HomeMy WebLinkAbout14-14864 ` CITY OF ZEPHYRHILLS ,,.='
' , 5335-8TH STREET
� (si3)�so-oo20 864
BUILDING PERMIT
Permit Number: 14864 Address: 6851 WIRE RD
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD/ALT COMMERCIAL Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcei Number: 02-26-21-0010-01200-0000
Improv. Cost: 3,500.00
Date Issued: 1/02/2014 Name: ELKS LODGE
Total Fees: 82.50 Address: 6851 WIRE RD
Amount Paid: 82.50 ZEPHYRHILLS, FL. 33542
Date Paid: 1/02/2014 Phone: (813)782-4604
Work Desc: BBQ PIT
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FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
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 cailed 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 aommencement 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."
Complet lans, Specifications Must Accompany Application.All work shall be performed in accordance with
Ci es and Ordinances. NO OCCUPANCY BEFO C.O.
CONTRAC O SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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, 2014000729
Repl:1672842 Ree: 10.00
DS: 0.00 IT: 0.00
01/02/14 B. MeBes, Dpty Clerk
PAULR 5.0'NEIL,Ph.D':�PiiSCO•CLERK 6 COMPTROLLER�
010R BK �9�� iPG�219
Permit No._ � y O�y NOTIC6 OF COMMFtvrc�,r��,T
Property Identification No.�Z - �(o- Z� .O(j�d �b l 2��-•�QOp
TFIE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in the NOTICE OF COMMENCEMENT.
1. Description of properly(1e go[�d ��phon.
a) Street Address; �j'"cj� w�
2. Genera7 description of improvemenfs �y � ,� 1l.. ;;�/
3. Owner Information W
a) Name and addrcss: �l/�J � � �.,7�.�� - (O f'fS/Lti%/`�.+ � ���lG�F�. 3.�5�/Z„ Q �Z V � O�C
b) Name and address of fee simple titlehotder(if other than owner) W ti W
c) Interest in property �� —
4. Contractor Information �?C_����O �
a) Name and address: I�CG �3/ " �O�/ W��n[. ��� J'(' �/• 33�Z ('L$�=Q N� a
b) Telephone No.:�-'� Z � -�j FaY rr m . ��� �-s O �W Z N a �W
5. Surety Infortnation ` r''� O= — J
a) Name and address: . � � �� Q O
b) AmountofBond: Z = t�,O V V�
c) Telephane No.: � �
6. Lender Fax No.(Opt.) Q�a W Y
a) Name and address: V ��U W
7. Identity of person withi e State of F�Iy7da des�' nated by owner upo��a noy or oth r ocuments ay �rv , � ~U m
a) Name and address: Q.�r t 1^`e{ht b e �W �� �-
b) Telephone No.: ��1_UZ � �7L��`C $R /0`7' :' ���v n�r r i� � �.�3.5�� O���"= O W
8. [n addition to himself,owna des�gnates the followin �—F�No (Opt.)
713.13 I B Pe�n to receive a copy of the Lienor's Notice as provided in Section � U �U�� �� ,
( )(b),Florida Statutes:
a) Name and address; � 0�
b) Telephone No.: w � Q J �
9. Expiratiomdate of Notice of Commenctment(the expiration date is nae year fr�oPm the date of reeording unless a ditY'eront date is Q �� �
specifted): F" W -- t"`�
N F=- �OS� Q �]
WARNIIVG TO OWNER:ANY pqyMENTg M,,�DE Bl,THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
FLORIDA ST TUTES ANl?CAN RESULT IN YOUR pylP►G TTS CE FOR PR EMENTS TO YOUR PRO ER7'Y,q
NOTICE OF COMMENCEMEIV'I'1KUST BE RECORDED AND STED ON THE JOB SITE BEFORE THE FIRST * * *
INSPECTION.[F YpU INTEND TO OBTAIN FINANCING, SULT YOUR LENDER R AN ATTORNEY BEFORE �C1J`� • .•
COMMENCING WORK OR RECORDING YOU NOTICE OMMENCEMENT. ' bPj
STATE OF FLORIDA '♦•
COUNTY OP PASCO 0/ ���! �
�p��(('FATRICIA L JOHNSON S� • � `,,, / � • (M
1;�"�p MY COA4MIISSION M EE18142 graNre OF pwner or r's Auth rixed O�cedpveeloNPs�er/Mana a � � +
�'Cf39 cXI'IRFS:��28.201-0 B � �
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a A.tRUU G SR. Q. � • �ldi
Print Name • ��`
The toregoing instrument was acknowledged beforc me this ' � �
�day of�'qN�Ap,Y 20 1`� b I1
� QFFicx,IL . y BRUG6 F2qNJ'BURG' t-
— (name of �n'Pe of authority,e.g,o(�cer�wstee,attorney in(act)for "7� • � �.
party on behalf of whom inshument was execu�edj,
Personally Knew�_pR Produced Identification � ��+ .f��� �s � • �
_ Notary SignaNre
Type of Identification Produced .D.L• Namc(print)
PH7'N ! L �.TOflnl.f0
Vcrification pursuant to Sation 92.525,Florida Statutes.Underpena�ties ofperjury,I declare that I have read the foregoing and that the Cacts statod
in it aze We to the best of my knowledge and belief.
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' Sfpunae elNalunl Pemm�Sipdn�Abovt
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City of Zephyrhills
BUILDING pLAI� REVIEW CpMN�ENTS
Contractor/Homeowner; 2 .� � � �j
J�.'��
Date�ed:5i� �C.j.� 1 ll�(2�
�e: I�E�C�i vi'� Z — �j _f'�
Permit Type: �
- �
Approved w/no comments:O Approved w/the below comments: ❑ Denied w/the below co
mments: ❑
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This comrnent sheet shall be kept with the permit and/or plans.
��-� � �- ��
Kalvin S r—Plans Examiner
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Date Contractor and%or Ho
wner
(Required when comments are present)
813-780-0020 City of Zephyrhills Permit A lication
PP Fax-813-780-0021
Building Department
Date Rec�ived
Phone Contact for Permittfn �5 �- L�z c,/ __ L�/���
Owner's Name �� �,�, \ �,�� �-��3 j
Owner Phone Number �� �– ��Z - L�(��
Owner's Address �p�5 l ,j^� �' � l � 3�
Owner Phone Number
Fee Simple Titleholder Name { , � ��� a 730 �
Owner Phone Number
Fee Simple Titleholder Address �p t7 S� � j�,L �� `_ r !',
Y1 1 33��I�
JOB ADDRESS ��� �/ �� �� � � ` ',`� �, 33��
LOT# �]
SUBDIVISION
PARCEL ID#
WORK PROPOSED B (OBTAINED FROM PROPERTY TAX NOTICE)
NEW CONSTR ADD/ALT � SIGN O Q DEMOLISH
INSTALL REPAIR
PROPOSED USE [� SFR Q COMM ^
TYPE OF CONSTRUCTION � BLOCK �---1 OTHER
Q FRAME � STEEL �
DESCRIPTION OF WORK � , �j ; � � •�
BUILDfNG SIZE �X Zd� SQ FOOTAGE��
HEIGHT
QBUILDING g
,3 �j(�(��� VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $
AMP SERVICE � PROGRESS ENERGY Q
W.R.E.C.
QPLUMBING $ f(���� I a�S � ��.�,t�
QMECHANICAL $ � ( l � � �
VALUATION OF MECHANICAL INSTALLATION � �GLP'� 1'E'^
` �,�� �
�/(''�
�GAS � ROOFING � SPECIALTY � OTHER �� � ����'``�~��
FINISHEDFLOORELEVATIONS FLOODZONEAREA �YES 1�� ���2°t �3,-�,(; �
J��
BUILDER �� �
SIGNATURE Z Q �1 r���` � K� �73� COMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address ��j� �t/i`/� �� � ��QQk � , `� 3��
License#
ELECTRICIAN
SIGNATURE COMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address
License# �_
aLUMBER
51GNATURE COMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address
License# �—
AECHANICAL
tIGNATURE COMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address
License#
�THER
IGNATURE COMPANY
REGISTERED Y/ N FEE CURRE� Y/N
Address
License# �—
ESIDENTIAL 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 Pians,Stormwater Plans w/Silt Fence installed,
Sanitary Facflities&1 dumpster;Site Work Permit for subdivisions/large projects
�MMERCIAL Attach(3)complete sets of Buiiding Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Pertnit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
GN PERMIT Attach(2)sets of Engineered Plans.
""'PROPERTY SURVEY required for all NEW construction.
rections:
Fill out application completely.
Owner 8 Contractor sign back of appHcation,notarized
If over E2500,a Notice of Commencement is required. (A/C upgrades over:7500)
Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
ER THE COUNTER PERMITTING (Front of Appiication Only)
�oofs if shingles Sewers Service Upgrades A/C Fences(PIoVSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned The undersigned a'ssumes esp ns bilty for compl ancg tw'th any
which may be more restrictrve than County regulations.
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRAea�o e E ensed iBaacoEdance th s ate and local egulationsc ifrthe
contractors to undertake work, they may be reqw I for the
contractor is not licensed as required by law, both �hare uncerta n as to what�licensengte qu�emen'ts may app y���ation
under state law. If the owner or intended contracto
intended work, they are advised to contact the Pasntractor torBco'ntraotorsP he��s advised to'have he cont actor(s) sign
8009. Furthermore, if the owner has hired a co rivile es in Pasco
P
ortions of the "contractor Block" of this application fo�r ef ichcensed''and s not enttled t permitting p Wn 9 sign as t e
contracior, that may be an indication that he is no pr p
County.
TRANSPORTATION IMPACTIUTILITIES IMPACT AND R eeOmay ap ECOV�ERc nS Estion of new bu9de gsnchangand
that Transportation Impact Fees and Recourse Recovery
use in existing buildings, or expansion of existing buil d's9that such fees,'asPmay be dueywO'�Il�be dentified at he tme �o
90-07, as amended. The undersigned also understan ,
ermitting. It is further understood that Transporta�i eleaseaclf the p ojecRdoesrno Rnvolve a ce tificatetof occ pancy or
p � or final owe Water/Sewer Impact
receiving a certificate of occupancy P
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco Coun
fees are due, they must be paid prior to P 13 'Fior da Stat tes, as amen'ded)Plif valu ton of woukt s$2,'500 00 or more, I
CONSTRUCTION LIEN LAW(Chapter 7 rovided with a copy of the "Florida Construction Lien Law—Homeowner's
certify that I, the applicant, have been p
Protection Guide" prepared by the Florida Dep ned ancofy of'the above descr bed documlent and promPsean good fa th to
other than the"owner", I certify that I have obta P
deliver it to the"owner" prior to commencement. Iication is
CONTRACTOR'SlOWNER'S AFFIDAVIT: I ce�tify thaU'a{'nheconst uction,l zoning anld land developme tn qPpt all wors
will be done in compliance with all applicable laws reg 9
hereby made to obtain a permit to do work th tlall work will be perfoemed to meettstandards of all laws"aegulating
commenced prior to issuance of a permit and � to the intended work, and that it is
construction, County and City codes, zoning regulati overnment agenc es m y aPP y ulations in the jurisdiction. I a so
certify that I un ders tan d t h a t t h e r e g u l a t i o n s o f o t h e r g
m responsibility to identify what actions I must takonoC e ess Bayheads SW tland A eas and Environment la ly t Sensitive
Y
Depa r tmen t o f E n v i r o n m e n t a l P r o t e c t i Y P Altering
Lands, WaterNVastewater Treatment. ress Ba heads, Wetland Areas,
_ Sout hwes t F l o r i d a W a t e r M a n a g e ment District-Wells, Cyp Y
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: ermitted.
Use of fill is not allowed in Flood Zone"V" unless expressly p lan addressing a
ermittin which is prepared by a professional engineer
_ If the fill material is to be be submitted at i me of P �t is u�nderstood that a drainage p
"compensating volume will stem wall
{icensed by the State of Florida.
If the fill material is to be used in F�ed onl�to filAthe area w'thin thetstem w m�tted building using
construc tion, I c e r t i f y t h a t f i l l w i l l b e u s Y be cited for violating
If fill material is to be used in any area, I certify that use o f s u c h f i l l w i l l n o t a d v e r s el y affect adjacen
properties. If use of fill is found to adversely affect adjacent properties, the owner may
ermit issued under the attached permit application, for lots less than one (1)
the conditions of the building p lan is required.
acre which are etevated by fill, an engineered drainage p ermittin conditions set forth in
If I am the AGENT FOR THE OWNER,t�u tion!S I'u derstand thatna�separat permit may b�e iva d en he alppli ati nork�,
this affidavit prior to commencing con as, or other installations not specifically
plumbing, signs, wells, pools, air conditioning, 9
hall be construed to be a license to proceed with ehof a�re mitprevent thehBu ding Officeal from thereval d
permit issued s ermit issued shall become m
set aside any provisions of the technical codes, nor shall issuanc
requiring a correction of errors in plans, construction or violations of any codes. Every p
orized by such permit is commenced within six f e�the t mpe the wo k s commenced aAn extensioe
unless the work auth y da s and will demonstra
the permit is suspended or abandoned for a period of six(6) ►r►e�iod not to exceed ninet (90) Y
may be requested, in writing, from the Building Official for a p
justifiable caus
e for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandone .
WARNING TO OWNER
; YOUR FAILURE TO RECORD A NOTICEOOU iN�END TO OBTAIN FIANANCSNGTCONSULT
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY• �F
WITH Y�UR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S. 117.03) CONTRACTOR
pWNER OR AGENT Subscribed and swom to(or aiflnned)before me this
Subscribed and sworn to(or affirmed)before me this by
by roduced Who Is onally knovm to me or haslh iaen'ficatlon.
Who is! era personally known to mas Identlfication.
Notary Public
Notary Public
Commission No.
Commissfon No.
Name of Notary tYPed�Printed or stamped
Name of Notary hlPed�Printed or slamped
_........�.a......
_......_..__.�..,���
Date Received
Phone Conhet for P�rmlN�n �SZ- G��c,/
- 4��lo�.
owners Name `� ��, � �,�C� �..2 7.3/
Owner Phone Number �� - ��Z - L��,�
Owner'sAddress �p�/ ,'r� �� - � 3,nJ
' �� � Owner Phone Number
Fee Simple Titleholder Name 1 � ��� a731 �
Owner Phone Number
� i Fee Slmple Tftleholder Addross � b,5� �'�.G _ `1 r !11 1 �3�CI�
Y
�,1 I JOB ADDRESS -�,� �i,��� �.j 2� �. ` �.\I f�1 3�s�� �
1 LOT N
/�, SUBDIVISION
� ' �' 1 PARCEL IDA�
h � � �
�.�1 ^�� WORK PROPOSED B (OSTAINED FROM PROPERTy TAX NOnCE)
NEW CONSTR� ADD/ALT C� SIGN Q
� INSTALL REPAIR Q DEMOIISH
/� PROPOSED USE Q SFR � COMM
'I �if' TYPE OF CONSTRUCT�ON [� BLOCK O OTHER
Q FRAME C� STEEL Q
DESCRIPTION pp yypRK �, �j , ��.�
BUILDING SIZE �X Z�� gq pppTAOE�
HEI(iHT
QBUILDING Z
3�j(���� VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL S AMP SERVICE �• �Q ��$
QPLUMBING s �MITfE� t'LH1V�S�tl�Y�S��Yp�:' �.E.C.
�Y YR LI.S�IRE h�ARSHAI.'S OFFI�,"
QMECHANIC/LL. �a � C• 3
s VALUAT10qt� I L T U► � �
.�i.dV:QVI"C!: �
QGAS Q ROOFING Q SPECIALTY � OTHER
FINISHED FLOOR ELEVATIONS
FLOOD ZONE AREA QYES NO
BUILDER
SIGNATURE Z Q �� `\,�,\� �t' K� �73� ��MPANY
REGISTERED Y/ N FEE CURRE�
Add►eas ��.5 (f/i f e Rt,� 7 � Y/N
� —eP � , �} 3�s� u�,se�
ELECTRICIAN
SIGNATURE COMPANY
REGISTERED Y/ N FEE CURREI. Y/nJ
Addrose
License#
PLUMBER
SIGNATURE COMPANy
REGISTERED Y/ N FEE CURRE� Y/N
Address
� Ltcensa!J
MECHANICAL
SIGNATURE COMPANY
REGISTERED Y! N FEE CURRE� y/N
Addross
�icense� �
OTHER
SIGNATURE CONPANY
REGISTERED Y/ N FEE CURRE� Y/N
Addrosa
License#
RESIDENTIAL Attaeh(2)Plot Plans;(2)sets of Building Plans:(1)set oi Energy Fortns;R-O-W Pertnit for new construction,
Mln�mum ten(10)wwking days after submittal date. ReqWred onsite,Constructlo�pla�s,Stortnwater Plans w/Silt Fence installed,
Sanitary Fadlltles 8 1 dumpster;Site Work Permit for subdiWsionsNa►ge projecfs
COMMERCIAL Attach(3)complete aets of Buildkig p►ans plus a Life Safety page;(1)set of Ene�gy Forms,R-O-W Permit Tor new consWctlon.
Minimum ten(70)working daya after aubmlttal date. Requlrod cnslte,Conskucfton p�ans,Stortnwater Plans w/Silt Fe�ce insfalled,
Sanitary Fadlides 3 1 Oumpeter.Site Work Pertn{t for all new projects.,qp commerdal requirements must meet compliance
SIGN PERMR Attach(2)sets of Erglneered Plans,
""PROPERTY SURVEY requlred for all NEW constructlon.
Dlroetions:
Fill out applicaUon completely.
Owner 3 Contracyw sig�pack of applicatlon,notarizad
If over=2500,a NoNce ot Comm�ne�ment Is rsqulnd. (A/C uppndas ow►f7S00)
" Agent(for fhe confractor)or Power of Attomey(tor the owner)would be someone wilh notarized letter hom owner aufhorizing same
OVER THE COUNTER PERMITTING (Front of Applicatlon Only)
Reroofs i(shingles Sewers SeMce Upgredes A/C Fences(ploVSurvey/Footage)
Driveways-Not over Counter if on puDlic roadways..needs ROW
" ZEPHYRHlLL� FIRE DEP�RTl�fE1�T
6907 Dairy Road, Zephyrhills, FL 33542
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.• Contractor.
Business Name: _�.� 5 a Billing Address:
Business Address:
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact:
Contact:
LAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE
Site Plan WC Mnual �M FEE
N/C Sprinkler �50 1stAlarm N/C
MuMi-Family/Commerciai .06 sf 1st Re-inspeCtipn N/C
(Minimum Charge a25.00 Standpipes S50 2nd Alarm N/C
2nd Re-inspection $100 Fire Pump �50 3rd Alarm
�Plan Revisions DBL 3rd Re-ins N/C
P��� 5250 Hoods S50 4th Alatm 3100
4fh Re-Inspection �500 Fire Alarm a50 5th Alartn
SPRINKLER SYSTEMS (Business dosed until a�'�
LP Gas 350 6th Alartn 5200
0-25 Heads S50 violallons corrected) Natural Gas
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- Perrank a50 �N��a� 5150
STANDPIPE SYSTEM �'�
Hydro Undergrounds a45 Sparklers $100
�Per Riser S50 Hydrostatic Test a65 per aym,,, F�re yyorks
FIRE PUMP a�0
Aoceptance Test a45 yersya�em Camp Fire �25
�Per Pump a100 Hydrant Ffow $75
FIRE ALARM SYSTEM Controlled Bum �100
Hood/Duct S50
0-25 Devices a50 FIRE qLqRM SYSTEM Place oi Assemb
2s�us newcPS S�oo s tem N Sso �,w�
c s ys Acceptance $50 Rre ProtecHon
SUPPRESSION SYSTEMS S25
Recali Acoeptance a50 Flammapte qpplk;atto� SSp �r,nwt
Wet E50 OTHER Waste Tire Storage $5p n,,,,ua�
�ry S50 Rre WaMJSmoke Waq a15 Per wau Generator<KW 3100
CO2 S50 LP Gas S25 ps.� Generator>30 KW 150
�� S50 Natural Ges �25 persystem Bio-Hazard Weste E100 awwai
KITCHEN DCHAUST
Hood/Ducts Fumfgation Tentlng S50
S50 Tent 10k10'or gr�eater �15 pe.�e„� Toroh PoUApplied S5p
OTHER Flre Pump �
LP Insqllatlon Haz.Material5 E100 �rx,uai
a`�8"k 350 Fire Suppression $30 �
Fuel Tank InstallaUon S50 System Acoepffince
(Pe�Tank) S50 8 E�aust Hood/Duct 530
�Naw►a�Gas InstaMauon S50 Re-inspedion DBL
(Per System) ❑ (other than annual)
�Spray Booth �50 InspecGon scheduled DBL
a�d canoelled less than 8
24 hours
Construcdon Insp. N/C
Emergency Vehide A� a50
__---- ---PtiW3�tiTi��----1NSPECTI9N-T@T�4i�--- _ _ _ __ �ERMI�-���i1t�---_ FAL3E�A�y�-�--—. . _
, GRAND TOTAL
Comments:
Date: ( Z- Z°� ��
Inspector. ,L`4��� �.�r
n�n
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