341 Seminole Rd (vault) I'
4. CI* OF r•..' t
mos, Beackliaidocto
June 21, 1972
COMMITTEE APPROVAL
We the undersigned Committee hereby approve the plans
as corrected on the following described lots in
accordance with Commission directives.
277 Saltair Subdivision
278 " 11
279 " 11
261 11 11
266 " 1'
268 " 11
269 " 11
, ,....V:A
R. L. Wardrep, Chairman Advisory
Planning Board
R. H. Hilliard, Director of
Pu lic Works
e(rY
R. C. Vogel, ity Manager
APPROVED
CITY of ATLANTIC BEACH
BUILDINC OFFICE
Date...... ,( C 4 j7,
FHA Form 2005 For accurate register of carbon copies, form Form approved. 7
VA Form 26-18:4 I may be separated along above fold. Staple Budget Bureau I■o. 63-8055.11.
Rev.3 Pti8 . completed sheets together in original order.
® Proposed Construction DESCRIPTION OF MATERIALS No.
(To be inserted by FHA or VA)
❑ Under Construction Le7- ..2,7,1( _ <-erlaiYi-Z _
Property address 5�6 / 4/ S/� City ��L NTlc/ / G dO/State � '
Mortgagor or Sponsor Empire Home Loans, Inc . 4 So. First St. Jax Beach, Fla .
Construction Sew'/ce Contractors 2843 San PabYelkoad
Contractor or Builder Corp. Jacksonville Florida
(Name) (Address)
INSTRUCTIONS
I. For additional information on how this form is to be submitted, number required, then the minimum acceptable will be assumed. Work exceeding
of copies, etc., see the instructions applicable to the FHA Application for minimum requirements cannot be considered unless specifically described.
Mortgage Insurance or VA Request for Determination of Reasonable Value, as 4. Include no alternates, or equal" phrases, or contradictory items. (Con-
the case may be. sideration of a request for acceptance of substitute materials or equipment is
2. Describe all materials and equipment to be used, whether or not shown on not thereby precluded.)
the drawings, by marking an X in each appropriate check-box and entering the 5. Include signatures required at the end of this form.
information called for in each space. If space is inadequate, enter "See misc." 6. The construction shall be completed in compliance with the related drawings
and describe under item 27 or on on attached sheet. and specifications,as amended during processing. The specifications include this
3. Work not specifically described or shown will not be considered unless Description of Materials and the applicable Minimum Construction Requirements.
1. EXCAVATION:
Bearing soil, type Sandy Loam
2. FOUNDATIONS: 2500 As Required
1:3: 5 ; strength si
P Reinforcing
Footings: concrete mix g
Foundation wall: material Conc. Block Reinforcing None
None Party foundation wall None
Interior foundation wall: material Y
Columns: material and sizes None Piers: material 1riil reinforcing 8"x16" Conc. Block
Girders: material and sizes 8tf Aluminum Beam Sills: material 8 Alum . Perimeter Plate
Basement entrance areaway None Window areaways if As Required t
Waterproofing Footing drains 4 Perf.. Drain Tile when Req d.
Termite protection Soil Poison Addt�;1e
Basementless space: ground cover Non e ; insulation ; foundation Vents x l Al 111n -
Special foundations
Additional information: Solid cat) block and termite shield where required -- 1 access
door -- 18llX24" min.
3. CHIMNEYS: None
Material Prefabricated(make and size)
Flue lining: material Heater flue size Fireplace flue size
Vents (material and size): gas or oil heater ; water heater
Additional information: Total Electric -- None Required
4. FIREPLACES: None
Type: ❑ solid fuel; ❑ gas-burning; ❑ circulator(make and size) Ash dump and clean-out
Fireplace: facing ; lining ; hearth ; mantel
Additional information: 1✓ ,riOey`3 &oGpe$�n4gs
.tnnw �� • r i^ o} = Jlnn,�l 17 11
5. EXTERIOR WALLS: Studs el l Cj• y
%?I d ffexxDb1 radf, and species 2 t"x4 it Aims Studs �'�o�ner b cl=ng. tSUI(ding paper or felt •
S ea mg tDj as ; thickness 1/2" ; width 48" ; fic] solid; ❑ spaced " o. c.; ❑diagonal;
Siding ; grade ; type ; size ; exposure "; fastening
Shingles ; grade tf ; type ; size ; exposure "; fastening
Stucco3 coat work ; thickness 1 , Lath Exp Lath ; weight 1.8 Galv . lb.
Masonry veneer Sills Lintels Base flashing
Masonry: ❑ solid ❑ faced ❑ stuccoed; total wall thickness "; facing thickness ": facing material
Backup material - ; thickness "; bonding
Door sills Window sills Lintels Base flashing
Interior surfaces: dampproofing, coats of ; furring
Additional information: . 3
Exterior painting: material
Prime - oil base __; number of coats
Gable wall construction: ry same as main walls; ❑ other construction
6. FLOG FRAMING: Jst. Alum. Strapping
Im. ALCOA OA tl 4 tl ; anchors —
joists: grade, and species ; other 2 x Alum.• ; bridging 4
Concrete slab:�] basement floor; ❑ first floor; g] ground supported; ❑ self-supporting; mix 1:3:5 ; thickness
r 6 r'x 6 tt #10 WW Mesh ; insulation ; membrane ---
reinforcing sl _ All vegetation, Topsoil
Fill under slab: material 'land ; thickness _"• Additional information:
& Foreign matter removed.
7. SUBFLOORING: (Describe undef flooring for special floors under item 21.) t type Material: grade and species 3/4tt T&G Nailed and glued plywood ; si t ze X8 ; typ AD pine
Laid: ❑ first floor; ❑ second floor; ❑ attic sq. ft.; ❑ diagonal; ❑ right angles. Additional information:
8. FINISH FLOORING: (Wood only. Describe other finish flooring under item 21.)
Loc.4 nov [ Roovs GRADE SPECIES THICKNESS WIDTH BLDG. PAPER FINISH
First floor Al] bedroom and living room - Carp t - See Section. 27 for specificati'
X)&gfloor All other rooms : Armstrong* Vinyl- sbesto>'3 Tile --
Attic floor sq. ft. 1 _ _
Additional information: °s"^""°"
FHA Form 2005 1 DESCRIPTION OF MATERIALS
VA Form 26-1852
21. SPECIAL FLOORS AND WAINSCOT: .
THB ESHOLD WALL BASE US�ERFLOOR
La ATION• /4. - BORDER,COLOR, 1RD[A,SIZES. GAGE,ETC.an MATERIAL MATERIAL MATERIAL
--d storage utilit room 1 16' V.A.T. None Wood Conc.
8 Kitchen . ' rmstrona V.A.T. or equal None Wood Cone.
Bath
All other rooms - Caroet Alum. wood
HEIGHT HE
GHT IN SHOWERS
LOCATION I
MATERIAL, COLOR, BORDER, CAP. SIZES. GAGE, ETC. HEIGHT OVER TUB (FROM FLOOR
Z each Fiberglass Reinf. Tu• -INFENNII .4"
3
Chr. Plate htlmber 10
Bathroom accessories: ❑ Recessed; material
; number ;70 Attached; material
Additional information:
22. PLUMBING: _
L._.-. - - �"1"�"..�--O ---`�- MFR'S FIXTURE IDENTIFICATION No. Slit. CowR
FIXTURE NUMBER LOCATION T MAKE
Sink 32 X 2� hi to
1 � Kit Gerber 76-234 3
16-744 1•"x16' bite
Lavatory 2 Baths Gerber `hits
2 Baths Gerber 21-202
Water closet Fiberglas (one Diets) _ 5' white
Bathtub_ 2 Baths Corl I
Shower over tubA 2 Baths Gerber 48-720
Stall showers
Laundry trays Guy Gray T-200 white Conn. 1
A ] Curtain rod n❑ Door ❑ Shower pan: material
Water supply: X] public; ❑ community system; ❑ individual (private) system.*
Sewage disposal: ® public; ❑ community system; ❑ individual (private) system.*
*Show and describe individual system in complete detail in separate drawings and specifications according to requirements.
House drain (inside): in cast iron; ❑ tile; ❑ other House sewer (outside): zJ cast iron; ❑ tile; ❑ other
Sill cocks, number. 2
Water piping:XJ galvanized steel; ❑ copper tubing; ❑ other ; it cocks,, number 0
Domestic water heater: type Dbl . El . EleCtr .Make and model Rheem heating capacity 40 gallons.
27.5 gph. 100° rise. Storage tank: material Gl as 9 lined ; capacity g
Gas service: ❑ utility company; ❑ liq. pet. gas; ❑ other
Gas piping: ❑ cooking; ❑'house heating.
Footing drains connected to: ❑ storm sewer; ❑ sanitary sewer; ❑ dry well. Sump pump; make and model
; capacity. ; discharges into
23. HEATING:
❑ Hot water. ❑ Steam. ❑ Vapor. ❑ One-pipe system. ❑ Two-pipe system.
❑ Radiators. ❑ Convectors. ❑ Baseboard radiation. Make and model
Radiant panel: ❑ floor; ❑ wall; ❑ ceiling. Panel coil: material i
a
apcty gPn'
❑ Circulator. ❑ Return pump. Make and model Btuh.; net c cap Btuh.
Boiler: make and model
Output
Additional information:
Warm air: ❑ Gravity. pc] Forced. Type of system Overhead Sur ply Central H
(x' .I Same _ Insulatiort�er YTS thickness 21! ❑ Outside air intake.
Duct material: supply ; return 3 OOO Btuh.
Furnace: make and model
Carrier 40EA002 Input 10.5KW Btuh.; output 7,
Additional information:-_ *or equal
Btuh.; out put Btuh.; number units
❑ Space heater; ❑ floor furnace; ❑ wall heater. Input P
Make, model Additional information:
Controls: make and types Minn. -Honeywell
Additional information: ; storage capacity
Fuel: ❑ Coal; ❑ oil; ❑ gas; ❑ liq. pet. gas;n electric; ❑other
Additional information:
Firing equipment furnished separately: ❑ Gas burner, conversion type. ❑ Stoker: hopper feed 0; bin feed ❑ —
Oil burner: ❑ pressure atomizing; ❑ vaporizing Control
Make and model
Additional information: volts; output Btuh.
Input .__watts;
Electric heating system: type
Additional information: ; capacity cfm.
Ventilating equipment: attic fan, make and model & Electric ji00d & Fan
kitchen exhaust fan, make and model_Gray
Other heating, ventilating. or cooling equipment Bath Exhaust Fan - Nutone Model 8661
*I or equal
24. ELECTRIC WIRING: Fed .Pacific AMP's 1 FO No.circuits 24
Service:ID overhead; ❑ underground. Panel: ❑ fuse box; it] circuit-breaker; make Fed Pa w /�rO MP's S NMC
Wiring: ❑ conduit: ❑ armored cable; ® nonmetallic cable; ❑ knob and tube; ❑ other l
Special outlets: El range; [water heater; N] other nryer nut.1At.
® Doorbell. ❑ Chimes. Push-button.locations
Front & Rear Additional information:
25. LIGHTING FIXTURES: per plans
Total number of fixtures 13 or Total allowance for fixtures, typical installation,
Nontypical installation
Additional information: r
3 DESCRIPTION OF MATERIALS
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PLOT P
DoT Z 7 9- SECTION N° 2 -
SA LEA 1 Q
pTL2NT I C 5E4Ct-1, FLORIDA
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`� _� S ASP 2AY AVENUE- 50
4 N
W �
! 20►
. - DATE: 3-29-
PLAN N0: a �B - J 15�A 54-4717-5-71
CS TITLE: L O T CNKD:
-- SHEET OF
x:: -- -
s
;,r)NS[PUCTboN St:RV CL — CONTRACTORS CORPOR
ntcr
DUBLIN GECRG'+
JAC1�5 9NVILlE. FLORIDA
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
PERMIT NO. ,--0/2 .3 Date : J on/ "22 fii72
LOCATION ;341 SeN1 i,JoL e, Street
LOT NO. 3,27q BLOCK NO. S/D Tc.i t
OWNER ev,JST SE✓ ✓ I CE, Orlr p.
MASTER PLUMBER ( (5, ,c/i J6„)
Bldg.
BUILDER OR CONTRACTOR CQA■S/. 5er. Lcrip, Ferrait_No... 199g
TYPE OF BUILDING
I SINKS 02 LAVATORY BATH TUBS URINALS a2 CLOSETS
FLOOR DRAINS SHOWERS IWATER HEATERS DISHWASHERS
DISPOSALS OTHER c, ----
TOTAL FIXTURES @ fi1 .00 9, 0-9
NO WORK MUST BE DONE UNTIL A PERMIT HAS BEEN PROCURED
PLANS AND SPECIFICATIONS must show a plan and description of the
size and location of all the soil and vent pipes, and the number and
location of all fixtures , (in accordance with Ordinance no. 188 of
the City of Atlantic Beach, Florida) must be shown on back of appli-
cation and be approved by the Plumbing Inspector.
DRAW PLAN AND SPECIFICATION OF ABOVE PLUMBING ON BACK.
Approved by
Plumbing Inspector
Date
(FOR OFFICE USE ONLY)
ROUGH-IN INSPECTED REMARKS (-/(
FINAL INSPECTION:, /6- /O --?-11 CERTIFICATE ISSUED:
FOR OFFICE USE ONLY
Date WV/ 197)
Permit #..{-.[l--f-� Fee$--7QO
CITY OF ATLANTIC BEACH Valuation $ /5.1°00-
' FLORIDA - .r- a
.
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic
Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard-
ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can
be verified. /
Date \1L/i,e I , 19..2.2e..
Owner Address Telephone No
Architect Address. Telephone No.
ClrN57A eye T/O/V =s'r€✓i Y6 /Vi ' 3c/10H 04/000-
Contractor Builder Ci?!Y rattS +Et. Address .e - { G(- -, Telephone No...a2 6`7/B8
Lot No. h e Zone
�/ Bloch No:.. # Sub Division ��fir/¢
Side Between ` Asre/a-y and 4151.4de Adr. St.
Valuation $ ZS;(.0 For what purpose will building be used....!!d-C €--Type of construction
Dimensions of Lot X Q
?c /40 Size of Footings 4e.-.
Dimensions of Building �r _ //�ErE� aN Cb ennii.e.4
Size of Piers , X--/.fA N Size of Sills -4/ Greatest Sill Span in ft..._.Lce_.14-t- Type Roof__ /m-7--are)
fr // �iG�
How will Building be Heated?--_L�.el,���- OTC"- Will Building be on Solid or Filled Ground?.- 1�0.
Size of Ceiling Joists.2.104 �i-v..1�,.-ZXI,Distance on Centers ,�.2. a Z d' , Greatest Span "
v "'
LU9�1i,1/U� —® „
Size of Floor Joists....�.,X-�„ � , Distance on Centers.-._._....2 � ��� • , Greatest Span
Size of Rafters-_x221/,C. 1--Tkess-, Distance on Centers .2Y' ,/_4d - , Greatest Span
This rectangle is to represent the lot.
Locate the building or buildings in the
right position. Give distance in feet from
all lot-lines and existing buildings.
REAR LOT LINE
Two copies of plans and specifications shall
be submitted with application. Jj
Inspections required.
1. When steel is in place and ready to pour footing. W -�I I/ 7, ✓Z
2. When steel is in place and ready to pour columns and/or lintel.
.i1-14
2. a
3. When steel is in place and ready to pour beam. E., F
4. When framing is completed. 3 S
5. When rough plumbing is completed,and ready to cover up. W W
6. When septic tank drain field or sewer is laid but before it is covered. A - A
7. Electrical inspection by City of Jacksonville. rn if.
8. Final i
Note: In case of any rejection,re-inspection MUST be called for alter o
corrections are made.
FRONT OF LOT
In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said
work in accordance with the attached plans and specifications, which are a part hereof, and in accordance with the building
regulations of the City of ntic Beach /3 �/4A/ '✓4 4,i/ �/L/Ae
Signature of Builder
Address P4' k t?4.if ,Gi.4.‘Wy.. J 44 —
Signature of Owner Address
'7 ' 5
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
JOB LOCATION: al( J6.- "1 C' ( e J.
Loco- I TELEPHONE::
OWNER OF PROPERTY: �s r�
CONTRACTOR: //`><1?/!
A o�/ 4-)
CONTRACTORS ADDRESS: / 2 ,e/ S c,u C=-.c
K0Nf/( L c. a_ ( 6 /M 4 ZIP: - •=-0 S
STATE LICENSE NUMBER: C 00.5',1 7 a)C
TELEPHONE: 90 ° 3 7 .a./ f/
DESCRIBE WORK TO BE PERFORMED: 744S//).27074-e..._ / -g_ /2t'/
VALUATION OF PROPOSED CONSTRUCTION 1 /i95 'C1l( O 7 _yyp 0
MATERIALS TO BE USED: /0 SC? mod i�ao T ,docvA.J - ..--
SIGNATURE OF OWNER: u L
SIGNATURE OF CONTRACTOR: 0.I�'+ 4
L
Z ao°
SWORN TO AND SUBSCRIBED BEFORE ME THIS 2 DAY OF
, 19_
AS TO OWNER: Nci •Y PUBLIC •
SWORN TO AND SUBSCRIBED BEFORE ME THIS 2 V DAY OF `7 , 19___
AS TO CONTRACTOR * 1 -1,7416-11/./ •`A
NOTARY PUBLIC n�rn_,.,uui1S'
\- 1e:::-''':,:. 1
Liability Insurance Supplied X 'qE 3, ,l�yfOWS
Workers Compensation Insurance Supplied ,.,.._-
Contractor License Information Supplied
Occupational License Information Supplied
r —._ ROBERT M.WILLIS W0.L1 I
s o
P MY COMMISSION#CC 743841
EXPIRES:May 17,
Bonded Tam Notary Put*Undanwiters 1
L ,,P.::::-_____ ---
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road -Atlantic Beach, Fl 32233 - Tel. (904) 247-5826
ROOFING PERMIT
PERMIT INFORMATION _ LOCATION INFORMATION
Permit Number: 20404 Address: 341 SEMINOLE ROAD
Permit Type: RE-ROOF ATLANTIC BEACH, FL 32233
Class of Work: ROOF Township: Range: Book:
Proposed Use: SINGLE FAMILY Lot(s): Block: Section:
Square Feet: Subdivision: SALTAIR
Est.Value: Parcel Number: — --—
Improv. Cost: - OWNER INFORMATION
Date Issued: 7/25/2000 , Name: BARRETT, LARRY & JUDITH
Total Fees: 37.50 Address: 341 SEMINOLE ROAD
Amount Paid: 37.50 ATLANTIC BEACH, FL 32233
_ Date Paid: 7/24/2000 Phone: (000)000-0000
__Work Desc: RESIDENTIAL REROOF
CONTRACTOR(S) APPLICATION FEES
THRIFT ROOFING PERMIT 37.50
3
Ins - tions Required ,
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND AWRY BY FROM THIS CONTRACTOR MUST NOT BE PLACED IN PUBLIC SPACE, AND
MUST BE CLEARED UP AN D
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY
OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" -,
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
$37.50 14
_ _ Date: 7/26!00 81 Receipt: 0%7b141
GASH
CITY OF AT NTIC B H 00100003221000
Book 9691 Page 469
5 MIN. RETUR
o� , tiu of fomneneement
NC' ' tP1.1�M1.111 WKtiAfa
PNO
made to certain red ptooerty. end in
To whom it may concern: rpvynellt. will be �s this NOTfChL
ed hereby informs you that $ta the following information i. .teted
The undersigned florid' Slalom., /�
teeordar+ce with sactk.► 7h!•t! of the / �''''► `�!:� � `�.
OT CONIMSNCSIONT'
------------
Address --. .t4 --------
OM of the improvement _-_____.
OV/Tilde interest in Simple Title bolder (U than owner) - ---- --- -
Tee c9R tor - 2
_ 1at_f-_1------ Q------
0 ike Address m C (uFes 4-11-4_ -- am '--- - - --- ` '
Surety (If any) .----------------------- __------------------------------Remount et bond f---------- ---
Address --_- ---------- ------ 4 the improvements.
lson makings loon fbr the conntuction o ---'---- ---__
addle►►of any Pe ---'-
Name and ------------
Address -----•--------------------+---- owner upon whom notices w other
Name of person within the State of Florida, other thin himulf, designated by documents
traybeer-----' - ---- ---------------•--------------------•--------------------------------------------------. ._
Name '- _.....
Anemia ----'-'--"'"--'-"r_____.-------------------------
owner dedgnstes the following person to receives copy of the Lienor's Notice as
ln addition to Mengel!,provided In Section 713.0g [Z) [b). Tlorida Statutes. tTl11 in at Owner's option).
Name 6.-;
Address
MOB IM/AG.Prow 11ECO00e1111 Uf.ONLY Cott. jcAs .
\t. 1 .
Owner
Fi z,- o:+a _ Sworn to slid subscribed before me this
.5 -om ere C
g�i~"n4 t..WM _2 day of --- - '-
ga ..,0 c eavk , '0!0,
i No ry Public
.. -. o U ru
FA F+
P = N ,---- ROBERT M.WILLIS
°o o° `::- MY COMMI$SI�gCc743e41
'.) EXPIRES:Mel'17,2002 item
I '0,..... BrndP'TMr1MawyP �
_
DEPARTMENT OF BUILDING 9254
PERMIT NO.
CITY OF ATLANTIC BEACH.FLORIDA
PERMIT TO BUILD ���� r
THIS PERMIT MUST BE POSTED ON JOB �r5CCKY'
s7 ;d5 I A 11/11/6
Date November 12 19 — ��� �QpCC
1,950.00 Fee$ 7.50 655 IA i OCCAC
Valuation$
10�!C
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation of applicable provisions of law.
Co. RC0031854
Graston Roodin z
This is to certify that Oran e ?'-rk 32�
8480 Manresa Ave.
re-rf
has\ ermissiont00
o Pitg
Zone
Classification■Residential I
Jud Johnson
Owned by Block�S�
Lot_ j. , s
� _H� �i
House No. C
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
\ t AND FOOTINGS MUST BE
SPECTED BEFORE POURING.
PERMIT VOID SIX F MONTHS
T AFTER DATE OF
4'4' O Building material,rubbish and debris
z this work must not be placed
�_�� from and must be cleared
in pub];e-space,
u, ad auled away by either con-
t or ovlyner.
Z ii
L / A—/ �ing Official. ■
tl
CONTRACTOR
PERMIT DATE
FOR OFFICE NUMBER
USE ONLY ..... \
I ilillimill
IPLUMBING
■ ELECTRICAL IIIIIIIIIINIIIIII
SEWER
WATER i
`61. J
•
. .
• 1
•
CITY OF ATLANTIC BEACH •
• APPLICATION FOR ROOFING PERMIT
BUILDING OWNER i3 id DA./ PHONE
JOB ADDRESS 3 R •
LO'T'H BLOCK OR UNIT H SUBDIVISION
•
• CONTRACTOR c,R4s7on/ Raoptin/G c_D , PIIONE As - 0,218
• ADDRESS 840_0 MA-A/RAS Avg
LICENSE NUMBER 4_c-- C90 3/gsy EXPIRATION (c/3r'/P9
JOB VALUATION $ l� 9sO•
DWAI'ERIALS: /gkgvo� A - 14E4( i64R6LAss s
•
SIGNATURE OWNER DATE
SIGNATURE CONTRACTOR .,4:2 DATE 11/at/3'P
•
•
•
• •
•
• •
•
•