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<br />OJII'I'Ir&r.I'OII SKC'I'TOII ~. . <br /> <br />BUILDERS CaNST. co. OF LAKELAND, INC. <br />CXIIPAIII' <br />St.lttel:erl:. or 1fqU1:. . C Jj C Dl.:.;2 8 6 4 <br />euy Llc:aH lI8aletntiaa . 2 23 5 - CE R T <br />.......................................... <br /> <br />''iOIJ-O?-'':;U fR: 14:34 !D: <br /> <br />:EL NO: <br /> <br />11022 f-'\:Jl <br /> <br />" .~ <br /> <br />Al'I'LJ:UATXUII I'VB l'UIllT <br />CItr or III'IInUIILL8 <br />IVlLDIIG DUW1llllT <br /> <br />........- Robert White ....(.813)783-7655 <br />.....8'....... 39736 Meadowood Loop, Zephyrhills. FL 33540 <br />JOI,.- same as above <br />YUL DIlIC:Uftl., r.or(l) 0 13 0 ~ 0 0 CBilDlVUIOll Mea d 0 woo d (0 1 4 0 ) <br />'AaCIL I.D.,l 3 26 2 1 0 1 4 0 0 0 0 0 0 0 1 3 0 (QftA'I1I ... ......., uz ~) <br /> <br />-.: ....lIh-Jlw CouU1lc:tlml <br /> <br />X..,.tl' <br /> <br />AddtUoa -..uceC'atlml <br /> <br />taace11 <br /> <br />--J* <br /> <br />_....Ilove <br /> <br />--DMollah <br /> <br />nollOllD OAI 2.Js1D&le r_lq <br />_ea..Rlal <br /> <br />--1f./r _' of UIliu ---lUB <br />'I-laC. ---.lhfia. l'oo1 -,>>ther <br /> <br />_______c:aunat , Bu1tb hpuw.ut Appnwal <br /> <br />~ or IfaUIRepair damage due to sinkhole (plans attached) <br /> <br />1UlI.D1IQ SID:~. 1, 8 8 o Square ,..t. 1 2 ..islat <br /> <br />IISlDIftUL: ATI'ACII (2) PLOr I'UIIS . (2) SIIS OF 1UlI.D1IIG PUIS . (I) 11'1' IIIIlGf .... <br />~: A1TACB (3) SIIS OF IIUlUIUG PUIS . (1) 51'1' 1111IOI' ~. <br />nuran 8U1lVU IlIQUIIUID roa ALL 111I GUaDllC'fIOlJ. <br /> <br />PRItII'rTtt aIU'IIJRK'I'D <br /> <br />lJuILDDG <br />~ <br /> <br />S 1 9 ~ IS& . IRcJ <br /> <br />Valuatlml of Total Coaat~tiOD <br /> <br />AIIP Service <br /> <br />----"lodda PoIter COrp. <br /> <br />_v.a.I.c:. <br /> <br />--uIcaI. <br /> <br />s <br /> <br />Valuat.lml of ~cal lQIatdlattoa <br /> <br />~ <br /> <br />GAS <br /> <br />800PIJ1G <br /> <br />--JPJmALft <br /> <br />nn or ___"TuJll IC-Jloct ----.J~ --Jteel Gtbar <br /> <br />PDIISIIID ...... m.aAn..a:--.n. IS ""'10'1' 1ft I'toOD ZOII MIA' _ XL <br />tIS 10 <br /> <br />.......................................... <br /> <br />.rfl. <br /> <br /> <br />Ilpature <br /> <br />"~mAII <br /> <br />CCIIIl'AIIY <br />State Cut. or lq1..t. . <br />en,. LlceaM -.p.tnUoa . <br />.......................................... <br /> <br />..._.~ <br /> <br />In.....,- <br /> <br />CXIIPAIlY <br />Smra cere. Qr ",Iet. . <br />GitT Lic_ IealaUat~ . <br />.......................................... <br /> <br />Slpature <br /> <br />-.....c.r.1 <br /> <br />OODAIIY <br />ltata Cert. or "'1..t. . <br />City Liceue "'1..tnt~ . <br />.......................................... <br /> <br />lipat.. <br /> <br />JIIIIII <br /> <br />lDIPAIII' <br />State (;ert. 01' ",1IIt. . <br />Glt,. Llceue -..utntiGD . <br />.......................................... <br /> <br />Sipatun <br /> <br />AWLtCAU. AnmnI In' <br /> <br />nIKlT 0I'rlc:D. <br /> <br />/9t <br />I/J.-O <br />