672 Aquatic Dr 2014 fence 0.)U% .-I-
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC REACH, FL 32233
INSPECTION PHONE LINE 247-5814
/oil
Application Number . . . . . 14-00000430 Date 3/27/14
Property Address . . . . . . 672 AQUATIC DR
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
6ft fence replacement
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
WYATT, CAMERON J OWNER
672 AQUATIC DR
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/23/14
----------------------------------------------------------------------------
Special Notes and Comments
Avoid damage to underground water/sewer utilities . Verify
vertical and horizontal location of utilities . Hand dig if
necessary. If field coordination is needed, call 247-5834 .
Avoid damage to existing sewer main along east property
line .
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management. )
Make sure all debris goes into the dumpster and not in the
ditch.
owner will be responsible for removal and reconstruction of
fence in drainage easement if required for City access for
maintenance.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 3S . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MAP SHOWING SURVEY OF
LOT 15—D, AQUATIC GARDENS AS RECORDED IN PLAT BOOK 38, PAGES 71
AND 71A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CUTLASS ORNE
pp,\jED PUBLIC ROAD
50' RIGHT OF 'NAY
0 'T'
g)jOINNG 0 0 ---A
1 0 ai
n I STORY ;F, --A 0
0
0 RFSIDENCE 0
0 FOUWO /,2- IRON CA 0
FIELD)' o.3' -Tj
15B"E 99.16' pin, LB1704 ;>
(Np'2'43 it 9B.69 WOO FE$CE ;0
N82-4315B E I cn ---4
1.0' 0 lj�
1- 0 0
-NCF OX --i -� -11
FOUND 1/2"4 IR014 2.9 - cn
pIpF' LB170 29.0' 0 0
r-rn >( 70
Z S--V 0 R'� S-TUCCO 9t"�- =,I-3>, cy) lcl) 0
COVERE ONCRE 0 -
3.9 AND FRAME c:::,u-, rTl
pORC run,rzn
X, a, --i
RESIDENCE 7.9, )1- 0 4�
LD ER 672 zc' 00 r1i P
NUMB
3.
0 CONCRFTE DRIVI m m "Z—
('o
>
41 45.2' 0 (,n
rn -Z c:
0.9
0
31.0 0�. 5.2' c
IRON
—'NOT IFE
2C
rri FOU�"D 11/7A
PIPF-. LB 0
0 9B.99
S820431581 FIELD)
\,N
FOUND 11/720-41RON (SB'2'42'42"W 99-
pIpE, L13
1 0
0)
40
--RLY LOT LINE BEING N82'43'58"E
SHALL BE IN ACCORDANCE WITH
ESTABLISHED BY THE CITY OF
THIS SURVEY WAS MADE FOR THE BENEFIT OF
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: 6 7:77 Permit Number:
Legal Description *A C.r- Parcel
Floor Area of Tq-Ft-. Sq.Ft
Valuation of Work$ 3 ad Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration (!0 Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residential
If an existing structure,is a fire sprinMr system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product ap-p-r-o—v�a�orm�
Describe in detail the type of work to be performed:
—Re–I?cL' Pr.VCLC-y
Propertv Owner Information:
Name: Wy Address:
city WC ki State PZZip_3U73-Phone— C104i 2V-7 r(
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAEL ADDRESS:
Company Name: z Qualifying Agent:
Address: -city State Zip
Office Phone Job Site/ Number Fax#
State Certification/Registration#_
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and AddpKs
Bonding Company Name and Addrvg-r
Mortgage Lender Name and Address
.4pplication 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 will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void ffwork is not commenced within six(6)months, or i(construction or work is suspended or abandonedfor a period ofsiXP6)months at any time after
work is commenced. I understand that separate permits must be securedfor Electrical'Work,Plunthing,Signs, Wells,Pools, urnaces,Boilers,Heaters,
Tanks andA!r Conditioners,eta
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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certi is a
fy that I have read and examined th* _pplication and know the same to be true and correct. Allprovisions oflaws and ordinances governing this
work will be complied with whether s eci Fed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
I f fi
provisions of any otherfederal,state, or loca aw regulating construction or the peTformance ofconstruction.
Signature of Owner a,4�� Signature of Contractor
Print Name (U Print Name
... ......
.................... . ............................................... ........................................................................................................................................
Before Before me
this ay o 20 14f this Day of 20
Nota Notary Putilic State of Florida Notary Public
Shirley L Graham
my commission FF 086990 Revised 01.26.10
Of Expires 02/14/2018
CITY OF ATLANTIC BEACH
OWNER / IBMDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING"REQU I RES 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 ENEMPTION 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 TBE CONSTRUCTION IS COMPLETE, THE LAW WELL 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/CIR 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(l). 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.
OtN
672! 7UCI 222 Pg�(p
ADDRESS PHONE NUMBER
PRINT NAME
SIGNAT DATE
Before me this day ofmw-ck 20
-26— — -4-Minthe...ntycif
Duval,State of Florida,has personally appeared h.,inl"Imr�f/herself and affirms that
all statements and declarations are t d ._
Notary Public at Large,Stat..f FZccuro'unty.FZ&'k'j'-__L--'
,P.Prsonally Known
e %I
I I' ublic State of Florida
�Qroduced Identification-
Shirley L Graham
My Commission FF 086990
Explt*S 0211141�2018
Notary Si ture: ON f%eVAV%0~0VRV%-
RMLDG/Own�-Build�Affkdavit REWSED:4114.,
City of Atlantic Beach APPLICATION NUMBER
Building Department
(To be assigned by th Building Department.)
minole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Iz 17/
City web-site: http://www.coab.us 11 4-
APPLICATION REVIEW AND TRACKING FORM
Property Address: _ 74,1.,-6 Department review required Yes No
4)- ' B
Applicant: 4)?) E4 <::�_PLan ing &Zonin-4,-N
Tre-e-Ad-m-in-isfr—ator
Project: .'�F�A allcw
r Q=ZF44bli Utilit:ie-s�
T Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transport-I.ion
St.Johns River Water IV;-, ementDistrict
Army Corps of Engineer.,
Division of Hotels and Res, iurants
Division of Alcoholic Bex . 7esandTobacco
Other:
APPLICATION STATUS
Reviewing Department First Reviev, N<lp-proved. [:]Denied.
(Circle one.) Comments.
"___9646���
PLANNING &ZONING
Reviewed b Date: 4��4'4 1A_
TREE ADMIN. Second Review: E]Approved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Reviiz [:]Approved as revised. []Denied.
Comments
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Be.-Ich
APPLICATION NUMBER
(�nt ' 'EIVE
Building Departru D (To be assigned by th Building D partment.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 MAR 2 12014 -R- 40
Phone(904)247-5826 - Fax(904)247-5845
_1 -.-- 7,
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
--). -b—epartment review required Yes No
Property Address: 74."Jh'
Bufti!i!.
Applicant: 14) &Zonin��
Tre–e–AUMT
Project: h lic V'o—rk—s-N
Utiliffies
P Pu I Ul
ublic Safety
ir ic S'
e Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Rec A Date
of Permit Verifie, By
Florida Dept. of Environmental Protection
Florida Dept. of Transport :t;on
St.Johns River Water IV, , ement District
Army Corps of Engineer:
Division of Hotels and Res- urants
Division of Alcoholic Be� -es and Tobacco
Other: �F
APPLICATION STATUS
Reviewing Department First Reviev, �&pprovecl. RDenied.
(Circle one.) Comments.
BUILDING
PLANNING &ZONING Reviewed by. Date:-
TREE ADMIN. Second Review: []Approved as revised. []Deni(:;
t I�CWOR Comments:
UBLIC UTILITIE
y
PUBLIC*SAFEY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDen -
Comments:
Reviewed by: Date.-
Revised 05/14109
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: Permit Number:
Legal Description _?KU44V C&- Parcel#
r Floor Area of Sq.Ft. S q.Yt
Valuation of Work$ 306 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration <!o Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residential,
If an existing structure,is a fire spriWer system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval ro-rin
Describe in detail the type of work to be performed: f�e_j?cL it Fin V CL-C F�nce_ Ze /77
P0
Property Owner Information:
A C2-a% V%F a . %~ Address: &7
Name run"Mr—
city A&m%+& P-^� State fZZip-?AZZYXPhone ?041 24E ITS'&
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: z Qualifying Agent:
Address: city State Zip
Office Phone Job Site/ et Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Add
Bonding Company Name and AddrpV1111"
Mortgage Lender Name and Address
-4 'cal he ade to b a"n a ermi''a do the work or installation has commencedprior to the
11 be 0, ed to m thisjurisdiction. Thispermit becomes null
f f sixp�)months at any time after
i s w ,
P c io 's reby md h 1 k
Ps a eo a e an a a er
('6)mont " or a period o
u 'mit ot c', t 0 w - i'p
vo �p k d thin s
and id f is m c i
" is co t t s P , Per it,m, W,
rk e ced I d, sta d ha e a te ells,Pools, urnaces,Boilers,Heaters,
Tanks andAir 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 YOV]k NOTICE OF
COMMENCEMENT.
Ihere certify that I have read and examined th lication and know the same to be true and correct. A 11provisions of laws and ordinances governing this
111work will be complied with whether rle'csi 71e§herein or not. The granting of a permit does not oresume to give authoriiy to violate or cancel the
provisions of any otherfederal,state, or local aw regulating construction or the pe�formance of constructi.-)n.
4
Signature of Owner Signature of Cioritractor�
Print Narne 11 Print Name
.Iume.... 1. ... .... WV4
Be Before me
thi MCC 20 li- this Day'(if 20
20
Nota?��� Plli;p Notary Pub4l c State of 7FFIlorida Notary Public
Sh"'ey L aim
Shirley L GraN
s ,
"0
my commission FF 086990 Revised 01.26.10
Expires 02/14/2018
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAV
1. 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 DON'1, BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN E)&:viPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS T14E OWNER OF YOUR PRCTERTY.TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMTF-i�-OVE A ONE—OR
TWO FAN41LY RESIDENCE OR A FARM OUTBUILDING. YOU MAY 1-LSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LE&1. THE BUILDING
MUST BE FOR YOIR—USE AND OCCUPANCY. IT MAY NOT BE BUILT FOITZ�',ALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF 1,%'21'r HIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WELL PRESUME I!'AT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENS D PERSON AS YOUR CONTRACTOR- YOUR CONSTrUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING RE�,JT 1,ATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLO'y iLD BY YOU RAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUXICIPAL LICENSINQ
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.
Ill. 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(l). AN"OCCUPATIONAL LICENSE".IS NOT ADEQUATE. THE OWNE P-.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.
7U1 2-22 X57(p.-
677 Ap&+,,e- 46ve- PHONE NUMBER
ADDRESS P
elme-rdv-t
PRINT NAME
-6 E
SIGNAT44,-�
Before me this lib day of M04C-k 20-M in the county of
Duval,State of Florida,has personally appeared herin herself and affirms that
all statements and declarations are tr d accurate.
Notary Public at Large,State of County of
fersonally Known
P
mduced Identification- Naft ur"fic State of Florida
Shirley L Graham
CZ My Commission FF 086990
No, Expires 0211412018
Notary Si ture:
F:/BLDG/0wner-BL11ldu Affadavi�REVISED: 4/1 09
City of Atlantic Bvlich REC I ED1 APPLICATION NUMBER
Building DepartmL.nt VF (To be assigned by th Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 MAR 212014
Phone(904)247-5826 - Fax(904)24 1-5845
E-mail: building-dept@coab.us 13Y. Date routed: 'TA el
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
-7z 4, t Department review required Yes No
Property Address: Pf V fF A-
Applicant: -7) Plan i n g &Z o n i n-g-1
T re e 70-m Min-isTra—to r
Project: 77- (2
Ri C=���fiiities>
Public Safety
Fire Services
Review fee $ Dept Signature Ale—
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verifie(I By
Florida Dept. of Environmental Protection
Florida Dept. of Transport :t�on
St,Johns River Water IV, �, ement District
Army Corps of Engineer
Division of Hotels and Res- urants
Division of Alcoholic Bex . ies and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Reviev� O(Approved. ElDer,
(Circle one.) Comments.
BUILDING
PLANNING &ZONING Reviewed by: _414n' Date-..
TREE ADMIN. Second Review: nApproved as revised. F]Denie-,
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Revipw: E]Approved as revised. [-]Denieci
Comments.
Reviewed by: Date:
Revised 05/14/09
Cash Register Receipt Receipt Number
City of Atlantic Beach R3332
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $35.00
14-00000430 Address: 672 AQUATIC DR APN: 171818 5224 $35.00
BUILDING $35.00
BUILDING PERMIT RENEWAL 455-0000-322-1000 0 $35.00
!TOTAL FEES PAID BY RECEIPT: R3332 $35.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,Fl.32233
10:31,2017 16:44:40
CREDIT CARD
MC SALE
Card XXXXXXXXXXXX5718
SEQ 8
Bath 474
INVOICE 10
Approval Code: 03215B
Entry Method: Mamal
Mode: Onlk
Card Code: M
SAIE AMOUNT $351
CUSTOMER COPY
Date Paid: Tuesday, October 31, 2017
Paid By: CAMERON J WYATT
Cashier: BA
Pay Method: CREDIT CARD 10
Printed:Tuesday,October 31,2017 4:46 PM 1 of 1
TRAW