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<br />F RC~I <br /> <br />~ 1S~1 <br /> <br />(~iED) OCT 2~1 2003 1: 5'~!ST. 1: ~,8/I\O, 634351 ~,3~~2 P 2 <br /> <br />CONTRACTOR <br />RECONSTRUCTIONIIMPROVEMENT AFFIDAVIT <br /> <br />'" arcellO No.: /<> .:l(, ,., _ ~, . O~llO _ ~ <br />roperty Address: S2 .:l.~orl S+_. <br />O"lractor Name: _"'B ": i ....I :=::"t. '('" - <br />dares.: .....ls!..C\ ~ I - -, ~-tl.. _ ~ N. LPr.~ ~ I '"":f;. <br />c..c.~o4o,3~7 <br />1;1. i - S"q~- 'Sl~<:) <br /> <br />(Note: If there is no contractor, the homeowner may complete this packet.) <br /> <br />1~j 7 7 <br /> <br />cense No.: <br /> <br />alephone; <br /> <br />1ereby attest to the fact that I. or a member of my staff. personally inspected the above-mentioned property <br />,d produced the attaChed itemized list of repairs. reconstruction, and/or remodeling list which are hereby <br />Ibmitted for a Substantial Damage/Improvement Review. These damages/improvements are ALL OF THE <br />A.MAGES/IMPROVEMENTS sustained by this structure. and that all additions. improvements, or repairs <br />'aposed 0/'1 the subject building are Included in this estimate. <br /> <br />Jnderstand that I am subject to enforcement and penalties f()r violation action andlor fines if the inspeotlon of' <br />e propeny reveals that I have made repairs or improvements NOT 1~..ICLUDeD ON THE ATTACHeD LIST OF <br />EPAIRS/IMPROVEMENTS TO THIS STRUCTURE or any nonconforming or illegal sltucturesJadditlons or <br />pairs is included to the existing structure without having presented plans for such additions, I unaerstand that <br />'y permit issued by Pasco County pursuant to this affidavit does not authOrize the reconstruction, repaIr, or <br />aintenance of any illegal additions, fences. Sheds, or nonconforming uses or structures on th. Subject <br />operty. <br /> <br />See Attached itemized list <br />Total Labor and Materials <br />O\ferhead and Profit <br />Total Cost <br /> <br />$ 3 , "3. 2~ <br />~ ;;ti~Z..~t: <br /> <br />rATE OF ~ <br />)UNTY OF _ r +'~~,. _ <br /> <br />Affidavit <br /> <br /> <br />who, being duly swom <br />understands, -and agrees to comply with aU of the aforementioned <br /> <br />mtractor's Signature <br />lorn to and Subscribed before me this t,..JJ.. day of <br /> <br />oate:~ <br /> <br />r commission expires <br /> <br /> <br />A.O.d-p3 <br /> <br />OOiOll61 <br /> <br />~ a\. Celeste Dawn DoIberry <br />. ~ . My Commission 00028533 <br />~~~ ExpIred-fay 22.200:5 <br /> <br />~,. .~ <br /> <br />~...L~~~, <br /> <br />.....,-----"....-...,,- <br />