HomeMy WebLinkAbout10-10871 CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 10871
BUILDING PERMIT
� 9
Permit Number: 10871 Address: 6031 16T ST
Permit Type: DEMOLITION ZEPHYRHILLS, FL.
Class of Work: 636- DEMOLITION Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02- 26 -21- 0180 - 00000 -0030
Improv. Cost: 4,900.00 � " £
Date Issued: 8/27/2010 Name: GREENPOINT MORTGAGE FINDING INC
Total Fees: 75.00 Address: 7105 CORPORATE DR MS PTX B35
Amount Paid: 75.00 PLANO TX 75024 -4100
Date Paid: 8/27/2010 Phone: (972)744 -0568
Work Desc: DEMO UNPERMT WRK DETACHED/ ATTACH GARAGE/BATHRM /SCRN RM
":- • •� -I • L D •L I•N 75.0.
N S . t co(cePti.emerr
04-1 c1V
16r1 •
INAL
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 recordin • r � r notice of commencement."
�ONT' CTOR SIGNATURE PERMIT OFFI 7 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 / ^ y /
Gate Received / Z /� 0 Phone Contact for Permitti O G 1 3 3 cti _ � � Q l (/ / (1 /
�
e.
Owner's Name r nk 0 ' P(( J Y Ian •, Cry Owner Phone Number 1 p l. 7L J I ^ Z
Owner's Address 2375 / leldill . 311CGll,Pi 4 on,l / - 5O2Z. Owner Phone Number Ft — 74PO - X % 1/
1� W
Fee Simple Titleholder Name { )1\1 t lO r r �,�«
T° 1 � p
r rat:R I ) Owner Phone Number
Fee Simple Titleholder Address 1 uJ Cofpo . CS Plan CI TN 7r0 D--1
j , C _ r
JOB ADDRESS 6 DS I t (ooh 9 1 2 1 yl)T L 3394 Z— LOT # 3
SUBDIVISION Pctr k }} 11 PARCEL 10# 62- Z 1 vl b — CCOOD — o 0 5 0
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ® ADO /ALT I I SIGN n DEMOLISH
INSTALL REPAIR
PROPOSED USE „ IX"' SFR El COMM I I OTHER I I
TYPE OF CONSTRUCTION l>J BLOCK FRAME I I STEEL rr r-i I I /��
DESCRIPTION OF WORK Ia o On ft rMrI4 \ t)orL �"eecpu,�r� - J r \(fp2 lo-, (- u 4J
' F✓�i2 40(31r/a
BUILDING SIZE I SO FOOTAGE /5C0 HEIGHT / J/OL)
i
I.BUILDING $4 / 7
i \ VALUATION OF TOTAL CONSTRUCTION
I (ELECTRICAL $ ! V AMP SERVICE I PROGRESS ENERGY = W. R.E.C.
I $
1 (MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
( GAS ( ROOFING El SPECIALTY 1 1 OTHER . 40'4111h. FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA [(YES
BUILDER COMPANY I . i / eh , l �
` . . .
SIGNATURE - 7 /// � Q ✓ /' / p
7 REGISTERED f') N 1 FEE CURRREN I Y / N c' — I J
Address LL/ 7 Bah C, 1
e. , q T 476, A 7 License # Ic&c. ` S/S / / &,
ELECTRICIAN COMPANY I
SIGNATURE REGISTERED I Y / N I FEE CURREN I Y/ N I
Address 1 License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREE I Y/ N I
Address 'I License #
MECHANICAL COMPANY I
SIGNATURE REGISTERED I Y/ N I FEE CURREN I Y/ N I
Address License #
OTHER COMPANY I
SIGNATURE REGISTERED I Y/ N I FEE CURREN 1 Y/ N I
Address License # I
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forams; 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. Alt commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
"PROPERTY SURVEY required for all NEW construction.
1 1 1
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (A/C upgrades over $7600)
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 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.
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 slate 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 property licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACTIUTIUTIES 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 52,500.00 or more, I
certify that 1, 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 t have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner prior to commencement.
CONTRACTOR'SIOWNER'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 - Welts, 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 win 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.
111 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 FINA G, CONSULT
WITH YOUR LEND zc - +i:+ 'TTO EY BEFORE RECORDING ¥0U • ita •FCk: —, ,_�a .ii q, T.
FLORIDA J URAT (F. S. 117_03
OWNER OR AGENT & —_ CONTRACTOR ���
Subscribed and sworn to ( 5 7 " . . . A • - me his Subscribed and sworn 99,,(or - • wined) before = ' is
by 2. - by ( o e o h lh h ,
ire personally kn•wn t• a or h: I,. ave produced 2 /are personally known to to m me or hasaye ve produced
ay 11 as t'.i. :tion fp L as identification
if q /' )
-1011/ _.� — i 7'i 1f _ Notary Pubtic Notary Public
Cim mrs - ion No. Commisswn No. 3- 7 — {
It "7 $thwiri
Nam: • ■ _. or .t:. Name of Notary typed, printed or stamped
1` + OROBAH FAKHOURI
,ot el; - ; SHANE M. STRATTON
t Commission # 1764387 4:
i i r7-;.: Notary Public - Cafifornla i ; *; p ; *`_ MY COMMISSION # DD 6«�.
� J Ventura County ,7! : $. EXPIRES: March 1 10
..., Bonded Thru Notary Public 1,lu F ,,: .
MYri t �esAt,128.20i 1
NOTICE OF COMMENCEMENT 4I 201012750V.
i 11[ 1 II VIII IIIII IIIII VIII VIII IIIII11111111
QQ Rcpt:1324415 Rec: 10.00
Permit No. I ®p7I DS: 0.00 IT: 0.00
„_ X 09/07/10 i). Ziegler, Dpty Clerk
Property Identification No. 02---0(0---2:- _ L� O DC. 00 •-(J( >
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property (legal description:) Pttrk i ) SJ b ()Art 1 PR ! t4 P'V 70 Li> — 3
a) Street Address: (i • i>3) 1(v1' Sirrt'� 2� r 1 J 1 S 1P L 5�- -i i -
2.Gene al description of improvements:
• ' v1 ∎. 1 R (,tj r t, 1 J / PO(4) eXt rz 2 . " r t/) 02-cto
3.Owner Information �+ ll ,^ _ n -!
a) Name and address: r�ln�Dr 1�M12i1C 7S (� �/1 V l �e L>r, F► C�'lc -�s'"� � i�Z—
b) Name and address of fee simple titleholder (if other than owner)
c) Interest in property CAA) ne_.(
4.Contractor Information
a) Name and address: f'IA-1U �? em 5 �lt)C -I o!) L 6 Z - O ) c- 47 f'6i FL_ 336z Z
b) Telephone No.: i . t L> -- ST> i c j Fax No. (Opt.) 3- Ll fs'
5.Surety Information
a) Name and address: (• PAULA S . 0' NE I L , Ph . D . PASCO CLERK & COMPTROLLER
b) Amount of Bond: lJ 09/07/10 11:00am 1 of 1
c) Telephone No.: Fax No. (Opt.) _ OR BK 8413 PG 513
6.Lender
a) Name and address: __
Phone No.
•
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.) •
S.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: t-- 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 13Y 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, CO _ 1 T YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE 9F CO 114 =' _ EMENT.
STATE OF-F6QRTAA
COUNTY OE.PASCO \J 21')i't 3 rt-, \
Signature O r or ...er's Authorized Officer/Director/Partner/Manager
Z../An-) el
Print Name
The foregoing instrument was acknowledged before me this,.//' 1 day of '' 1.1 , 20 'L. , by ` , yc.'r ` t Z, t (- ;' `.v 'U t'v
as v' i ';' (type of authority, e.g. officer, trustee, attorney
in fat) for . me of party on behalf of whom instrument was a ecuted).
Personally Known OR Produced Identification , I Signature • ]
1.
Type of Identification Produced Name (print); t( 1 ('l
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, 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.
Signature ofNatural Person Signing Above
FORMSINOC rved2007
.. OROBAH FAKHOURI
r ,,; Commission # 176438
Notary Public - California
�t'h -j ,, Ventura County
. i ` • `� Ccaltrn, pig *es 28, 2G 1 t
sTQTE OF F" ` FOREGOING O IS A
THIS IS TO* R � �; . HE DOCUMENT
ORU L R e ' 7 It"' 1 THIS OFFICE
IT N f" � 1 THIS
W A 4 NE: r r %' 2 _,02.442'-.
; r r .; _ > TROLLER , .1i
f '
Hybrid Construction LLC
P.O. Box 20851
Tampa, FL 33622
-
p: : 813 13- 300801801
9
F: 813 - 489 -2524
CSC #1513916
Estimate
•
8/23/2010
Submitted To: Asset Mgr: Submitted By: Work Type:
Agent Brandon Leske Residential
Yvette Pazos C/O Bank of America blgskeetamoabav rr.com Commercial
Exit Express Realty 2375 N Glenville Bid B Remodel R/C
Richardson TX, 75082 REO /Fore.
Property address 6031 16th St, Zephyrhills, FL 33542
Site Meeting 8/20/2010
Sept:* of Work: Approv'd?
1 Option 1: Return Spaces to Original Condition
Detached Garage work: Denno drywall covering any electrical work. Demo and/or repair electrical
work in place to be approved for pent* and inspection. Remove existing stairway to loft and replace
with a ladder to loft. if possible.
Screen Porch Work: Deno all drywall, walla. electrical, etc... in order to expose the screened porch
to its original conrdtton. Price assumes hidden structure of porch Is to remain as Is with no further
work following demo.
Attached Garage Work- Every attempt will be made to salvage as much of the current condition as
possible. Work to be based on City requirements and approximately to include: Remove drywall as
•
necessary to expose electrical and plumbing as required by inspector. Remove AC wall unit and
patch with block and stucco. Remove wall and drywall in front of front window. 11 allowed by City.
finish off and extend central air ductwork into room. Repair electrical and plumbing concerns as
required by City inspector upon review.
Includes general conditions, labor. materials, permit, and lee.
Notes Includes Before and After Photos.
Price based on contractor spec and selection. Specification changes or requests may result in additional costs.
Price is based on contractor site inspection and imled to scope described above.
Price penning permit approval and inspection approval process.
Price based an contractor assumptions and conversations with City officials. Exact scope to be determined during
course of City review and processing.
By Signing this document, the contractor is hereby authorized to perform the work approved and will
Approval be paid according to the amount above. If a third party banWowner is responsible for payment and
does not pay, on signing shall be responsible for payment.
Sig
g �r
Print Name CE1
Company ifft/
Responsible Bank/Owner Name
1 af1
NOTICE OF ELECTION TO BE EXEMPT
^; read the instructions before compacting this application. Print legibly in each data entry field. If this application contains incomplete or
,,dormation or if the handwriting is not legible, it may cause n delay in the issuance of your exemption.
ON 1:
'Applicant Name (please print): 1J f) Al7r) Sice_ .
Applicant's social security number: - g CP f / 04 -1 / 5Z.9
Applicant's E -mail address (optional): bit°.S kt: (%. - a M)61 ban n rC CO1V1
SECTION 2: I am applying for exemption as a (You must check only one box in this section):
CONSTRUCTION INDUSTRY (S50 FEE REQUIRED) - The Division will accept a money order or a cashier's check made payable
to the DES WC ADMINISTRATION TRUST FUND.
❑ Officer of a Corporation (Title): -OR- [ Member of a Limited Liability Company (LLC)
NON- CONSTRUCTION INDUSTRY (NO FEE REQUIRED) , `
❑ Officer of a Corporation (Title): • )
An officer electing an exemption under Chapter 440, Florida Statutes is not entitled to benefits under this chapter.
SECTION 3. The corporation of which you are an officer or the limited liability company of which you are a member must be
registered and in an active status with the Florida Division of Corporations. Applicants applying as an officer of a corporation must
be listed as an officer of the Corporation with the Florida Division of Corporations. List the document number (document number
shown on our Annual Report) on file with the Florida Division of Corporations..
LOBOuoO( 30$ I )31(k
SECTION 4. This exemption application applies only to the person signing the application, the Corporation/LLC that is listed
below, and the scope of business or trade listed:
Name of Corporation or LLC: ' (1 �. cn on WC- FEIN: gOOZO 5g
UUUUUU AS REGISTERED WITH THE FLORIDA DIVISION OF CORPORATIONS
Business Name: Phone: (813 ) 3
IF APPLICABLE - LIST FICTITIOUS NAME; DOING BUSINESS AS (DBA); ALSO KNOWN AS NAME (AKA)
Applicant's Address of Record: ) Z-1Z ga Clot? Gir o)
INCLUDE APARTMENT OR SUITE NUMBER
,1 i
City: ) G i✓) pCq State: FL Zip: 3 3 ( 7 County: PIA Orot-91
Scope of Business or Trade: 1. co it C 0.4er t*r 2. ( - L ! t hL ,-. 3. RePGAI : 4. 2eivictki
SECTION 5. List all certified or registered licenses issued pursuant to Chapter 489, F.S. held by the applicant, or the certified or
registered license numbers held by the qualifier for the c• • .lion or LLC listed on this application of which the applicant is a
corporate officer: C. C7 e; .. . 1 S 1 S 1 Co a ria
SECTION 6. If you have submitted an electronic payment for this application, write the transaction confirmation number in the
following space:
SECTION 7. Are you affiliated with any corporation (including LLC) other than the corporation (including LLC) to which this
application applies? ❑YesJNo
IF YES, PLEASE LIST THE NAME(s) AND FEIN(s) OF THE AFFILIATED CORPORATION(s) OR LLC(s):
NAME: FEIN:
SECTION 8. If your corporation or LLC is engaged in the construction industry, you must provide the required proof of
ownership in the corporation or LLC.
A. To be eligible for a construction industry exemption as an officer of a corporation, the applicant must be a shareholder,
owning at least 10% of the stock of the corporation. A COPY OF A STOCK CERTIFICATE EVIDENCING THE
REQUIRED OWNERSHIP MUST BE ATTACHED.
B. To be eligible for a construction industry exemption as a member of a limited liability company, the applicant must
• confirm ownership of at least 10% of the company. THE REQUIRED OWNERSHIP MAY BE ESTABLISHED BY
PRODUCTION OF DOCUMENTATION REFLECTING THE REQUIRED OWNERSHIP, OR BY
SUBMITTING A STATEMENT ATTESTING TO THE REQUIRED OWNERSHIP.
THIS APPLICATION IS CONTINUED ON PAGE 2
DWC 250, NOTICE OF ELECTION TO BE EXEMPT - REVISED 12108; RULE 69L- 6.009, F.A.C.
Jacqueline Boges
From: Bill Burgess
Sent: Tuesday, August 24, 2010 10:18 AM
To: Brandon Leske
Cc: Jacqueline Boges; Bobbie Swetland
Subject: RE: 6031 16th St House
Good Morning,
Numbers 1,2 and 3 all sound good.
A $75.00 demo permit is required and a minimum $52.00 permit (possibly more dependent on valuation) will be
required to replace stairway. As an alternate per your other e-mail the bathroom can be salvaged but may require some
removal of finish material if deemed necessary at time of inspection.
From: Brandon Leske [mailto:bleske @tampabay.rr.com]
Sent: Monday, August 23, 2010 3:26 PM
To: Bill Burgess
Subject: 6031 16th St House
Hi Bill -
I spoke with you last week about the permit issues with the above /below referenced house. It appears the Bank/Owner is
probably going to pursue the option to demo unpermitted work back to the original state. In order to do this, my plan was
to do the following work:
1. Detached Garage - Demo existing hung drywall and demo electrical installed. Remove and replace stairway up to loft
area, if possible.
2. Build out of Screen Porch - Demo existing drywall and walls, electrical, etc... in order to get it back to a screened
porch.
3. Build out of Attached Garage - Demo Bathroom, demo wall in front of window, demo Ac window unit and fill in hole with
block, and remove any electrical work not associated with the original house (mostly in the bathroom portion).
Do you believe this will satisfy the concerns of the building department for the unpermitted work?
Also, do I just need to pull a demo /repair permit and what documents do you need in order to pull the permit? What are
the permit costs?
Thanks in advance for your help.
Brandon Leske
Hybrid Construction LLC
Commercial - Residential - Remodel - REO Property Preservation
P: 813- 300 -8019
F: 813 -489 -2524
bleske @hybridgc.com
CGC 1515916
www. hybridgc.com
1
Forwarded Message
From: Bill Burgess < bburgessOci.zephyrhills.fl.us>
Date: Thu, 5 Aug 2010 09:27:30 -0400
To: Yvette Pazos <yvetteOteamfloridachoice.com >, Bobbie Swetland
< bswetland@ ci.zephyrhills.fl.us>
Cc: Gene Brown < gbrown@aci.zephyrhills.fl.us >, Kalvin Switzer
<kswitzerftci.zephyrhills.fl.us>
Subject: RE: 6031 16th Street property
Good Morning,
To the best of our knowledge the detached garage "shell" addition was constructed with proper permits. Further
investigation (inspection of interior) will be required to determine if electrical service was installed without permits. If
electric was installed in the detached garage removal of interior finish materials will be required and proper permits
shall be obtained.
It also appears that the attached aluminum porch and garage of the main structure were renovated without permits or
inspections. These two areas will have to be returned to their original state or interior finish materials removed and
reconstructed with proper permits and inspections if code will allow.
Bill Burgess
Building Official
City of Zephyrhills
2
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F ey
' Y x s OLLARS a
Ir■I Q FO RENT U
V Q FOR R 2
Q CASH 0
AGGT 0 t218 FR°°rt? Dollars
AtfAiD
"^ �
DUE o . 1 .
Gp3 trs NON NEGOTIABLE
Retain this copy. Serial No required for any future inquiry .
rtemmer CUSTOMER COPY
-__ _cxemptionirom m - pro r1SrOns or the Workers' compensation law to the Division of Workers'
Compensation. THIS RECEIPT DOES NOT CONSTITUTE PROOF THAT AN
EXEMPTION HAS BEEN ISSUED TO THE APPLICANT. AN EXEMPTION SHALL
BECOME EFFECTIVE WHEN ISSUED BY THE DEPARTMENT.
DATE RECEIVED: 08/19/2010
APPLICANT'S NAME: 3 (7.Aj e(\ 1--e4�-
BUSINESS NAME: - 47)¢jfc\ on
Receipt Completed By: K. HLAVKA
The Division has 30 days to review your application. The Division will either issue a Certificate of
Election to be Exempt or notify you by mail that your application is incomplete and what
information or documents are needed to complete the application. The Division reviews and
processes exemption applications in the order they are received.
You can visit the Division's website at http: / /www.myfloridacfo.com and click on the Proof of
Coverage icon. As soon as the Division issues your exemption, it will be reflected on the Proof of
Coverage database and your Exemption Certificate will be mailed to you the day after it is issued.
The exemption application was received at the following Division of Workers' Compensation
Office:
Bureau of Compliance
1313 N Tampa Street
Suite 503, Park Trammell Bldg
Tampa, FL 33602
Telephone (813) 221 -6506
Pasco County Parcel: 02- 26 -21- 0180 - 00000 -0030 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, August 21, 2010
I Parcel ID 02- 26 -21- 0180 - 00000 -0030 (Card: 001 of 001)
Classification 1 01 - Single Family
Mailing Address Property Value
GREENPOINT MORTGAGE FINDING Ag Land $0
INC Land $19,056
C/O GREENPOINT HOME LOANS
7105 CORPORATE DR MS PTX -B -35 Building $55 987
PLANO TX 75024 -4100 Extra Features $4,550
Physical Address Market Value $79,593
6031 16TH ST Assessed (Non - School Amendment 1) $79,593
ZEPHYRHILLS FL 33542 -2601
Legal Description (First 4 Lines) Taxable Value $79,593
See Plat for this Subdivision ,4
PARK HILL SUB UNIT 1 PB 14 PG
70 LOT 3
OR 8354 PG 1742
Land Detail (Card: 001 of 001) I
I Line II Use I Description I Zoning II Units II Type I Price I Condition I Value
I 1 II 0100 I SFR 00R2 1 8,285.00 1 SF $2.30 I 1.00 I $19,056
Additional Land Information
Acres 0.19 Tax Area 30ZH FEMA Code X I Residential Code PAHILP1
I Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1978 Stories 1.0
Exterior Wall 1 Concrete Block Stucco 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 Carpet Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 2.0
I Line _ D Sq. Feet Repl. Cost New
I 1 Description
BAS 1,472 $57,555
I 2 II FOP II 56
II 47
I 3 II FEP 168 $4,614
I 4 II FDG II 616 II $9,619
I Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 DWSWC 1978 675 $540
2 CON PTO 1989 280 I $410
3 UUS I 2003 II 440 II $2,363
4 DCFENCE I 2006 71 1,104 I $1,237
Sales History
I Previous Owner 11 TRANTHAM MARTHA J
I Year II Month I Book /Page Type Amount
2010 I 06 I 8354 / 1742 CT I $0
I 2006 II 02 II 6862 / 1178 II WD II $175,000
I 2000 II 05 II 4377 / 0824 11 WD II $62,900
http: // appraiser. pascogov. com / search /parcel.aspx ?sec= 02 &twn= 26 &rng=21 &sbb= 0180 &b... 8/27/2010
- r
-411 : STATE OF FLORIDA
`-'
4S „ - t f_�; DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
w , -- CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
:. . 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
LESKE, BRANDON
6 " °° - °°(9'
HYBRID CONSTRUCTION LLC
P 0 BOX 20851 613 — (1 �( - 7
TAMPA FL 33622 --C -z 7
Congratulations! With this license you become one of the nearly one million . ▪ �, ` ' :) 1 ' .fil
Floridians licensed by the Department of Business and Professional Regulation 1 , a . 4 '` n? g 5 y ” `® .:
Our professionals and businesses range from architects to yacht brokers, from a a : .� ; ,, gta x ,. •y t. },� .� ." . • ,y
boxers to barbeque restaurants, and they keep Florida's economy strong. �` 4 r J €>'� , k ,. ,u, '
Every day we work to improve the way we do business in order to serve you better ` t a„ • - ; � > i
For information about our services, please log onto www.myfloridalicense.com -;: e.a �w m = w .. . :t t
There you can find more information about our divisions and the regulations that " a r ▪ y'"' �ti Y--$ `: ri.. r ;I 1, 1 -.
impact you subscribe to department newsletters and leam more about the rX .� '- k X ,,
Department's initiatives. y� a � ' ,a J y , y. }
Our mission at the Department is License Efficiently, Regulate Fairly. We ' .�' '�, , '4 a ' ' , - . +� ' �'
constantly strive to serve you better so that you can serve your customers. 's . G -'k . .r
on 4'E 1 •`; * ng,,c44)F " '�' ° r
Thank you for doing business in Florida, and congratulations on your new license! z, t, J� " �i ° ; ▪ . ' . '
DETACH HERE
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AW ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD"YYY)
6/14/2010
PRODUCER (727) 521 -2100 FAX: (727) 528 -0626 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Comegys Insurance Corner ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Florida Contractor Insurance ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
One Beach Drive S. E. Ste. 230
Saint Petersburg FL 33701 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Bankers Insurance Company
Hybrid Construction, LLC. INSURER 8:
Brandon Leske INSURER C:
P 0 Box 20851 INSURER D:
Tampa FL 33622 -0851 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 OFSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRADD'L' POUCYNUMBER POUCY EFFECTIVE POUCY EXPIRATION OMITS
LTR INSRD TYPE OF INSURANCE DATE IMM/DD/YYYY) DATE (MMIDD/YYYY)
GENERAL UABILITY EACH OCCURRENCE $ 1, 000 , 000
X COMMERCIAL GENERAL UABILITY PREMISES (Ea occurrence) $ 100 000
A CLAIMS MADE X OCCUR 090420000544901 7/3/2010 7/3/2011 MED EXP (Any one person) $ 10, 000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY JF° LOC
AUTOMOBILE UABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS - (Per person)
HIRED AUTOS BODILY INJURY
NON -OWNED AUTOS - (Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE UABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS I UMBRELLA UABIUTY EACH OCCURRENCE $ _
OCCUR CLAIMS MADE - AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WCSTATU- OTH-
AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
It yes, desvibe under
SPECIAL PROVISIONS below EL DISEASE - POLICY UMIT $
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DBPR DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
1940 N Monroe $ tr NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Tallahassee, FL 32399
IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
M Mercurio /JESSIC
ACORD 25 (2009/01) 01988 - 2009 ACORD CORPORATION. All rights reserved.
INS025 (200901) The ACORD name and logo are registered marks of ACORD
Fm:MyFax - Brandon Leske To:Building DepartmentZephryhills (18137800021) 15:35 09 /07 /10GMT -04 Pg 01-01
NOTICE OF COMMENCEMENT I II I I III I IIIII�IUIII 'IIIIII�IIUIIIII 1111IIIIIIIII 111
Q Rept:1324415 Ree:.10.00
Permit. No. 1 087 1 • DS: 0.00 IT: 0.00
,�
09/07/10 D. Ziegler, Dpty Clerk
Property Identification No. Q2.-( "Z I 01 D..) �7UC�GU-- -1 -� ._._ .._- ._.
THE UNDERSIGNED hereby give informs you that the improvement will be made to certain real property, and in accordance with
Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
t ile_ ihl i • • SJ b OA i-}- 1 PR i�-t PC:r (- T _
1.Deseription of property (legal description.)
a) Street Address: 603 I f (Ain >•irrP e / 7� ply f`kj) `. 1P L 33-V-/ Z- _
2.Oene :I description of improvements:
LPL • VA* -M1 -r W.. a ... , ✓. _ , ....:1....., . • / s• t y.7
3.Owner Information de
a) Name and address: _c . (tj NNutb[.t 1 7S al eny•1 le_
• b) Name and address of fee simple titleholder (if other than owner)
c) Interest in property t A):Nt_e
4, Contractor Information fb _-
a) Name and address: _ i & C ,-it L
D 0. cc_ fb &L76 ZO ) `
— 7 p ft-33402 Su 33402 Z-
E b) Telephone No.: _ 1 _trio
?t=>" i r1 PaxNo. (Opt.) 5 �
$ 1 5 - -- Z.c"
5.rety Information
a) Name and address: /1 ( fit _PAULA S.0' NE1L, Ph.D.PASCO. CLERK 8 COMPTROLLER
b) Amount of Bond: l—V/J- 1 09/07/10 1 of 1
c) Telephone No.: Fax No. (Opt.) _ OR BK "'1' 1 * 1 P5 513
6.Lender — — — —
a) Name and address: ` /4"
. Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
h) Telephone No.: Fax No. (Opt.)
&In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13 (1)(b), Florida Statutes:
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 AFTERTHE 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 1'AYIWG 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, CO 1 T YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE 90 co t , ' .M ENT.
STATE OF4 s,8flfNA C1 '
COUNTY Ou E .$Go I V1')}tlieet, .
L Signature o Or ore .. er's Author zed OfficcdDirectodParmedMenager
Print Name
r . i
The foregoing instrument was acknowle before me this. day of ,� , 20 =i,, by '' ';.'v' :',.1‘:::.../(A.„ :...lV t
(&'. Mr if I as i-P2-X' I WAVI y (type of authority, e.g. officer, trustee, attorney
in faht) for _ fithme of party on behalf of whom instrument was e ted).
Personally Known _ OR Produced Identification Notary Signature ` a .� k
Type of Identification Produced Name (print) _;\ � ; ti ' ( \ l t . t i l l l l i .
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I bave read the foregoing and that
the facts stated. in it are true 10 the best of my knowledge and belief.
FoRMaiNOCjvsd2007 Signarure ofNaturet Person Signing Above
i .. 126I r gi." ,. .. OROBAN FAKHOURI .
.4111 Commission # 7764307
• .i Notary PubIlc - California I
r � \ -z ./ Ventura' County
CI , . MyCar Biplio 2 8.203 1
HILLSBOROUGH COUNTY BUSINESS TAX RENEWAL INSTRUCTIONS
Chapter 205.0535 (5) Florida Statutes requires one of the following:
FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER
1. SIGN and return entire form in enclosed envelope. Your validated Business Tax receipt will be returned to you.
2. Business Tax receipts expire midnight, September 30th. Failure to display a valid Business Tax receipt after
September 30th is a violation of Hillsborough County Ordinance 95-4, as amended by 02 -5.
MAKE CHECK PAYABLE TO:
DOUG BELDEN, TAX COLLECTOR
POBox172920
TAMPA, FL 33672 -0920
2010 -2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 -2011 FOUONO.
0 _.. -. _ 0 0 1 — 1 11 236889
H. WASTE TAX
CATEGORY CODE BUSINESS TYPE SURCHARGE
090.010 GENERAL CONTRACTOR 40.00 18.00
ca r....; u it iu it r t: t -CIG
3:. �n c '.T Wit 4 '"1
co .! 1 .ra ,y,
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BUSINESS 1212 BAY CLUB CIR r� r M , Y" - •
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LOCATION T' 1 ' A 3 • . )7 i !: 4? :i) - ., t.:; P :. .. = ;.
E N ES s R � t , '' ? t : ' 607 to r > f1L
L . r,Y 4, -. r
BUSINESS ��z/ r-cnt g -. .
fr' i •w- ti.- �.
t of
DOUG BELDEN, TAX COLLECTOR c i , :.;1 co , ;14
HAS HEREBY PAID A PRIVILEGE TAX TO ENGAGE 813 -635 4200 .. r -
INRuSINESS. PROFESSION, . OR OCCUPATION SPECIFIED HEREON. THIS BECOMES A TAX RECEIPT WHEN VALIDATED. . - f 4 +- � tx
.A J. Xt ,T' C. I.J. r - '
CC. C• C.' r --- Lt' 4' C C
7•
4206 23688900002 000018002 000040004 In
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CZ/ t�
:m:Brandon Leske - Hybrid Construction To:Building Department - Zephryhills 15:33 09107110GMT -04 Pg 03-04
A • DATE crwoD,YYYYI
CERTIFICATE OF LIABILITY INSURANCE 8/27/2010
PRODUCER (727) 521 -2100 VAX: (727) 528 -0626 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Comegys Insurance Corner ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Florida Contractor Insurance I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
IOne Beach Drive S. E. Ste. 230 I
Saint Petersburg FL 33701 ;INSURERS AFFORDING COVERAGE { NAIC #
INSURED .. — ... _
_INSURER A. Bankers Insurance Company i .._.. —_. ...__._.,
Hybrid Construction, LLC. ; INSURER B:
(Brandon Leske
j P 0 Box 20851 1 INSURER 0:
• I Tampa 1 FL 33622 -0851 1 INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WITHSTAN DING
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.
_ � _.. _ ..__.. _
Wilk ADM' 1 POLICY NUMBER POLICY EFFECTIJE POLICY EXPIRATION - _ -_
LLB SURD TYPE CF_IdBUBANC 'DATE (MWDOt YYY T I I DATE IMMIOOIWYYI LIMITS
GENERAL LABILITY I , EACH OCCURRENCE f — 1 r 00 L 900
X COMMERCIAL GENERAL 'Amur( II t _ )• i1 100,
A
CLAIMS MADE j
OCCUR 1090420000544901 17/3/2010 7/3/2011 MED ESP (Fay ons pera,� •- f 10,000
; .. .. -.._.. ____........- - --- _ -.... 1 PERSONAL a ADV INJURY f 1, 00_0„ 000
I i ! GENERAL AGGREGATE 18 2,000,000
GENT AGGREGATE LIMIT APPLIES PER: ' LPRODUCTS - COMP/0P AGG t f 2 000,
°RO r^ i i __.
POLICY I_ jFCT • . LOC
I AUTOMOBILE LIABILITY : ' I C I
: � Ste) SINGLE Low S
1 ANY AUTO
_ _ ALL OWNED AUTOS
I ! : BODILY INJURY : S
I • SCHEDULED AUTOS . (Pst P i ______
_.
I L._._.. HIRED AUTOS i • BODILY INJURY
, NON -OWNED AUTOS (Psi aocidenl) f
PROPERTY DAMAGE
i .... - -- - -- --- -------- 1Pa accidaccidenaccident) S
i GARAGE LIABIUTY ' AUTO ONLY - FA ACCIDENT S
1 ANY AUTO OT THAN
7 EA ACC E _,
L 1 — j AUTO ONLY: AGG :1
I I EXCESS/ U MBRELLA LIABILITY
- _ -. EA CH OCCURRENCE • 8
OCCUR ! CLAIMS MADE AGGREGATE f S . - - —.. __.......
1 •
i i DEDUCTIBLE - -- "._.-- -'- -._ f
j RETENTION S • 1 is
WORKERS COMPENSATION WC STATU OTF —
• ANDEMPLOYE/O' LABILITY Y I N ; .___ I TQRY IJfa1TS . ...Tit . . ___________
ANY PROPRIETOR/PARTNER/EXECUTIVE ( 1 I I E.L. EACH ACCBIENT f
1 Y EMBBEER EXCLUDED? Li - -- — -- in NH) E.L DISEASE - EA EMPLOYEE S
1 { nye IAL s aibe wrier ( - -
J1 SPEC PROVISIONS Wbw ! i E.L. DISEASE - POLICY LIMIT ' S
IOTHER I
1 I
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
•
•
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OFT EABOVEDESCRIBEDPOLICI ESBECANCELLED BEFORE THE EXPIRATION
City of Zephyrhills DATE THEREOF, THE ISSUING BISueER WILL ENDEAVOR TO MAIL L . DAYS WRITTEN
5 335 8th Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Zephyrhills, FL 33542
IMPOSE NO OBLIGATION OR LABILTY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVE&
AUTHORIZED
Mcrcurjo/ ESSIC .tJf -AA
M Mercurio /JESSIC
ACORD 26 (2009/01) ®1988 -2009 ACORD CORPORATION. All rights reserved.