HomeMy WebLinkAbout12-13626 CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oo20 13626
BUILDING PERMIT
Permit Number: 13626 Address: 38009 LAWANDA LOOP
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: MOBILE HOME SUBDIVISION Lot(s): Block: Section:
Square Feet: Subdivision: WAYWARD WIND
Est. Value: Parcel Number: 14-26-21-0160-00000-0330
Improv. Cost: 7,590.00
Date Issued: 11/20/2012 Name: WYMORE, JERRY&TRESEA
Total Fees: 112.50 Address: 38009 LAWANDA LOOP
Amount Paid: 112.50 ZEPHYRHILLS, FL. 33542
Date Paid: 11/20/2012 Phone:
Work Desc: RE-ROOF WITH NEW RUBBER OVER EXISTING SHINGLE ROOF
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REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspec,tion
trips are necessary due to any one of the following reasons: a)wrong address b)oondemned work resultlng
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 properly. If you intend to obtain financing,consult with your lender or an attorney
before recordin our notice of oommencement."
Compl Plans,Specificatio Accompany Application.All work shall be pertormed in accordanae with
Ci Codes and Ordinanaes. NO OCCUPANCY BEFO C.O.
C TRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
II{II�IIIIIIIIIIIIIIIIIflIIIIIIIIIIIIIIIIIiI�IIiIIIIIIIIiI �ULa 5 0'NEIL,Ph D PRSCO �LERK 4 COnPTROLLE� , ���
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Rept:1476735 Ree: 10.00 _ -
DS: 0.00 IT: 0.00
11/20/12 C. M[ner, Dply Clerk
Permit No. ParcellD No '����Z�-D/G�-M4�-0330
NOTiCE OF COMMENCEMENT
State of Counry of
THE UNDERSIC�NED hereby yivea nottee that improvement vAY be made to certain real propeAy,and in accordance vAth Chapter 713,Florida Slatutes,
the folbwing infortnatlon h provided in this Nodce ot Commencement.
t DescrlDhon of PropeAy: Parcel IdentHicaGon No.
Street Addroas:
38009 Lawand Ze h r '
z. General oesu+puon oi Improvement r e r o o f M H R u b b e r
3, Owner Information or Leasee infortnation fi the Lessee coMraded fa the improvament:
Teresa !•Jymore
Name Ze�hvrhil��f FT. R'�St.�
City State
Addiess
Interest in Properly:
Name of Fee Simple Titlehofder
(II different hom Owner I�ated above)
��ry State
nddress A Bartlett Roofing
Contractor:
� Name �nhvrh'll T_�� ���1i2
Ciy State
Addresa $13-782-5585
ConVactora Tdephone No.•
5. Surety'
Name
�� State
Address Telephone No..
Amount ot Bond: i
8. Lender:
Name
• ��� State
Addresa �" *
Lender'e Telapho�e No. _`�� '• *
• � b
7 gectlon 7 Jt t'3(1)(a)(��Floiida Sta utea:eignated by tAe owner upon whom nolfces or other documents may be served as provided by �GV �
�� �
� �
Name • � `•�„ � •
d �
��ry State � � • �
Address Q•. �� •- �
Teleplwne Number of Deaigneled Fersorr
�,- 7„ �`
p, In addiUon to himself,lhe ormer designatea
to receive a copY of the Lknofs NoUce as provided in Sectlon 713.73(1)(b).Fbrida Statutes. �� . • �
Telepho�Number of Person or Entity Designated by Owner. '�,g * • *,
g, E�vation date of Natice of Canmencemem(�he explratlan date may not be before the canpleUon oi conaWCtlan and finat payment lo the ¢ � w Y
conVador,but wlli be one year Vom lhe date oi recurdin9�^less e difterenl dale is epeeifled):
ARE CONSIDER DE MPROPER PAY ENTS UNDER CH�ER 7�PAR7�SEC ION 713.73 HFLOR DAESTA UTESEANDMCAN O � W� (�,� � �
RESULT IN YOUR PAYING NNCE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTIC� OF COMMENCEMENT MUST BE U � �� J U
RECORDED ANO POSTEO ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT (n Z ��� J
WI7H YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT � � O� — �� _
�
U��pe�1�y p/perjury,l dedsre Mat I have road the fo aing noUce ol cortxneneemeM end lhat Ihe tads stated Uierein are Uue to the best O ,, z Z � � �
..!
ot my knowledge aM beNef.
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STATE OF FLORIDA z =,�Q� U ��
COUNTY OF PASCO ppT�y ppg�CSTATE OF FLORIDq Signaturo o(Owner a ee.o� s or Lessee's Aulhorized
�„��..,, Richard C. Bartlett ONicerlDireclorlPaAne r,aye. C]� a W O Y
=�`!�!+!(E Commissioc+I DD878490 U Q O �
sam^mrmFaen.�vnce'�aLmYuolea.n�la Si9"°i°'Y�`° "� ~ F— .:a Q —W-� -
q aay or so oy C? �L v m o � U=�—`
The foregoing inatrument was acknowled9ed before me this L � � O �. �Q¢ O J
(type M eulhority, trustee,attor in fact)far
9�
�� p�y al of m nment 1� � (� Q� = OQ 2
Personalty Known❑46 Produced IdenNficaUOn L7 Notary Sfgnalure U' O p � �� 0 �
Name(Print) yy� � Q� tn� �
Type oi IdentHication Produced W ��
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wpCatalbcalnoticec�xnmencemeM�c053048
Florida Building Code Online Yage 1 021
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Gi��.:��`��.��e��•dl BCIS Home lDg In User Registration Hot Topics SuDmrt�rcnarge S[ats&Facts Pubhcations FBC Staff BCIS Site Map Unks Search
Busines '�� � �
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Professi� � F�Ir USER Pubhc User
Regulatjon !
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�� Product Ao�roval Menu>Protl�c[or Aonhcation Search> li i n i >Appltutio Deqil R�'� /1,�
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-- FL# FL5293-R5 �
_ Z�PI�Yf�!-I;�L.��-
Application Type Revision
� �LANS EXAI1�{N��.' _ . � �,
, -.. , Code Version 2010
- � - Application Status Approved
Comments
Archived
Produd Manufacturer GAF �iLL 1�o��� SI1,'�Z L �l;�;i:j )'iY" ,
1 RE1A1Ll?��r(' 7 �It1;'.1_1_
Address/Phone/Email Alps Road O')( � �.� ��fZ��,i J�i�]j I)1�`��J
wayne,N�o�a�o C'�DC.;�;1t7;)\��! ; i ,. -
(973)872-4421 �1Tti, � .� �.� I�;I� C�_�DI�����ll
Ii�dareith�trinftyerd.co ��}"i�_; 1 j', r�r��� � ,y � ��
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Authorized Signature Beth McSorfey
li nda reith@tri nityerd.com
Technical Representative Beth McSorley
Address/Phone/Email 1361 Alps Road-Bidg 11-1
Wayne,NJ 07470
(973)872-4421
BMcSorley�gaf.com
QuaHty Assurance Representative
Address/Phone/Email
Category Roofing
Subcategory Single Ply Roof Systems
Compliance Method Evaluatlon Report from a Florida Registered Architect or a Licensed
Florida Professional Englneer
Evaluation Report-Hardcopy Recelved
Florida Engineer or Architect Name who Robert Nieminen
developed the Evaluation Report
Florida License PE-59166
Quality Assurance Entity Underwriters Laboratories Inc.
Quallty Assurance Contract Explration Date 04/13/2012
Validated By ]ohn W.Knezevich, PE
Validation Checklist-Hardcopy Received
Certificate of Independence FL5293 R5 COI Trinitv ERD CI-Nieminen.odf
Referenced Standard and Year(of Standard) Standard Year
ASTM D6878 2006
FM 4470 1992
FM 4474 2004
TAS 114 2011
Equivalence of Product Standards
http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDquwV cULes7wT... 6/8/2012
�lorida Building Code Unline rage � or�
Certified By
Sections from the Code
Product Approval Method Method 1 Option D
Date Submitted 02/16/2012
Date Validated 02/21/2012
Date Pending FBC Approva� 02/24/2012
Date Approved 04/03/2012
Date Revised 04/06/2012
�mmary of Products
FL# Model,Number or Name Deccri tion
5293.1 EverGuard TPO Single-P�y Roof Single-ply,thermoplastic polyolefin roofing systems
Membrane Systems
Limits of Use Installatlon Instructionc
Approved for use in HVHZ: No F�5?43 RS II A1 er021612FINAL GAF TPO fL5293-
Approved for use outside HVHZ:Yes
Impad Resfstant: N/A Ve�ified By: Robert Nieminen PE-59166
Desiyn Pressure: +N/A/-502.5 Created by Independent Third Party: Yes
Other: 1.)The design pressure noted in this application Evaluation Reports
relates to one speciflc assembly In the ER Appendix. FL5293 RS AE er021612FINAL GAF TPO FL5293-
Refer to the ER Appendix for all systems and associated f
max.design pressures. 2.)Refer to ER Section 5 for Created by Independent Third Party: Yes
Limits of Use
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Contect lJS ��-�North Monroe�re�L Tallaha«!!F�32399 Phone:850-487-1824
TAe State of Florida Is an AA/EEO employer coovdaht 2007-2010 Sate of Flodda.: Privacv Sntement Amessi6111tv S[atement Refund StstemeM
Under Florida law,e-mail aAd255es are publk records.If yau Oo not want your e-msil address released In response to a Dublic-records rcquest,do not
un0 ekRronic mall to this eMtty ins[ead,conbct the office by Dhone or by tradttional mail.If you have a�y Questions repardinq DBPR's ADA web
accessiblltty,please conWQ our Web Master at�M*a�t._r�dber.st•*_e.B.�_,
Produd AOproval AocaPts:
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http://www.floridabuilding.arg/pr/pr_app_dtl.aspx?param=wGEVXQwtDquwVcULes7wT... 6/8/2012
a�saso-oozo City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received ��� ���. pho�e Contact for Permfttfn --
Owner's Name Owner Phone Number
Owner's Address r1� Phone Number �
Fee Simple Titleholder Nam er Phone Number -1
Fee 3imple Titleholder Addresa
JOB ADDRESS LOT# �
SUBDIVISION � PARCEL IDN
(OBTNNED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR 8 ADD/ALT [� SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q
DESCRIPTION OF WORK �- y
BUILDING SIZE SD OTAGE� HEIGHT
BUILDING � � � VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGF�S ENERGY [� W.R.�.C.
;% / �
OPlUM81NG � � �� v � '
�,��„� ��'
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION -`��--m---`'l~�r
/"'�f�/� ......-.,.--
�GAS Q ROOFING Q SPECIALTY � 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# r-
PLUMBER � � COMPANY
SIGNATURE REGISTERED Y! N FEE CURRE� Y/N
Address License# �
\
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/
Address Licens #
OTHER COMPANY
SIGNATURE REGISTERED EE CUR E� Y/
Address License# �
RESIDENTIAL Attach(2)Piot 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 subdivisionsllarge 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,ConsVuction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Pennit for all new pro�ects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""•'PROPERTY SURVEY required for all NEW constructfon.
Directlons:
Fill out applicatton completely.
Ovmer&Contractor sign back of application,notarized
If over t2500,a Notice of Commencement Is required. (A/C upgrades over 57500)
•" Agent(for the contractor)or Power of Attomey(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(PIoVSurveylFootage)
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 regutations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
cont�actors 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 unce�tain 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 respons(ble. 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 IMPACTIUTILITIES 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 exlsting 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, wili be ident�ed at the time of
permitting. It is fuKher understood that Transportation Impact Fees and Resource Recovery Fees must be paid p�ior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a cert�cate 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 applicabie Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I
certify ihat 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'bwner", 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 applfcation 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 o� 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
ce�tify 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 inciude 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, Navigabte Waterways.
- Department of Health 8 Rehabilitative Services/Environmental Flealth 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
prope�ties. 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 a�davit prior to commencing constn.iction. 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 Qfficial 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: YO FAILURE TO RECORD A NOTICE OF COMMENCE NT MAY RESULT IN YOUR
PAYING TWICE FOR IMP EMENTS TO YOUR PROPERTY U INTEND T " BTAIN FINANCING, CONSULT
WITH YOUR LEND N ATTORNEY BEFORE R ING Y R TI F O N EM T.
FLORIDA JURAT(F.S . ) �,,/
r
ONMER OR AGEN CONTRACT
Subscribed and s fflrm )before me Subscrib (or aflirm )b me this
b _
Who islare ►s all e or h ave produced Who Is/ , ers y known a�d nHfica�n. `
as entlflca8on.
,
Notary Public
�> ;'" Notary Public
Commissfon No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
�'asco County Parcel: 14-26-21-0160-00000-0330 001 Page 1 of 2
uata Current as Of: Weekly Archive - Saturday, November 17, 2012
Parcel ID 14-26-21-0160-00000-0330 (Card: 001 of 001)
Classification 02 - Mobile Homes
Mailing Address Property Value
WYMORE]ERRY&TRESEA Ag Land $0
38009 LAWANDA LOOP Land $38,696
ZEPHYRHILLS FL 33542-5634 Building $36,600
Physical Address Extra Features $9,578
38009 LAWANDA LP
ZEPHYRHILLS FL 33542 7ust Value $84,874
Assessed (Save Our Homes) $84,874
Leaal Descri�tion (First a�ines) Homestead 196.031 - $25,000
See Plat for this Subdivision Non-School Additional Homestead Exemption - $25,000
WAYWARD WIND MOBILE HOME
SUBDIVISION Non-School Taxable Value #34,874
PB 28 PGS 61-62 School District Taxable Value $59,874
LTS 33 &34 warning: A significant taxable value increase may occur when sold.
Click here for details and info. regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
Line Use Description Zonin� Units Type Price Conditfon Value
� 0200 M SUB M OOM 1 8,400.00 � $4.60 1.00 $38,640
� 0200 MSUBM OOM1 80.00 � $0.70 1.00 $56
Additional Land Information
Acres 0.19 Tax Area 30ZH FEMA Code X i 1 WWMHLPl
Buildin� Information - Use 02 - Mobile Home (Card: 001 of 001)
Year Built 1996 Stories 1.0
Exterior Wall 1 Above 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 Cork or Vinyl Tile Flooring 2 Carpet
Fuel Electric Heat Forced Air- Ducted
A/C None Baths 2.0
Line Description Sq. Feet Repl.Cost New
1 B� 1,782 $45,530
2 �A 300 $5,366
3 F A 513 $2,632
4 F�'T 96 $1,099
Extra Features (Card: 001 of 001)
Line Description Year Unfts Value
1 DWC 1996 783 $1,096
2 A -4 1996 1 $420
3 COOL DK 1998 612 $1,838
4 POOL-6 1998 312 $4,618
5 SCRN-AF 1998 1,784 $1,606
Sales History
Previous Owner MOATES JERRY A SR
Month/Year Book/Pa�e Type C de Condition Amount
��
http://www.appraiser.pascogov.com/search/parcel.aspx?sec=14&twn=26&rng=21&sbb=... 11/20/2012
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C/O Richard Bartlett
38408 3rd Ave.
Zephyrhills, FL 33542
One of the Largest, Oldest, Most Dependable OFFICE
Roofing Companies in Central Florida PHONE
? , Specializing in Mobile Home JP Stevens White Rubber Roofs (g13) 782-5585
j & lnsulated Aluminum Roof Overs
(813) 973-7737
RESIDENTIAL • COMMERCIAL • MOBILE HOME (352) 523-1944
LICENSED - INSURED - BONDED Lic. #CCC 1325499
• MEMBER OF THE CHAMBER OF COMMERCE �
Serving Zephyrhills, Dade City, Quail Hollow, Wesley Chapel, Land O' Lakes and Surrounding Areas
We have re-roofed or repaired more roofs(18,000) in fhe past 39 years, than the four local leading roofing comp�nies combined.
We do not charge extra fees for credit card purchase. Most companies charge 3 to 5%. =�,
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President & Own�r A. Bartj,ett Ro�ing.Qf Central F,�, Inc.
Sign: � �' , .
' Richard C Bartlett �
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THANK YOU � ' `" •'
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Your Business is Appreciated. ��
Payment upon completion unless previous arrangement made.Warranties pertain to original owner
All anangements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomado and other necessary insurance.
Our workers are tulty covered by Workmen's Compensatron Insurance.Customer is liabfe for any charges incurred in collecting this bill. ,
Rotten wood is an extra$35.00 per sheet(4-ply).Rotten fascia is$2.00 per linear foot. -��� ` LL �
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
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��ontractorf�Iomeowner:
Date Received: ��' �� �
Site: - �(�v� ��'��i-r� ��-%��
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Permit Type: --
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the pemut and/or plans.
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Kal ' witze ans Examiner Date Contractor andlor Homeowner
(Required when comments are present)