248 Levy Rd sign/elec 2013 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002251 Date 3/12/13
Property Address . . . . . . 248 LEVY RD
Application type description SIGN PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2000
----------------------------------------------------------------------------
Application desc
cabinet sign w/ elec
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
ROCK GARDEN ENTERPRISES, INC GENERAL SIGN SERVICE CORP
248 LEVY ROAD 1940 SPEARING ST
ATLANTIC BEACH FL 322332614 JACKSONVILLE FL 32206
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/08/13
----------------------------------------------------------------------------
Special Notes and Comments
Sign to be 51 from right-of-way per plan.
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 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 ELEC DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 8 . 00 8 . 00 . 00 . 00
Grand Total 98 . 00 98 . 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
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002251 Date 3/12/13
Property Address . . . . . . 248 LEVY RD
Application type description SIGN PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2000
----------------------------------------------------------------------------
Application desc
cabinet sign w/ elec
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
ROCK GARDEN ENTERPRISES, INC GENERAL SIGN SERVICE CORP
248 LEVY ROAD 1940 SPEARING ST
ATLANTIC BEACH FL 322332614 JACKSONVILLE FL 32206
----------------------------------------------------------------------------
Permit . . . . . . SIGN PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/08/13
----------------------------------------------------------------------------
Special Notes and Comments
Sign to be 51 from right-of-way per plan.
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 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 ELEC DBPR SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 8 . 00 8 . 00 . 00 . 00
Grand Total 73 . 00 73 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 k[F I:LE COM
W
Office(904) 247-5826 Fax (904) 247-5845
JobAddress: 9-Llg Ze,.,,, 1?oc--rj Permit Number:
0
Legal Description Floor Area of Sq.Ft. Parcel Sq.Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): Addition Alterati Repair Move Demolition pool/spa window/door
ornmercial Residential
Use of existing/proposed structure(s)(circle one): c�r c�Mio
If an existing structure,is a fire sprinkler system installed? (Circle-6ne): Yes No N/A
Floni da Product Approval 9
For multiple products use product approvil form
Describe in detail the type of work to be performed- e_� r?e Ld i-n
L
Property Owner Information:
Name: IZO(-k 6yc--Jer, Address: 9 9
city State F)zip 3 0��
E-Mail or Fax#(Optional) 409 ;L'41 '(04- 12a33 Phone 104 -aLil v11j6:,
Contractor Information:
CompanyName: &e,-,e_.,t 4;L4,1 1/0 1-r
Quaff*g Agent:
Address: i ,L4 t�, city � '�J State I--I Zip
Office Phone ?Oq 1-355 `34-3— Job Site/Contact Number F&,e -96 8 -tyo 6 Fax#
State Certification/Registration# I�C.->- -- C,>-i
Architect Name&Phone#
Engineer's Name&Phone iln
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication is hereby made to obtain apemit to do the work and installations as indicated. 1certj&that no work or installation has commencedprior to the
issuance ofa permit and that all work will bepedbrmed to meet the standards ofall laws regulating construction in thisjurisdiction. Thispermit becomes null
and void ffwork is not commenced within six(6)months,or ifconstruction or work is suspended or abandonedfor a period qfsix�,6)months at any time after
work is commenced. I understand that separate permits must be securedfor Electrical Work,Plumbing,Sigits, Wells,PooLv, urnaces,Boileis,Heaters,
Tanks andAir Condhioners,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.
Ihere cer!ify that I have read and examt-ned this application and know the same to be true and correct. Allpravisions oflaws and ordinances goveming this
Vwork will be complied with whether specyted herein or not. The g nting of a permit does not presume to give authority to violate or cancel the
provi.si.ons ofany otherfederal,state, or local la,,�regulating construction rthe performance of construction.
Signature of Owner Signature of Contractor
Print Name Print Name
Sworn to and subs Sworn to and si ibscrib"fore me
this Day of A20 this
Day of 20f3
Notary Public N—otary Publio
ej N%- SYBIL E. VINSON
L* MY CONMSSION#EE212690
EXPIRES:Augast 03,2016
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH OPN y
FILE C
800 Seminole Rd, Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845
JOB ADDRESS: gd PERMIT# 3--
�Ij
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK$
NEW SERVICE 0 Overhead Ej Underground Underground up Pole
EIResidential(Main)Service
110-100 amps El 101-150amps El 151-200amps El amps of Meters
LICommercial(Main)Service
E10-100 amps El 10 1-I 50amps 0 151-200amps arnps 11 CT Servi*cc_amps
Conductor Type_ Size
DMufti-Family(Main)Service
110-100 amps E]101-150wnps El 151-200amps 0—arrips 4 of Unit Meters
[]Temporary Pole L1 amps
SERVICE UPGRADE El .......amps F1 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.)
E1100amps 0150arnps 0200anips 0_____anips EICT Service amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 3 1-1 00amp s 10 1-200amps
A/C Circuits: 0-60amps 61-100amps
Heat Circuits: # circuits kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
[]SwimmingPool jKSign 0 Smoke Detectors_Qty ElTransformers KVA El Motors hp
FIRE ALARM SYSTEM (Requires 3 sets of plans)
Qty_volts/amps VALUE OF WORK$
REPAIRS/MISCELLANEOUS
[]Replace Burnt/Damaged Meter Can 11 Safbty Inspection []Panel Change 11 OH to UG
J-o eKil<
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 Name (Xk"r'� 64W(tse-S -PhoneNumber
Electrical Company Office Phone Fax-SSS—S&3-a,
Co. Address: City StateF1 Zip-?=WXo-Z
y
License Holder(Print): ft-ok State Certification/Registration 7�6S—&0 Y
4-�
Notarized Signature of License Holder this
Sworn and subscribed day of -Mc-tc-" 2013
RSYBIL E. VINSON
My COWAISSION#EE212690
F-01RES:August 03,2016
V
FILE COPY
LETTER OF AUTHORIZATION
TO: CITY OF ATLANTIC BEACH
BUILDING &ZONING DEPARTMENT
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
RE: LETTER OF AUTHORIZATION
TO WHOM IT MAY CONCERN:
THIS AUTHORIZES GENERAL SIGN SERVICE CORP. AS OUR LICENSED
SIGN CONTRACTOR (OR AGENTS OR SUBCONTRACTORS) TO SECURE
PERMITS, VARIANCES, AND PERFORM SIGN INSTALLATIONS, REMOVALS OR
MAINTENANCE AT THE PROPERTY LOCATED AT:
RPC GENERAL CONTRACTORS, INC.-248 LEVY ROAD-ATLANTIC BEACII-1, FL 32233
BY:
STATE OF Title: -6��m lor- V,oe ?-)n-
COUNTY OF__I)AJV/1 I
T HE F(JRL(3U
M ADA OF la�'Aji, 2013 By Vv)bi-)a, F" S �)evltnv (LfwsI&r1]
W)A
0 F I , klt9A I MY71r*&4_ �ejDfld-&�- CORPORATION, ON
BEHALF OF SAID CORPORATION, WHO DID NOT TAKE AN OATH AND WHO:
V//IS PERSONALLY KNOWN TO ME.
PRODUCED CURRENT FLORIDA DRIVER'S LICENSE AS
IDENTIFICATION.
A 11 A
MELVA BATTIS-flC
My COMMISSION#DD 887689
EXPIRES:may 7,2013
Bonded Thru Notary Public Underwriters
NOTARY PUBLIC
SEAL/ STAMP
NAME OF NOTARY PRINTED- Melva Ea �hshl"
2012 NOTICE OF PROPOSED PROPERTY TAXES DO NOT PAY
Duval County, Florida
THIS IS NOT A BILL
Legal Description:
18-34 38-2S-29E
SEC H ATLANTIC BEACH
LOTS 1 TO 4 BLK 239 Aft
ROCK GARDEN ENTERPRISES INC F I L E C
248 LEVY RD
ATLANTIC BEACH, FL 32233-2614
007564
2-2
RE No: 171069000OR Use: 4897 Dist: USD3 Prop. Address: 248 LEVY RD
Taxing Authority Tax Information
Prior(2011) Your Final Tax Rate Current(2012) Your Tax Rate and Taxes Your Tax Rate and Taxes
Taxing Authority Taxable Value* and Taxes Taxable Value* This Year if NO Budget This Year if PROPOSED
Last Year(2011) Change is Made Budget Change is Made
COLUMN1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7 COLUMN 8
RATE TAXES RATE TAXES RATE TAXES
County 471,400 6.7446 3,179.40 294,600 6.9443 2,045.79 6.7446 1,986.96
Public Schools:
By State Law 471,400 5.3050 2,500.78 294,600 5.5523 1,635.71 5.3520 1,576.70
By Local Board 471,400 2.2480 1,059.71 294,600 2.3528 693.13 2.2480 662.26
FIL Inland Navigation Dist. 471,400 0.0345 16.26 294,600 0.0341 10.05 0.0345 10.16
Atlantic Beach 471,400 3.3285 1,569.05 294,600 3.4550 1,017.84 3.4550 1,017.84
Water Mgmt Dist. 471,400 0.3313 156.17 294,600 0.3437 101.25 0,3313 97,60
SJRWMD
TOTAL AD VALOREM PROPERTY TAXES 8,481.371 5,503.77 5,351.52
Property Appraiser Value Information
ASSESSED VALUE ASSESSED VALUE
MARKET VALUE (Bef—&eWj-.) (80om Exe�pfi�
Applies to School Millage Applies to Non-School Millage
PRIOR YEAR(2011) 471,400 471,400 471,400
CURRENT YEAR(2012) 294,600 294,600 294,600
If you feel the market value of the
Applied Assessment Reduction Applies to Prior Amount(2011) Current Amount(2012) property is inaccurate or does not
Save Our Homes or Portability Benefit All Taxes 0 0 reflect fair market value as of January
- 1. 2012, or if you are entitled to an
Agricultural Classification All Taxes 0 0 exemption or classification that is not
reflected, please visit the Duval County
Non-Homestead 10%Cap Benefit Non-School Taxes 0 0 Property Appraiser's Office at 231 E.
Forsyth Street, Jacksonville, Florida
Exemptions Applies to Prior Amount(2011) Current Amount(2012) 32202, call (904) 630-2011 or one of
Charitable& Institutional All Taxes 0 0 the numbers on the back of this notice.
First Homestead All Taxes 0 0 If the Property Appraiser's Office is
unable to resolve the matter as to
Additional Homestead Non-SchoolTaxes 0 0 the market value, classification or
exemption, you may file a petition for
Disability All Taxes 0 0 adjustment with the Duval County
Value Adjustment Board. Petition
Limited Income Senior County/Municipal 0 0 forms are available at the address
Operating Taxes above or online at www.duvalpa.com.
Wiclow/Widower All Taxes 0 0 Petitions must be filed on or before
Historic Preservation County Operating 0 0
Taxes
Deployed Servicemember All Taxes 0 0 September 18, 2012
SEE REVERSE SIDE FOR EXPLANATIONS OF THE COLUMNS AND SECTIONS ABOVE.
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i-S LAilf City of Atlantic Beach VAR 0 Im
4.
APPLICATION NUMBER
Building Department
(To be assigned by the Building Department.)
00 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904 247-5826 - Fax(904)247-5845
it 1!9) E-mail: building-dept@coab.us Date routed:
City web-site: http:/Avww.coab.us .1 -
APPLICATION REVIEW AND TRACKING FORM
Property Address; De ent review required Yes No
ui
Applicant: S' /V lanning &Zoni��
r istr
-Tr-e-e--A-d—ministrator
Project: C2 lef e_
Public Utilities
J191V Public Safety
Fire Services
u
Review fee $
Dept Signat'0 -
Other Agency Review or Permit Required Review or Date
—-of Permit Verified By
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. nDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: DApproved as revised. nDeniJ ot
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 07/27110
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
SS
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L__!Ite routed:
City web-site: hftp://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address- D9par"ent review required Yes No
< Bujiain�
Applicant: _27 it A/ :::::--Planning &Zonin4
.-T-re-e-Ad—ministrator
Project: C5�.07/V - ev & -,r5-u bi ic Wodkt;.,
Public Utilities
Public Safety
Fire Services
ReView fee s, Dept Signature-
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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
Fother--
APPLICATION STATUS
Reviewing Department First Review: [�J<proved. [-]Denied.
(Circle one.) Comments:
BU
±PL=ANNING &ZONING 43/A
D Reviewed by: Y Date: 1201
TREE ADM IN.
Second Review: F]Approved as revised. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
-5445
Atlantic Beach, Florida 32233
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.0O2b.us I
APPLICATION REVIEW AND TRACKING FORM
-L�l i
Property Address: 67?�g DqpzdMent review required Yes,,Mo
Build
Applicant: C) /V ,�--Nanning &Zo2jpo
766-6-A-dm—i n istrato,r
Project: c5:7 C2_'111 ',,:�15ublic Work_t>
Public Utilities
Public Safety
1v
19 Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
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 L
Other:
APPLICATION STATUS
Reviewing Department First Review: Ep<pproved. [-]Denied.
(Circle one.) Comments:
PLANNING &ZONING Reviewed by: h71r�_ Date:5 3
TREE ADMIN. 11 7T
Second Review: FlApproved as revised. Ej&nied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [-]Approved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
Application N er . . . . . 13-00002394 Date 3/29/13
Property Address . . . . . . 248 LEVY RD
Application type description ELECTRIC ONLY
Property Zoninc. . . . . . . . TO BE UPDATED
Application valuation . . . . 0
-------------------- --------------------------------------------------------
Application deEc
addl work for sign
-------------------- --------------------------------------------------------
Owner Contractor
------------------------
---------------I---------
ROCK GARDEN EN .ERPRISES, INC LIMBAUGH ELECTRICAL CONTRAC
248 LEVY ROAD 42 WEST 8TH STREET
ATLANTIC BEACH FL 322332614 ATLANTIC BEACH FL 32233
(904) 241-9051
-------------------- --------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee 90 . 00 Plan Check Fee . 00
Issue Date Valuation . . . . 0
Expiration Date 9/25/13
-----------------------------------------------------------------------------
Other Fees . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
-----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
-------------- -- ---------- ---------- ---------- ----------
Permit Fee To:al 90 . 00 90 . 00 . 00 . 00
Plan Check To:al . 00 . 00 . 00 . 00
Other Fee Totil 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
2012-11-29 08:07 BuiLding Dept. 247 5845 >> 904 2490703 P 1/1
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd,Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDREss: L=qi -)t j,—E CA—, YERMIT
a
JEA INFORMATION REQUIRF D ON ALL PERMITS ANTS VOLTS PHASE
VALUE OF WORK S
NEW SERVICE El Overhead F7 Underground Underground up Pole
OResidential(Main)Service
00-100 amps 0101-150amps 1.115 1.200amps 1-1 amps 9 of Meters
OCommercial(Main)Service
00-100 amps 0101-150amps 0 15 1-200amps F_____,ainps FICT Service amps
Conductor Type Size
FlMulti-Family(Main)Service
00-100 amps [1101-150=ps 0 151.200amps O—amps 9 of Unit Meters
OTernporary Pole 0 Amps
SERVICE UPGRADE D amps 0 CT Service amps
NEW FEEDER(ADDITIONS,A CESSORY STRUCTURES,ETC.)
0100amps 0150amps L3200amps 0 amps OCT Service amps
ADDITIONS,REMODELS,REPAXRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switclics: 0-30amps 31-1 00amps 101-200amps
Appliances- 0-30amps 31-100amps 101-200amps
A/C Circuits: Q-60amps 61-1 00amps
Heat Circuits: � circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PX0JECTS hp
OSwimmingPool LYSign 1'.]Smoke Detectors_Qty D Transformers_KVA OMotors_
F M, ALARM SYSTEM (Requires 3 sets of plans)
Qty volts/amps VAL U9.OF WORKS
REPAIRS/MISCELLANEOUS
11 Replace Burnt/Damaged Mi-.ter Can 11 Safety inspection , F-TanelChange 0 OH to UG
00thcr:
certify that I have
Permit becomes void if work does not com,7ence TMithin a six month period or work is suspended or aband ned for six months. I hereby
read this application and know the same to )c true and correct, All provisions of laws and ordinances governing this work will be complied with whether
specified or noL 'ilia peffnit does not give authority to violate die provisions of any other slate or local law regulation construction or the performance of
construction.
Property Owners Name ct-f-0. Phone Number 2-1-4 1
P66 Phone Cq-2-44
Electrical Company ri-)V7!1 t A-)
Co. Address: HL L-Q?Si4 -V Ilk) (,Pee city�Aitctnt�C- kip
License Holder(Print) State Certification/Registration ®R
V I MUM-W 4
Notarized Signatur
-efv NO ry NCA
y b 0
Bi'aa Fa!
M f Commission D086878 ic
E,pireftfiWfe of Not Public