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srSr n m A "�"`^-...+--�•___.�_..._..-.--"...^'. .. b._ .,.__. .,��____ .- <br /> f�ate Writfen 10/25/2012 <br /> � P O. Box 'ifi9°Winter F-faven, FL 338$2-1699 <br /> Phone; 863 234-�f00-�ax; 863 294-6610 Cust PD#: <br /> ������� ��f�,p�p,�$jp�; Impairmer�t Required? Y <br /> Customer- Evanyelisto Corestruction Permit Re uired? „ Y <br /> Address. 2426 Ecien Field Place � Submit ermit application to: <br /> City, State, Zi�: Lakeland, �L 33�01 _ City of Zephyrhills <br /> Contaot: Doug Evangelisto <br /> Phone: 863-4Q9-�985 -_ _ -__ _ _ __-_ __ - _-__ _ °-- -_-° - <br /> Email: �JOU�, cU,uuan;:elis.U.u:� Warksite Access Hours <br /> Pro�ect/ Sit� Inforrnation: <br /> Site Name. Medicai Suiidout Pasco County Haspitaf <br /> Address: Publix Shopping Center Gail Road - ,-- -..i �`�"..,,..;: --� :.- :.-- -:-°=�-` „' � <br /> City, State, Zip: Zephyril[s, FL Monitorin Acct Information <br /> Contact: Doug Evangelisto J_ � Phone# <br /> f'hon�: 863-409-6985 Access la# <br /> Email: d��+�r_'�i���rar��,��:l�:�lc�,,�s Operator(D# <br /> �cope of 1Nork: Provide iabor anc! material for the following. _ _ _ <br /> 1 Move a proximatPly 10 existin�fire sprinkler�to accommodate for ne�vtenant buiidout. <br /> 2. Add no more than 4 new 155 degree pzndent fire sprinklers to accommodate for new tenant�uildout __ <br /> (Continue on Sup lemenial Sheet if tJecessaryj <br /> Cu�t01T1�9�At!'�hOi"1Z��lO11: 1 hereby authorizs/deciine(circl�one) above described wark � <br /> � If work is rtot authorized within <br /> ��, � � ,�_.� ,�� ',f° /Z._, 30 days af qiwte,NC�wil! <br /> Sign e o Owner nr owmers Re resentative � Q g assume work is declined. <br /> Work sche�uled#o be pertarme� on: <br /> 1Nr�rk Perform�d: <br /> J (Continue on Supplementa!Sh2et if iVecessary) <br /> �ck�owledgement af CompDetion: <br /> Nofe: 7erms and ConditFons on a 2 of this propos�!are intsgral parts af i1�Js Agr�ement <br /> Date vdor4c campleted: <br /> Time Monitorinc� Left Oniine Rricing: (Seiect�ne <br /> Daf� Valvzs Lefi Open T�M � Fixed Price � <br /> t�tain Drain Static: Item Rat° Qty Sub Totaf <br /> �tain Drain Residual Labor $ 190.00 2� $ 380 OQ <br /> Labor ' $ - <br /> -� L and M �v 1,770 00 1� $ 1,770 00 <br /> .�` ,n_ ` _���� , � � D and E $ 375.Q0 1 �i S75 00 <br /> '� Cu�.��Signature, D e • Permit $ 325�0 1 $ 325 00 <br /> Svc Chg. $ - <br /> Tax $ 3,350 00 7% $ 23�4.50 <br /> Foreman Signature, Date Totai 3,584 50 <br /> ' 0£'I l �l0'l l£101 £l� .', aE�d O 199-PG��E93� l+ .;e j ol S64r-84L�:99"cl '^'e j olsga6uena 6nup:uw.ij <br />