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06/04/201a 10:40 FA% C�002 <br /> BUILDING DEPARTMENT QUESTIONNAIRE <br /> (If you have performsd work in multlple Jurisdictions, rr�ake sddltlanal copies of this fonn and <br /> havs it con�pleted by at le�st two[2� building departmenta.) <br /> �'p; auilding Of�cial- <br /> «.'a����d��1I69ded t01'MNIf D�.DQ�ranee•elay*f1Y11!tl1�1�COIY1�15LbY�11�1q OII� <br /> . },h�1b1�i�na au,r,�„�stlonnairo"'"` <br /> The following ;ndividual is currently on prabation with tl�e Florida Construction lndustry Licensing Board (CILB). <br /> please complete this fam and sign, if you have any questions ar concems, piease contact Wrvk! Spingler wlth <br /> the CiI.B at$50.717.1405 0�vi�email at davi�.sninaler(a�dbnr.state.fl.us . <br /> 7his i�am once completed may be emailed or faxed to my �ttention at 850.817.4�157. 7fiank you for your <br /> assistence. <br /> SUBJECT: $T�VEN ALLEN�Hearin�Date:July 11, 2013 <br /> License#(s): CGC1521189 <br /> •��■r���r����■r���Rr����������■����������■r����������������r����r������r�����r�����r� <br /> On behalf of the bullding department,t#te following answers are supplled. <br /> 1. Has the above named contracMr pulied any permits or called for any inspections in y�ur Jurisdiotfon <br /> dudng the last six months7 If your answer is"no°, you do not need to answer questions 2 through B, <br /> unless applic�ble. <br /> Y�S' NO <br /> 2. Has any qf the contractor's work been issued a stop work ocder in the last six months? If yes, please <br /> provide suppor�ng documentatbn. <br /> YES NO <br /> 3. Has the contractor failed to obt2�in permits on ame? !f yes, piease state amount and any flnes that <br /> may have been imposed. <br /> YES NO <br /> 4. Has any locai disclpline been started or completed again ctor in the last six mvnths7 <br /> YES NO <br /> 5. Wave there been any serious code vlolations by the co ' the last six months? tf so, please <br /> explain. YES NO <br /> e. In general, do you have any adverse comments conceming this contractor's performance during the <br /> last six months? if so, please provide brief detalls and a tional sheeta,as nevessary. <br /> YES NO� <br /> TO BE O pLETED BY BUILDING QFFiC1AL PROVIDING ABOVE ANSYVER8: <br /> .�'�. � �Z�; <br /> B d g cial's ignature Date <br /> Printed Name: ��-� K C��`��J License#; <br /> Job TiNe: 0�► ' �' Phane#: <br /> t • <br /> Name of Building Department: <br />