Permit Kitchen Remodel 440 Ocean 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�J,3
Application Number . . . . . 11-00002878 Date 11/10/11
Property Address . . . . . . 440 OCEAN BLVD
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1900
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Application desc
REMODEL KITCHEN
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Owner Contractor
------------------------ ------------------------
HILL CURTIS V JR & JENNIFER J OWNER
440 OCEAN BLVD.
ATLANTIC BEACH FL 32233
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . . REMODEL KITCHEN
Permit Fee . . . . 60 . 00 Plan Check Fee 30 . 00
Issue Date . . . . Valuation . . . . 1900
Expiration Date . . 5/08/12
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total 30 . 00 30 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
'SS S CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002878 Date 11/10/11
Property Address . . . . . . 440 OCEAN BLVD
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1900
----------------------------------------------------------------------------
Application desc
REMODEL KITCHEN
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
HILL CURTIS V JR & JENNIFER J OWNER
440 OCEAN BLVD.
ATLANTIC BEACH FL 32233
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Permit . . . . . . PLUMBING PERMIT
Additional desc . . RELOCATE PLBG TO KITCHEN SINK
Permit Fee . . . . 62 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/08/12
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 62 . 00 62 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 62 . 00 62 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002878 Date 11/10/11
Property Address . . . . . . 440 OCEAN BLVD
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1900
----------------------------------------------------------------------------
Application desc
REMODEL KITCHEN
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
HILL CURTIS V JR & JENNIFER J OWNER
440 OCEAN BLVD.
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . . RELOCATE SWITCH IN KITCHEN
Permit Fee . . . . 55 . 60 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/08/12
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE ELEC DCA SURCHARGE 2 . 00
STATE PLBG DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 60 55 . 60 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 12 . 00 12 . 00 . 00 . 00
Grand Total 67 . 60 67 . 60 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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k (OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
4�� (���,,� 316 4 �i l`
DDR S PHONE NUMBER
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IN NAME
ATU I(�� DATE
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Before me this r Y day of 20Y in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that _Y,_.•�J°'''"""
all statements and declarations are t and accurate. pMpNDAWHI�E
Notary Public at Large,State of—,�,Coiu/nty_of,� yA1�r'! ''
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MISSION#EE 057349❑Personal) Known � � o . ES:May 2i,2015 Public Underwrites
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F:BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009
s�a,y;yJCity of Atlantic Beach APPLICATION NUMBER
Js Building Department (To be assigned b the Building De artment.)
eS� 800 Seminole Road g y_�(/�Q p
Atlantic Beach, Florida 32233-5445 j5 D
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: //-/0 —//
City web-site: http://www.coab.us
---- ------A-PPLrtCi 1`KM—R€t IEE AND TRAeKM-F@RM-- - -- - -
Property Address: �� � ��. - De nt review required Yes No
u'din
22
Applicant: Planning &Zoning
Tree Administrator
Project: l�` 4't-�--� Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [Approved. []Denied.
(Circle one.) Comments:
IBUiLDING
PLANNING &ONING ��/
Reviewed by: � � Date: C)-
TREE ADMIN. Second Review: ❑Approved as revised. ❑D ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. [—]Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
A. Settlement Statement (HUD-1) OMB Approval No.2502-0265
H dhilli�.
B.Type of Loan
1.r-] FHA 2.[-] RHS 3.[--] CONV.UNINS. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
4.r-] VA 5.F� CONV.INS. 2011-56
C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked"(p.o.c.)"were paid outside
the closing;they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender.
Curtis V.Hill,Jr.and Jennifer J.Hill,husband Elizabeth McQuaid Dechard f/k/a Elizabeth
and wife McQuaid Zucchi,a married woman Anna
440 Ocean Boulevard Elisabetta Zucchi,a single woman
Atlantic Beach,Florida 32233 503 Cushing Road
Newmarket,New Hampshire 03857
G.Property Location: 'H.Settlement Agent: I.Settlement Date:
440 Ocean Boulevard Osborne&Sheffield Title Services,LLC October 27,2011
Atlantic Beach,Florida 32233 4776 Hodges Boulevard,Suite 206
Lot 3,Block 23,Plat No. 1,Subdivision"A" Jacksonville,Florida 32224
Atlantic Beach,Book 5,Page 59,Duval 904-641-8401 fax:904-645-0005
County, Florida
i Place of Settlement:
Osborne&Sheffield Title Services,LLC
4776 Hodges Boulevard,Suite 206
Jacksonville, Florida 32224
Phone:(904)641-8401
J. Summary of Buyer's Transaction K. Summary of Seller's Transaction
100.Gross Amount Due From Buyer: 400.Gross Amount Due To Seller:
101. Contract Sales Price 525,000.00 401. Contract Sales Price 525,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Buyer line 1400 1,172.87 403.
Adjustments for Items Paid by Seller in Advance: Adjustments for Items Paid b Seller in Advance:
106. Ci /Town Taxes 406. Cit /Town Taxes
107. County/Parish Taxes 407. County/Parish Taxes
108. Assessments 408. Assessments
120. Gross Amount Due from Buyer- 526,172.87 420. Gross Amount Due to Seller: 525,000.00
200. Amounts Paid by or In Behalf of Buyer: 500. Reductions In Amount Due to Seller:
201. Deposit or Earnest Money 5,000.00 501. Excess Deposit see instructions
202. Principal Amount of New Loan 502. Settlement Charges to Seller Line 1400 43,264.30
203. Existing Loans taken subject to 503. Existing Loans taken subject to
204. Daily interest credit 504 Payoff of First Mortgage Loan-none per
seller/none per title.
205. 505. Payoff of Second Mortgage Loan
206. 506. Purchase Money Mortgage
207 507 Portion of Seller's Proceeds to Anna Elisabetta 210,000.00
Zucchi
208 508 Portion of Seller's Proceeds to Elizabeth 269,235.70
McQuaid Zucchi
Adjustments for Items Unpaid by Seller: Adjustments for Items Unpaid by Seller:
210. Cit /Town Taxes 510. Cit /Town Taxes
211. County/Parish Taxes 511. County/Parish Taxes
212. Assessments 512. Assessments
213. Per Contract amendment,credit in lieu of repairs 2,500.00 513. Per Contract amendment,credit in lieu of repairs 2,500.00
220. Total Paid b /for Buyer: 7,500.00 520. Total Reductions in Amount Due Seller: 525,000.00
300. Cash at Settlement from/to Buyer: 600. Cash at Settlement to/from Seller:
301. Gross Amount due from Buyer line 120 526,172.87 601. Gross Amount due to Seller line 420 525,000.00
302. Less Amount Paid by/for Buyer line 220 7,500.00 602. Less Reductions Amount due Seller line 520 525,000.00
303. Cash From Buyer: $518,672.87 603. Cash From Seller: $0.00
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.
This agency may not collect this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.
No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information
during the settlement process.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: Tv 06"11 �/� Permit Number:
Legal Description Parcel#
� Floor ea o q. t, t
Valuation of Work /y00, Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structures) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval # r
For multiple products use pro uct approval orm
Describe in detail the type of work to be performed: t�Cli&42�1_-
Property O ner Information:
Name: '� V . $4�� /J
Ci t�1 Address:
h StagZip 322 Phone 44
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work wall be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is susp ended or abandoned for aWeraod of six 6)months at any time after
work is commenced. 1 understand that separate permits must be secured for ElectricalpWork,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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.
I hereby certify that 1 have read and xamined this,application and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied ith hether specified herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
provisions of any other Mel ra tat , or local v regulating construction or the performance of construction.
A4Signature of Owner Signature of Contractor
Print Name Print Name
l7G/7 !�, (�
................................................................
.............................................................................................................
Sworft d subs d before m ,.•, Sworn to and subscribed before me
t � ay of this Day of _ 20
MMissi # 9
Notary Public e Notary Public
62 F d` Bonded Than No1arY Pubik
Revised 01.26.10
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
.TOB ADDRESS: 040 ece-44 64).—k - PERMIT#
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS / PHASE
VALUE OF WORK$
NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole
❑Residential (Main) Service
110-100 amps ❑101-150amps ❑151-200amps []_amps #of Meters
❑Commercial(Main) Service
110-100 amps ❑101-150amps ❑151-200amps ❑ amps [I CT Service amps
Conductor Type Size
❑Multi-Family(Main) Service
❑0-100 amps ❑101-150amps ❑151-200amps El—amps #of Unit Meters
❑Temporary Pole ❑ amps
SERVICE UPGRADE ❑ amps ❑ CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
❑100 amps ❑150amps 0200amps ❑ amps OCT Service amps
ADDITIONS,REMODELS REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 31-100amps 101-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
El Swimming Pool ❑ Sign []Smoke Detectors_Qty ❑Transformers KVA ❑Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans&Fire Alarm Checklist)
Qty volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change ❑OH to UG
❑Other:
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have
read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether
specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of
construction.
Property Owners NamePhone Number
Electrical Company — Office Phone Fax
Co.Address: City State Zip
License Holder (Print) State Certification/Registration#
Notarized Signatur
Jim -
ID AnA�NroDq
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EXPIRES:May 21,2015fit
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PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
.TOB ADDRESS: PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
**SJRWD Well Completio�rm. Completed form to be submitted to the Building,Dertment for final inspection.**
❑ Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read
this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority t violate the provisions of any other state or local law regulation construction or the performane of construction.
Property Owners Name l �- C/. / �� Phone Number 3Wl
Plumbing Company Office Phone Fax
Co. Address: A I City State Zip
License Holder(Print): A16 ' State Certification/Registration#
Notarized Signature o f JV�►
}" igaaEE d subscribed befor tis d f 20
EXPIRE$:May 21,2015
Bonded 7hruldowyPubkUrde ure of Notary Public _j:L77�i�