HomeMy WebLinkAbout12-13420 CITY OF ZEPHYRHILLS
« � 5335-8TN SIREET
(si3)�so-oozo 13420
BUILDING PERMIT
Permit Number: 13420 Address: 7446 GALL BLVD
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 35-25-21-0010-08800-0010
Improv. Cost: 27,335.00
Date Issued: 9/05/2012 Name: SYBEA,INC.(ARBY'S)
Total Fees: 175.00 Address: 7446 GALL BLVD
Amount Paid: 175.00 ZEPHYRHILLS, FL. 33542
Date Paid: 9/05/2012 Phone:
Work Desc: REROOF 28 SQ OF GENFLEX TPO
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TAPE JOINTS OOF INSP
FINAL (; �"I�
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� 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.
"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 reoording our notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
CONT R SIGN T RE PERMIT OFFI R
PE IT EXP ES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 35-25-21-0010-08800-0010 001 Page 1 of 2
Data Current as Of: Weekly Archive - Saturday, September O1, 2012
Parcel ID 35-25-21-0010-08800-0010 (Card: 001 of 002)
Classification 23 - Financial Institutions
Mailing Address Property Value
ST FLORIDA PORTFOLIO III LLC Ag Land $0
919 E MAIN ST FL 14 Land $249,861
DELANO Building $273,328
RICHMOND VA 23219-4622
Physital Address Extra Features $38,166
7446 GALL BLVD )ust Value #561,355
ZEPHYRHILLS FL 33541-4310 Assessed (Non-School Amendment 1) $561,355
LeSlal D6SC�IDtl0�1 (First 4 Lines)
ZEPHYRHILLS COLONY COMPANY Taxable Value #561,355
LANDS PB 1 PG 55 POR OF TRACTS
73 &88 DESC AS FOLL: COM AT
NW COR OF SW1/4 OF SEC TH ALG
Land Detail (Card: 001 of 002)
Line Use Description 2onin� Units Type Price Condition Value
1 2300 FINANCIAL OOC2 11,000.00 �F $8.10 1.00 $89,100
� 2300 FINANCIAL OOC2 22,965.81 � $7.00 1.00 $160,761
Additional Land Information
Acres 0.78 Tax Area 30ZH FEMA Code X i PAR2A
Buildin9 Information - Use 23 - Financial Institutions (Card: 001 of 002)
Year Built 1991 Stories 1.0
Euterior Wall i Common Brick Exterior Wall 2 None
Roof Structure Flat Roof Cover Built-Up Tar and Gravel
Interior Wall i Drywall Interior Wall 2 None
Flooring 1 Carpet Flooring 2 Quarry or Hard Tile
Fuel Electric Heat Forced Air- Ducted
A/C Central Baths 2.0
Line Description Sq. Feet Repl.Cost New
1 BA�S 4,230 $420,462
2 �AIV 1,704 $50,793
Extra Features (Card: 001 of 002)
Line Description Year Units Value
1 PAV A P 1991 22,630 $4,583
2 �� 1991 1,230 $538
3 DRINWIN 1991 1 $2,791
4 PNEUTUB 1991 2 $13,082
5 VAU�T 1991 220 $3,240
6 NITEDEP 1991 1 $3,073
7 VAU LTDR 1991 1 $10,859
Sales History
Previous Owner SUNTRUST BANK
Month/Year Book/Page Type Code Condition Amount
01/2008 7752/0804 Warranty � Improved $0
Deed
02/2002 4864/0068 � Improved $650,000
Warranty
http://appraiser.pascogov.com/search/parcel.aspx?sec=35&twn=25&rng=21&sbb=0010&bl... 9/5/2012
8�s-�eaoozo City of Zephyfiiils Permit Application Fax-813-780-0021
Building Department
Date Received �•- �Z) •- phone Contact for Permittin �� I c�. — C9 O°1�
Owner's Name �„L Owner Phona Number
Owner's Add►ess e � Ow�er Phone Number �
(�}I�nt19 ►� b
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS � �� . . '1�, �.S LOT� �
SUBDIVISION PARCEL ID# � -c��• ' � � � °� i
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e NSTALLST�8 REPAIR � �G�� 0 DEMOLISH
PROPOSED USE Q SFR Q COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK F � �S
BUILDING SIZE SQ FOOTAGE� HEIGHT
�BUILDING $�� � C �°— VALUATION OF TOTAL CONSTRUCTION
J
DELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY [� W.R.E.0
QPLUMBING $
� �jU
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �� `� �
QGAS � ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
MECHANICAL COMPANY
SIGNATURE � EGISTERED Y/ N FEE CURRE� Y/N
Address � � License# �
OTHER COMPANY � �� IU(�11�?� �1 T.�-
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address � c License# � �
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit tor new consUuctio�,
Minimum ten(10)working days aRer submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FaGllUes&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Buflding Plans pius 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,Constructlon Plans,StoErnvwater Plans w/Silt Fence installed,
Sanitary Facilities 8�1 dumpster.Site Work Permit for all new proJects.All commerdal requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out applicatfon completely.
Owner&Contractor sign back of application,notarized
If over s2500,a Notice of Commencement Is requirod. (A!C upgrades over i7500)
'" Agent(for the contractor)or PoweFOf Attomey(for the ovrmer)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(Plof/Survey/Footage)
Oriveways-Not over Counter if on public roadways..needS ROW
NOTICE OF DEED RESTRICTIONS: The unders(gned understands that this permit may be subject to"deed" restrictions"
which may be more �est�ictive than County regulations. The undersigned assumes responsibility for compiiance with any
applicabte 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 Ifcensed in accordance with state and local regulatfons. 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 Ifcensing 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/Sewe� Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I
ce�tify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Depa�tment of Agricuiture and Consume�Affairs. If the applicant is someone
othe�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'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 instailation 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/Wastewate�Treatment.
- Southwest Florida Water Management District-Welis, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Watervvays.
- Department of Health 8 Rehabilitative Services/Environmental Flealth Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmentai Protection Agency-Asbestos abatement.
Federal Aviafwn Authority-Runways.
I understand that the foilowing restrictions apply to the use of flll:
Use of fill is not allowed in Flood Zone"V"unless expressiy 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 materiai 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 flll 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 Buiiding 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 fo�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: YOU�EN'TS TO YOUR PROPERTI(.TIF YOU INTE DETO OBTAINnFI�NANCSNG C'ONSULT
PAYING TWICE FOR IMPROVE NT.
WITH OUR L R R AN ATT EY FOR ECORDI G YOUR NO IC OF
FLORIDA JURAT(F.S.11 .03)
OWNER OR A(3BNT CONTRACTOR ��S
Subscribed and swom (or
Subscrfbed and swom to(or affl d efore thf by
by Who Is/are perso nown to me or has/have produced
Who fs/are personally known to me or hasfiave produced � as idendficatlon.
as identlflcaUon.
i f
•,
� Notary Public
Notary Public
,�i�"'�, JACQUEU E BOGE
Com ssion _ �
Commission No. �; �:
••.:��•..
% Expires December 12
Name of Notary typed�printed or stamped
Name of Nota • 80°�°�7019
, Invoice Number:080712
Purchase Order: FLC909-5906
������''""" , �l�es,�ep.: Jason Morphet
� ��CbSe�Date: 08/07/]2
Residential Division Due Date: 09/07/12
Page Number: 1 of 1
License#CGC 1517771 - — -- - -
INC.
Customer: 94]
Location:
RTM Operating Company, LI,C Arby's Unit#5906
1155 Perimeter Center West, 6th Flr 7446 Gall Blvd.
Atlanta,GA 30338 Zephyrhills, FL 3514
Quantity Unit Description/Part Number Unit Price Tx Price Extension
� pp 27,335.0000 27,335.00
WE PROPOSE TO FURNISH MATERIAL AND LABOR-CONRPLETE IN ACCORDANCE WITH THE
ABOVE SPECIFICATIONS, FOR THE SUM OF: $27,335.00(T`venty- Seven Thousand Three Hundred
Thirty-Five Dollars&00 Cents)We Hereby Submit Proposal for�he following project and specs: remove
existing EPDM roof to metal deck,install 3.1" R-19.1 ISO Insulation board mechanically attached with 3"
steel plates&#]5 HD screws, install 60 mil TPO membrane over 8S0 with 2 3/8" plate HD screws.
All TPO seams will be heat welded. Install new scuppers,drains,vent flashing,and metal wall coping cap.
Wall flashing will be fully adhered on all vertical walls and or surfaces. Price includes all warranties, labor,
materials,permits, inspections,and debris removal.
Warranry: 20 year No Dollar Limit Manufactures warranty/5 year contractor warranty
Exclusions: metal deck replacement,gutters,downspouts, interior mold or damage due to existing leaks
Im�oice Net 27,335.00
36413 SR 54• Zephyrhills, Florida 33541 • Telephone: 813-782-0825• Fa�c 813-,788-6773
www.rymanconstruction.com
� f-Floric�a Building Code Online Page 1 of 2
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Finrida�par�r�,Ci IL`" BCIS Home Log In � User Registration 'Hot Topics ' Submi[Surcharge I Stats&FacLS Publications � FBC SWR ;BQS Site Map !Links Search '
Busines "' � '�
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�' Product Approval `_.
Professi�n�af 1� � USER:Pub�itUSer � �
Reg�lation , � s��
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Produc[Aooroval Menu>Product or Aoolication Search>A�`Iicat(on List>Appliwtio�Debil
J ���Q����S�?11�
�� 1.� fL# PL6943-R3 �s, ��71�8 yQ�O ��?�1�rd32�d�ZI
��� �g� Applitdtion Type Revision :� ��J�IM� 7� ,S�Q.O �r,t6'��Q �
r.,
�,�`--•�� i : . Code Version 2010" , 1d�VQ� ��/�1 � ��
�~�,�.��>�• ' � �?b,ys��M�1�d
Application Status Approved `
comments � 77b'
Archfved r "`�------�� ��U/�
T, �►'UpT� ,
Product Manufacturer GenFlex Roofing Systems,LLC Cl I r oF z � '
Address/Phone/Email Suite 50 96th Street p`�iN����HYRH����
Indfanapolis,IN 46260 ��� /
(317)816-3806 "�...`���
mcquillentim@flres[onebp.com ''—��
Authorfzed Signature tim mcquillen
m cq u i I l e n ti m@ fl resto neb p.c o m
Technical Representative Tim McQuilien
Address/Phone/Email 250 West 96th Street
Indianapolis,IN 46240
(800)443-4272 Ext 53806
mcqui Ilend m�Flrestonebp.com
Quality Assurance Representative David Wally
Address/Phone/Email 393 Denton Circle
Tuscumbia,AL 35674
(256)386-8383
david.walley@omnova.com
Category Rooffng
Subcategory Single Ply Roof Systems
Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed
Florida Professionai Engineer
P' Evaluation Report-Hardcopy Received
Flo�ida Engineer or Architect Name who Robert Nieminen
developed the Evaluation Report
Florida License PE-59166
Qualfty Assurance Entity Underwrtters Laboratories Inc.
Quality Assurance Contract Expiration Date 03/30/2013
Validated By John W.Knezevich,PE
� Validation Checklist-Hardcopy Received
Certificate of Independence FL6943 R3 COI Trinitv ERD Q-Nieminen.odf
Referenced Standard and Year(of Standard) Standard Year
ASTM D6878 2006
FM 4470 1992
FM 4474 2004
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDqu%2foRM43 U... 3/14/2012
Yage l oi L
• .,Floria�Building Code Online
TAS 114 2011
UL1897 2004
Equivalence of Product Standards
CertiFled By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submttted 12/12/2011
Date Validated 12/14/2011
Date Pending FBC Approval 12/20/2011
Date Approved O1/31/2012
Summary of P�oducts
FL# Model,Number or Name Dascri tion
6943.1 GenFlex TPO Single Pty Roof Thermoplastle polyolifln,single-ply roof systems
5 stems ---
Limits of Use Installation Instructions
Approved for use lo HVHZ:No FL6943 R3 II A1 er120911FINAL GENFLEX
Approved for use outside HVHZ:Yes TPO FL6943-R3.odf
Zmpact Resistant:N/A Verifled By:Robert Nieminen PE-59166
Design Pressure:+N/A/-292.5 Created by Independent Third Party:Yes
Other: 1.)The DP in this appiication refers to one Evaluation Reports
i speciflc roof assembly. Refer to ER Appendix for all FL 943 R AE er120911FINAL GENFLEX TPO FL 43-�
�assemblies and max design pressures. 2.)Refer to ER ��d by Independent Third Party:Yes
Section 5 for Limits of Use.
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The State of Florida is an AA/EEO employer.Ce�:•:iaht 20074030 State of Florida.::Privacv Statement: Ac���sibilitv Statement.:Refund Statement
Under Florida law,e-mail addreues are public records.If you da na[want your e-mail addras reteased in respo�se to a public-records request,do not
send electronic maii to Chis entity.]nstead,contact the office by phone or by tradiUonal mail.If you have any questions regarding OBPR's ADA web
accessibility,please contact our Web Masfer at wabmaster�dbor.state.fl.us.
Produd Approwl Aceapts-
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NOTICE F CORp�gIVC'��
Siate otFlo p'Qa �
County of ,��J�('� Permit No. _
����� 7 ax Folio No.
77re undersigncd hereb�,gives notia tha[�mpro�ement wiit be made[o certyin real property.and in acwrdance wrth
Chap[er 7l3,Florid Statuhs,th�following infprmaYOn�s p vided in this No' �_`
the
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2. General d� a.« � L j.
n esuiRtion f�mprorement�: � ���f✓r�111�� � ��/ � (
3 �'nrortn a t i o n o r�o�y�����5��contradedfor the improvement
e Name and Address: p�'i
b. Ineerest in Properry�� � � � 'rlt"CY�V C`�J 1' ,y,�
c. N addrus of fee simple tiNeholder(ifdifferent from � T7T i,o�1�r!�, f�-��C��g`���?
�,�=�ff m•��¢'1 '�1+r � ,O,iwnerlistedabove):
4 Contractor/�'�'S (��5.}p-;,yur.�i—
��t�upe�-+r; r���� (�.��'u�.�tiv��S� �t�:��.1���T�.
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b. Phoce number- �M}��'^���, 33��:.t'r ,
5 S�rery(ifappiicablqa ��
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a Name and Addnss:
b Phonenumber: Rcpt:1457833 Ree: 10.00
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6. Lenda
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PqULR S 0'NEIL,Ph D PqSCO CLERK 8, COMPTROLLk
a Ne'�`�,°"°°'�: 08/30/12 09:41am 1
b. Phone numbc: -------.-- OR BK ���'� � q ��'T
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a. Name�d addras:
b. Phc.me numbas of designmed pay�:
8. a. In addidon to h+mxlf or
he+sdf,Ownv daignsfet
Staaae.c. ��eive a copy oft6e Liqqr•S��q P��idod m—Seq'.�ian 7 j1 33 j Ky).Florida
b. P�wne number of Pe+sa�or auity desi�bY owiw:
�__
9 �P��ion date ofnotice of�qmrt�v�
castruction and final pay���,bW will 6e!Year from Me date of (the ocpiration date may nal be before the comp�aim of
recording ufdess a diffaent daoe is specified)
W'��T�0��: ANY PAYMENI'S Mqpg BY THE OWNgR qFC�R 71iE E�,���OF,�,�NOTICE OF
����ENT ARE CONSmERED ONpROPE1t PAYMh1d7S(nNDFJt�{qp�R 713.PA}tT I.SECTION 713.13,
F[ARIDA STA"iLJ'I'ES.,qNp CqN f��.p m Y�PAYING'f1VICE FOR IMpROVEMF]JTS TO YOUR pRpPE(t7'�•
A NO')'�E OF COMMETJCg�g��S'i BE RE(„'pRpE[�qNp POS.i.E�ON THE JOB SITE BEFORE'iyE FIIt�
�P�T�ON. IF YOU INTENp TO OBTAfN FM�Q.rG.CpNSULT
BEFORE (_ �TM'Y���DER OR AN q77p�y
�MMETJCMG WORK OR RECpRDp�G YO�Np77CE Op Cp�g�.
� Under prnalties of 0�7�ry,1 declare that 1 have rwd the faegoing Notia of Comrtien
j truc W Uie best uf mY�mowled . �tf�attltl��EE faas staled'm it are
ge and bdief. ���1` /
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� Ow�w cr Lessee.or Ownu•s or
Autlwri p�ar���a Lessee's
s,���sT��-�: V���� Q. Jones, Jr.
STA7EOF_(���, ate Counsel
COUN7V OF�.�,�t.y..v.� r `,,,�1 1 11 f f I//
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STqT�OF FLQRIDA, COUI�TY C7F p,qS�;�
THIS IS TO CERTIFy THAT Th'E Fp;��G�;�rG!S A
C�I�C�j� TRUEAND CORRECTCOPy 0�7'NF .��};.,�UE -
�J� • ' �' OIV FILc OR OF PUBLlC RECpr�p ��7yi�
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� •,� WITNESS MY HAND A; ����CE
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a , �d ` � ' * BY F'`K OMP�'R�L—�
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' �,� DEPUTY CLERK
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
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�� ontract omeowner: �
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Date Received: ,�f - �U -�� f �
Site: � �
Permit Type: � ? .:�ff ,�
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Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comm t shee s 1 b kept with the permit and/or plans.
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Kalvin 'tz s Exaxniner Date Contractor and/or Homeowner
(Required when comments are present)