TYPE OF CONSTRUCTION = BLOCK FRAME I STEEL m' i PI (J� C DESCRIPTION OF WORK 1 I 3U pCikk / / x,J� ( I 10511 BUILDING SIZE I / ' k 1 SQ FOOTAGE MN HEIGHT 41) ? T1 I t � 1 r �BUILDING 18 1 SOD VALUATION OF TOTAL CONSTRUCTION (;) 3 V Ca r1ELECTRICAL 18 300 AMP SERVICE )6 0 PROGRESS ENERGY = W.R.E.C. niPLUMBING IE 1 00 r1MECHANICAL 18 (.Jj'o I VALUATION OF MECHANICAL INSTALLATION =GAS r i ROOFING Q SPECIALTY r-] OTHER FINISHED FLOOR ELEVATIONS I FL000 ZONE AREA nYES NO BUILDER COMPANY m.2_2_14, 1 _ . �r1► . _. 11 _ .:.. 12 SIGNATURE .ice . , ,..„ s : _ - ,.. ® c*RRa, P . � / & �� Address 1 al. -! . • T ) i fl //r.9 License, ( 111 ObI/ 3Sll 1 SIGNATURE C. q M , 1 6 i /())I , � I Cl Address 1 3 1 S / ' .W� A L ` SIC (J✓� 19 c t License, ( f4 0)/a910 a91() 1 PLUMBER SIGNATURE /' 4,./ , / :�� REGISTERED I Y / N �� Y / C Address 1 . _i /0, ' _�. ft'T IS rrtpuc Liicensee, II ) II / r. tI I SIGNATURE L • � r : �(� qcthic EEC LA E/. I Y/ / c 1 r Address ' I i9' Otel n Id 7 -hit .) Fi 3341y Lim, Icy OD ( •/3 yLg I OTHER COMPANY I SIGNATURE REGISTERED C Y/ N I FEE cuRREA I Y/ N I Address 1 I License I I II III IIIuuI IIIIIIII1II I1I1IIIII,IIII11111I11I11 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/ Sift Fence installed, Sanitary Facilities & 1 du npster,, Site Work Permit for subdivisionsAai ge 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) wooing days after submittal date. Required onafte, Construction Plans, Stornwater Plans tin Sift Fence installed, Sanitary Facilities & 1 dumpater. Site Work Permit for WI new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ""PROPERTY SURVEY required for all NEW construction. 1 1 Directlons: Fill out application completely. Owner & Contractor sign bads of application, notarized N over S2500,1 Notlu of Commencement is required. (NC upgrades over $7600) •' Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing sane OVER THE COUNTER PERMITTING (Front 01 Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) Driveways -Not over Counter if on public roadways ..needs ROW NOTICE OF.DEED RESTRICTIONS: The undersigned understands that this permit may be subject to 'deed' restrictions' which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNUCENSED 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 buiktings, 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 UEN 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 goverment 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 inoude 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, 1 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 YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT CONTRACTOR . .. � � r ; Subsaibed and sworn to (or affirmed) before me this Subscribed and = • to (or : ' • me this / by . , A •• Js IP' Or Who Is/are personalty known to me or falhave produced • Is/ are • known • me or has/have produced as identification. ��/ / / /��, ��_ {)/n as identificalbn. Notary Public Minn Sn ( / ' / (// Notary Public Commission No. Com - - • No. / - Name of Notary typed, printed or stamped N: : of Notary typed, pri ed • - 7!'.`:' kotari. o,, Ntic :state of Florida CO : tW 752576 0 ..r: s u1r27F201.7 Pasco County Parcel: 24- 26 -21- 0030 - 00000 -0000 001 Page 1 of 2 I Data Current as Of: Weekly Archive - Saturday, June 26, 2010 I Parcel ID 24- 26 -21- 0030 - 00000 -0000 (Card: 001 of 001) I Classification 77 - Clubs, Lodges, Halls Mailing Address Property Value NHC -FL115 LLC Ag Land $0 6991 E CAMELBACK RD STE B -310 Land $23,782 SCOTTSDALE AZ 85251 -2493 Building $343,365 Physical Address Extra Features $50,112 3751 LAUREL VALLEY BLVD ZEPHYRHILLS FL 33542 -8408 Market Value $417,259 Legal Description (First 4 Lines) Assessed (Non - School Amendment 1) $417,259 See Plat for this Subdivision •-` Taxable Value $417,259 MAJESTIC OAKS COMMUNITY - PHASE ONE PB 35 PGS 107 -112 TRACT C I Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type I Price 1 Condition Value 1 7700Q CLUB t OPUD 1 1.88 , AC $12,650.00 1.00 I Additional Land Information Tax Acres 1.88 Area [3ozH ( Cie -- I Residential Code 3ZHR.A1 Commerical Code RRVPCL4 Clubs, Lodges, !! • 001 of 11 Year Built 1998 Stories 1.0 Exterior Wall 1 Average Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Sheet Vinyl Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 4.0 Line Description Sq. Feet Repl. Cost New 2 'FOP 1,492 $26,181 3 tIffkl 440 $7,714 1 -i A !SOWN i r4 _Qp i : cif QQ 1) rr Line Description Year Units Value 1 PAV CON 1998 1,952 $3,416 2 1 TENNSCT 1998 12,960 $22,680 3 CLFENCE , 1998 4 560 1 4 POOLCON 1998 640 $10,240 5 FIRE PL 1998 1 $2,100 6 I SHUFFLE I 2001 3,744 1 $3,510 I 7 UDU -M 2003 1 j $495 I 8 ' CANOPY 2003 1 840 $6,064 I Sales History Previous Owner 1 MAJESTIC OAKS RESORT LLC I Year Month Book /Page Type Amount 2006 1 01 6825 / 0087 WD ; $0 http: // appraiser. pascogov. com /search/parcel.aspx ?sec= 24 &twn= 26 &rng =21 &sbb= 0030 &bl... 7/6/2010 J� DATE (MMIDDIYYYY) coir CERTIFICATE OF LIABILITY INSURANCE OP ID CM PETER -3 07/01/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hillcrest Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 1364 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Mount Dora FL 32756 Phone: 352 -383 -8164 Fax: 352- 383 -5899 INSURERS AFFORDING COVERAGE i NAIC # INSURED INSURER A. Auto- Owners 18988 INSURER B: Owners Insurance Company 32700 Petersons Construction & Mobile Home Setup, Inc. INSURER C: Southern Owners Ins. Co. 10190 P 0 Box 108 INS S URER D: Ferndale FL 34729 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 POLICES. AGGREGATE LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS, 1 LT MNSRC R I N POLICY (MMIDDIYYTYY DATE (M Y) LTR SRC TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 U At IJ I<= B X COMMERCIAL GENERAL LIABILITY 72688080 08/24/09 08/24/10/47 MI ence _ s 300000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 1000000 X Non - Owned/Hired C GENERAL AGGREGATE s 2000000 GEL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2000000 POLICY d LOC AUTOMOBILE LABILITY COMBINED A X ANY AUTO 4101977201 08/24/09 08/24/10 aacderlq NGLELIMIT $ 500,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Perms) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) -.- -_ ___ -_ -_ -- __ - - - - - - -_ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ C ANY AUTO 4101977202 08/24/09 08/24/10 OTHER THAN EA ACC $ X G $100,000 AUTO ONLY: AGG $ EXCESS/UMBRELLA UABILTTY EACH OCCURRENCE $ OCCUR (. - CLAIMS MADE AGGREGATE $ $ __ -- DEDUCTIBLE $ RETENTION $ / $ WORKERS COMPENSATION NJ WC S I AI U- O (N AND EMPLOYERS' LUIBILRY X ITORY LIMBS 1 __ I ER A o ER IETO ECUBV 72 68 8 081 08/24/09 08/24/10 EL. EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS William Peterson # IH00O0354 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYZEP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Zephyrhills REPRESENTATIVES. 5335 8th St. AUTHORIZED REPRESENTATIVE Zephyrhills FL 33542 ACORD 25 (2009/01) CORD CORPORATION. All registered rights reserved.. The ACORD name and logo are Istered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) Peterson Construction & Mobile Home Setup, Inc. Po Box 108 Ferndale, Fl 34729 407 - 469 -4366 407 - 469 -5518 Fax City of Zephryhills Building Division July 6, 2010 I , William Peterson, authorize Jama Peterson, to act as my agent and sign on my behalf for all permits. I also authorize her to register my license. Please call if there are any questions @352-516-2312. Thanks, William Peterson A n Ge I (p Notary Public S ` of Florida Teresa K Yenor P • INy C 4�mmission DD752576 b pd" Exp /27/2012 • 1 AND AIC INC. ) C PROP £rce 7988 813-782-5013 4441 Allen Road — Zephyrhills, FL 33541 July 1, 2010 CITY OF ZEPHYRHILLS, BUILDING DEPARTMENT Dear Sir, Effective immediately, the following individuals will be permitted to sign and pick up Permits for Kevin J Bahr of Bahr's Propane Gas & A/C Inc. State License #CAC043948, City #17. Lenny Bahr / Jama Peterson Sandy Bahr/ Stacey Hartwig./ Bobbie Burke' Debbie Steve v' Jaime Misener f Misty Easler v Donna Moon v Suzanne Bahr " Thank you, e______.//, Z Kevin B State of Florida County of Pasco Subscribed and sworn before me this 771 day of 4)4 O 2010. ,..4,,,,-, ce , / %Lk Notary Public 1 NO'PARY PUBLIC -STATE OF FLOP I' ■ Sylvia A. Campbell -,,: Commission # Dll883699 Expires: JULY 19, 2013 BONDED TIIRU ATLANTIC BONDL\G CO., INC. NOTARY STAMP Plan Review Modular Home Set -ups and Aluminum Packages 1) All property markers shall be exposed and clearly marked at time of first inspection. 2) All set -backs shall be met. 3) All garages shall comply with section 309.2 ( Fire separation ). 4) Access shall be made available at time of inspection. 5)Manufacture specification manual, approved plans and permit shall be available at time of inspection. 6)No electric, plumbing, mechanical or framing is to be covered without inspection and approval first. 7)R.O.W. Use permit required for driveways on public streets. 8) At least 10' separation between other units. 9) All work shall comply with the 2007 F.B.0 and the 2008 N.E.C. R.O. W. - Right Of Way F.B.C. - Florida Building Code N.E.C. - National Electric Code Richard Crandall Electric, Inc. 395 Louise Drive Zephyrhills, FL 3354 ($13) 788 -3146 July 6, 2010 City of Zephyrhills Building Department RE: Building Permits Effective immediately, the following individuals will be permitted to sign and pick up permits for Richard Crandall Electric, Inc. State License # ER0012910 Stephen H. Crandall - Richard P. Crandall Jaime L. Misener .1 Misty Easler ., Kevin Bahr Jama Peterson.; Thank you, f Cali m / L Richard Crandall Richard Crandall Electric, Inc STATE OF FLORIDA County of Pasco The forgoing instrument was acknowledged before me this Co day of 3A -t f 2010. Personally known to me ✓ . � s scorrAJOI • M MY C N DD 744203 Notary J EXPIRES: January 27, 2012 , ." Banded TMuu Notary Public unwmvtrers . ,,si �;t IY ti,� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: AieVSeY) dYc,Suc% Date Received: / -7 / & //1 3 38/ 6 4per Site: � ,� �. • '' Permit Type: / /�G' ' %'/C 3( Approved w /no comments: ❑ Approved w /the below comments: 71 Denied w /the below comments: ❑ eke SL/ This comment sheet shall be ept with the permit and/or plans. 7 - 7 7-T �� /iii Kalvin z — Plan xamine Date Con actor and/or . • eowner (Required when • mments are present) BOB MGKEE 2009/2010 ACCT NO. 787 LAKE COUNTY TAX COLLECTOR LAKE COUNTY BUSINESS TAX RECEIPT RECEIPT NO. 2250000014 STATE OF FLORIDA EXPIRES SEPTEMBER 30, 201C FACILITIES/ ROOMS SEATS EMPLOYEES RENEWAL MACHINES $30.00 1 TYPE OF CONTRACTING BUSINESS ORIGINAL TAX $30.00 BUSINESS PETERSON WILLIAM W 18745 THIRD AVE FERNDALE, FL 34729 AMOUNT $30.00 WILLIAM W PETERSON TOTAL $30.00 PO BOX 108 FERNDALE, FL 34729 -0108 PAID - 6004917 08/17/2009 30.00 2089 4911k4010 WO** VAVINgt 0101411. Lam: i " rr ar License : 10 -1 -09 State of Florida - Dapartmant of Highway Safety and MOter V McIsa - DtWYion of Motor Whit Ns Jul 06 2010 2:56PM HP LASERJET FAX p..a , :., KE '" . 2000/203A •ACCT''NO1 ." 787 LAKE COUN'ty,1 x COLLECTOR• LAKE coup pS" AXtRECErip :FACla S TATE Dlr *LDRICfA : FLL -CEIPT f0 ��SOLk00Q14 iES/ EXPXREs S MEM�'30., 2010 MACHINES ROOMS SEJ4TS PLCYLYEE5 ,• EM REN.EVV/ L $30 00 *PE OF CONTRA . r \t 11#0"...-..!4-,,,,:* ` ti \ BUSINESS :BUSIN PETER�40N WII.,LIAM N► , :...„.L t . ,, 74 9 a th • AL TAX $30.00 QRI G I IY Y'8�4TN�tD �v 1 , FERIi1D4LE, FL 34 5 \ •*' . f aNILLIi W `PETERSON P O BOX 1 T1TAl S30it0 3. FERNDALE, FL 34729 .-0108 P AID -'bOD4 .3.7 '0:8/].7./2D04 -.9O.DO •' . . • • L � • • • 1 • • Ri c/ add-c) 0 ��/J �ti jai e • �J ( � coU a • l EVIEW OA *ITV OF ZEPH RHILLS P ' NS EXAMI ER (LocU2 , . OD . . n, T so v 0O 0 0 b r N Cx a to w m i ECR 55 4 �- i 1 T O 00 3,, I S � Q Wel XI OZ XI 1 Pit y co I v \ NC (0 Ov I. 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