HomeMy WebLinkAbout15-16086 CITY OF ZEPHYRHILLS
, � ' 5335-8TH STREET
' (si3)�so-oozo ' 16086
BUILDING PERMIT �
PERMIT INFORMATION � LOCATION INFORMAT ON
Permit Number: 16086 Address: 5610 GALL BLVD �
Permit Type: RE-ROOF ZEPHYRHILLS, FL. I
Class of Work: ROOF REPLACEMENT Township: Range: Book:
i Proposed Use: COMMERCIAL Lot(s): Block: Section:
� Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-05700-0255
Improv. Cost: 20,250.00 OWNER INFORMATION
Date Issued: 3/13/2015 Name: BURGER KING
Total Fees: 140.00 Address: 5610 GALL BLVD
Amount Paid: 140.00 ZEPHYRHILLS, FL. 33542
Date Paid: 3/13/2015 Phone:
Work Desc: REROOF SHINGLE SINGLE PLY
CONTRACTOR S APPLICATION FEES
DE PSEY ROOFING COMPA Y C REROOF COMMER IAL 140.00
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Ins ections Re uired
DRY ROOFI SP
, TAPE JOINTS ROOF IN,S,,P�
FINAL_ � - / - /J
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REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
� inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly that
may be found in the public records of this county, and there may be additional permits required from other governmental
� entities such as water management, state agencies or federal agencies.
' "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."
Complete Plans,Specifications Must Accompany Application. All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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' O CTOR SI ATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION '
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED -
PROTECT CARD FROM WEATHER
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Feb 2015 03:13p Dempsey Roo��n_C�om�an.� 863-68��274 p.3 �
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the CoUcction pf smd ob1Pp,�tion.inclu�irlg r�qpp�ic:rttnmep fees,fur�yemiarc,ali unpeid obliga0oo�hcreuader shall accauc intenetf et the.�le
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CAN��I.LAT IONS
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Own¢rfs)Name;A.ddress Aate Contrncx avo.
Attt�:�oe Fu2far� 2l24;25 CUl5022QQI
7ho Jen Companie�
35 5ockanos�:�t G4�oss Road 1 his:�mh$ct Agttecnenz,hcaEinaRer rofemed to as"Agteanent'.is
Cran:aron,RI 02920 I ictv�een O+rne�,a5 dcscribed at lef�het+e:ata8er rcf�ett'ed ta f�s"�wner(s),.,
ProjeC[Nazne::Address
A nd i�mpsey Roofin�C�.,lnc.,herai,nafter ref�ed to as�Compan�°.
Bur,gel�King��079
561d GaEI kSl��cl.
Ze�h�rhills.I�L
� SC:OPE OF VYpRK
TN is_A��reemet�t includes: �
t) Fumiski and inscall Duro-Last Under a3m�cnt c�ver d�c caistin�r�ofi s,v9tem.
2� Fumiski and insiati Dnro-�,a5t 40 rni{;�i.n�;Ie-p1y rnc�f sys2ersa.
3� rurnssrc a7tG insta2t X�ro-Last��C tt�c�t1.n�,�s.
4) F�misks and inStaI]Duro-[,ast curbec ptcjedinn fla,q��ngs.
5) Aurnist'snd in;�13 Lhtra-Last stsck ilaFitings un e(eettica3 and plumbingpetsett�tians. -
E,) Fumist;and izestail Auro-Last appror i;d c:dge det�il,
7) FumisTl a 15 yea�o�2uudactureis wer�nt�.
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N4k�This A;gsemelst may Nc vtithdravm b>>4e Vf mci eccaptM�vithin 3Q d:ry5.T!!is prapt�ut f�b1�td upast o�C euisting mof SySiee�if
co�fplCte tcer aff i5 iCquitcd ChiS tvit{6c additicrtvit,t,trt�n dcek ieg Yn'!1 t�e npnitetT b$9cd r�n Gmc xRt$matcri�t.Rcmdva(snd reii�st,^.flpmM OT
elcc�ric�l�roc�f top cquinM�ni�i+r tl�e Rol,+�ipR iRu�ilad�n cvil'6e pmvided b,y thc wmcr.
�+ym.ent Te�,ns r� r�(►"•fi duc upqn c�ofn�IMior:oC9ro,icu Cbrttract PTioc $20.250.OD
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Conde'6a»s:
"t t►ls�reernent ddes gut�nc ade
Ciwrges for ney ur(s)duetoroof demaqi bS�oUms,���qLS inCUrn.�d due tp inwnpktc c��truMfon,or T�atute sehcdutingpyad+ers.
Additionel trip9 tC ptojdci duc to ina�ofilplctc mngtlli:fien mpmrrmfuro scfiedtiling,(Qnc trip�s e�cppCtod aflcr raofepltlpielion foe�ny mCta1
workj Any we�:or ehan�rcqssitcd Uayqttd the spt:ifiC StOpe oFtttis Ag�emcpG Aay cn8a rcquile�n�ii5 t4 ritCthunient Pnitc Gt eteelric�tt
firtea I�cNed OR t4af.Any rttovCmr,ne ot'mccitan+cat re ci��cerie�t ttiliCt,e�ntiuits io�oa thCraotor undc�11tC Ceckto in�alt ncw rovf.
DF.Y AYS
ti�pflDy is dclaycd�t atty tinic cettser bdhtre cam»trx etflat�t ot'wp►k ot u�irlfe ln thr pm�of wptk b}��y iruuuetions of Usc awrter(9),c+r
tliC6 dWy�sntAwrtz�cd a�cnt or In�•�oia snnw smsm.i�i1�,.wrei�n4�re,heil.a.nrm,lomrtdn.ftncxl,ORher"Aet�oFdod'.Iabor disput�c,,musual
delayv in�nsp+xtalinn,unwvoidab)c oaarNCies.e�g ri ea,,cs�,yona t,'pmpany cenROL 1Ne pnticipsGCd date pf eotnmencemeDl or aomplcdan
sh;tl2 bF eauended by a rGaSac.abtc Amoont c£time.
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s�saao-oozo City of Zephyrhills Permit Application Fax-813-780-0021
. � Building Department �
Date Received ' � ,_ Phone Contact,for:Permittin Y �,.$ . , =21 . ''
Owner"s Name ' � " - � . . '�,.Owner.Phone Number. - `
Owne�'s Address 35 Sackanosset Cross oad Cran ton RI 0292 - 5 �: �.Owner Phone.Number, ° .
� � • , � , . . . , . .. . ; �: ; , . , �
Fee Simple T7tleholderName, . - - • � Owner Phone.Number •� •
Fee Simple TiUeholder Address ' ' ' � ' ' � ' �� ' � ' ' ' ' � -
JOB ADDRESS 5610 Gall Blvd Z h lulls FL 33542-3413 „ - , LOT# �
SUBDIVISION _ ' ,PARCEL ID# .11-26-21-00�10-05700-0255 �
_ . .�(OBTAINEO FROM PROPERTY TAX NOTICE) .
WORK PROPOSED NEW CONSTR .ADD/ALl' [� 1�,�SIGNt- ••;,Q,, ; ;,,. Q ;, DEMOLISW ,_ , .
. - :B � INSTALL 8 =,REPAIR, ; , . _.
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PROPOSEDUSE ' �• • � • SFR : -_ �� �COMM ° . .�: _; OTHER� : � .
TYPE OF CONSTRUCTION • BLOCK - , ° FRAME '� � STEEL' � ' �
. ,-0 ,._�... _. . 0 . 0. , F . �. . ,
' � � , .... '
DE3CRIP7'ION OF WORK Install a new roofing system.=FL#16039-R4� • � 's � � ' � - � � '
BUICDING SIZE ' ' � ' ' S4 FOOTAGE 2,400 ''��' ' °' ��HEIGHT � �: '�' ' • - .
�BUILDING ' ' $ � . ;•-VALUATION OF l;OTAL�CONSTRUCTION:„ 4 � , , ' r �
� ' 20,250:00 � - � ' "
� .,;, ;-- ,
QELECTRICAL ,:_ , $, , ,.AMPSERVICE., •, � , Q. ��PROGRESSENERGY Q W.R.E.C. ,
i L]PI:UMBING• ,.. ` $ , , V � . � ,.,,. - . . , - ^ . . � .
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QMECHANICAL ` ' �� VAWATION'OF MECHANICAL INSTALLAl'ION: � � '
QGAS � ROOFING Q SPECIALTY Q OTFiER b��
_ .�r��
I FINISHED FLOOR ELEVATIONS _ FLOOD 20NE AREA' QYES��� � �NO �` ` � ' �-�j��
. . . . . . . . . . . -. . : . . .
SUILDER • nD COMPA Y �`^._ Z '� � . •� CD, � -
SIGNATUR l� REGI$TEF�ED - Y'/ N: T(FEE;CURRE� Y•/N .
Address- U ��iC '7 .,,�/.. L ��O� -' ' ,. i, `' ,/�Se`#: � . _
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ELECTRICIAN COMPANY ,� > -
SIGNATURE REGISTERED �Y/ N , Fee CuRttEn� Y:/N -,
Address � ` � . . - . , . . ' ,`License# �
' ., . , ��+� _ �, - � ' , ' ' , : �. '
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PLUMBER. _, , . , � ,> ;r, ,..: , ., ;. ; COMPANY , _ ..... .. _._
SIGNATURE REGISTERED, A � �Y/�N_, � FEE CURRE� � Y/N
Address .. : „ . '`_ ' ' ' - ' �� . . . � ,Cicen'se# -
MECHANICAL ' . � ' '. ' � , > `.COMPANY �` .�'' -'' �• � " '`� • � ,
SIGNA7'URE �� - � `RE��srE'tieo Y`/' N� ' FEE CURRE� � Y/N � � �
Ad'dress. , . . _. . , __ i. , . .. �.: ( - ,� - . Ricense# ' ' ' , , ��
� .. , ,.. , , , . , . �� . . : . . . „ _ , . , , - .,
OTHER - • ' �-� - � � COMPANY' � ' � ` ;; '
SIGNATURE � REGISTERED��. ,,. �:� ;Y/!-N� �.,;_ FEECURREr ' Y/N " _ � - '
.. , ,. , _ _ ;i: - , �:. - . -� ' . ' ' , ' .
Address License#
� � � �i � � � i � i ���: � � i. � � � i � � � t � �;�:� � i .�. �,� i,�.i�� .� � r �:�-�-� �..� �_ r �_��.� � �:� � � � � � � � :� ��� �..� � � -
RESIDENTIAL Attach(2)Plot Plan,s;(2)sets of Building Plans;.(1�)set of Energy Forrns;R-0-W Pertnit�f,oc new�construction, = � ,
�� Minimum ten(10j�vyorking days after�submittal date.•Required onsite,Construc4ion Pl�ns,:Stormwater Plans w/Silt Fence installed,. ,
__, _ __—_ _Sanitary_Facilities`8��1 dumpster,•Site VUork Pe�mit_for subdivisions%large_�proje.cts_ , _� _ _ �_ � ____ __ __ ._,_�_ __
COMMERCIAL Attach(3)complete sets of.Building Plans plus a Life Safety Page;(1)set of Energy Forrns.R-O-W Permlt for new constnietion.
Minimum ten(10)working days after submittat date.. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence.insta�led,,_
-Sanitary Facilities&1 dumpster,-Site Wo�k Permit for a�l new projects.All commercia[requirements mu§t meet compliance , ,
� SIGN PERMIT Attach(2)sets of Engineered Plans: - :. � � _ -
`"*"PROP.,ERTY,SURVEY.required for aII NEUV,construction. ,. � , , . � � , � ,. ,
. . . . . , . . . . . . . . . . . . . , - . ..... . . . . . . . . . . . . .
Directions: _ ... _ . . - - - . . _ . _... .. __
� . Fill out application completely.
Owner&Contractor sign back of application,notarized
If over�2500,a Notice of Commencement.is required.. .(A/C upgrades over�7500) ,�
'* Agent(for the contractor)or Power of Attomey(forthe owner)would be;someone with notarized letter from owner authorizing same _
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles- Sewers - -Service-Upgrades A/C��--•Fenr.es(Rlot/Survey/Footage) -- - - _ ,. __. - -- -,r - • -. -
Driveways-Not over Counter�if on�publ,ic;roadway,s..needs R W � � , � - � � V .''I, , r,
_. ... , ,. . . , 4�, . ,,;., ,. , ,
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, .;�.�_..._.._��____--'-_ _...,..�._.._..._-'_.--�___'`_'_:.� ' ; ,,_ .�'_..,... _'_. _2 _.--..w.. ,.,_�,.
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NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more resrtrictive than County;regulations: TMe un�ersigned assumes.responsibility for compliance.with.any ,
applicable deed restrictions.� � � ` ' ' ""� �
UNLICENSED,CONTRACTORS AND CONTRACTOR RESPO�ISIBILtTIES: If_the owner has hired a�:contractor or °�
contractors to undertake work,-they may be required to be licensed in accordance"with°state and local regulations. If the
contractor is not licensed as required�by law, �both the ownee.and contractor may be cited for a misdemeanor violation �
under state law. lf the owner�or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County_Building I.nspection Division—Licensing Section at 727-847-
8009. Furthermore, if the. owner_.has hired-a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as.the owner sign as the
contractor, that may be an indication that he_is�not properly licensed:.and is not entitled to.permitting privileges in Pasco
County. � . ,
TRANSPORTATION IMPACT/UTILITIES•IMPACT AND RESOURCE RECOVERY FEES:_The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buitdings, change of
use.in existing buildings, or_expansion of.existing buildings, as specified in Pasco County Ordinance number 89=07 and '
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It'is further understood that Transportation Impact Fees and Resource Recavery Fees must be paid prior to '
receiving a "certificate of occupancy" or final power release. If the p�oject does not involve a certificate of occupancy or
final power release, the fee5 must be paid prior to permit issuance:� Furthermore, if Pasco County WateNSewer Impact
fees are due, they must be paid prior to permit issuance in accordance.with applicable Pasco County ordinances. -
CONSTRUCTION LIEN�LAW(Chapter 713, Florida Sfatutes,as amended): If valuation of work is$2,500.00 or more, I
certify that I, the applicant, have been provided with a_,copy of the "Florida Construction Lien Law—Homeowner's
Protection�Guide° prepared by the.Florida Department of Agriculture and Consumer Piffairs. If tlie applicant.is someone
other than the"owner", I certify that I have obtained a copy of the above described.document and promise in good faith to �.
deliver it to the`bwner"_prior_.to commencemerit. _` _ _ �-. . �� , : , � - ,. . ,,. �
CONTRACTOR'SIOWNER'S AFFIDAVIT: I�certify that all the information in this application-is accurate and that all work
will be done in compliance with all applicable laws regulating constructiori, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that_no work or installation has
, comrrienced prior to issuance�of�a permifi and that all work wilf`be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that ( understand that the regulations of other government agencies may aPply to the intended work;.and that it is
my responsibility to iden�ify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection;Cy,press Bayheads,.Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment. � r
- Southwest Florida Water Management District-Wells, Cypress Bayheads, INetland Areas, Altering
Watercourses. - � -
- � Army Corps of Engineers-Seawalls, Docks, Navigable-Waterways.- , ,
- Department of Health & Reh�abilitative Services%Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks. � - � ' - -
- US-Environmental Protection Agency-Asbestos abatement. - �� �
- Federal Aviation Authority-Runways. . , �
I understand that the following restrictions apply to the use offill:: . _,_ - �
Use of fill is not allowed in Flood Zone"V"unless expressly permitted. �
- . If_the fill material is to.be�used in Flood Zone "A", .it_is understood. that .a drainage plan addressing a
. - �� "compensating volume" will 6e submitted at time of permitting-whicfi is prepared by a professional engineer
, licensed by the State of Florida. . � -�
- If the fill material is to be used-.in'Flood Zone "A° in connection with a permitted building using stem'wall °
construction, I certify�that fill will be used only to fll the area within the stem wall. ^ �
- If fill material-is to be used_in_.any area,. I certify that use of_such._fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the�building-permit issued under the attached permit application, for lots less than one (.1) '•
acre which are elevated by fill,'an engineered drainage plan isrequired. _ - =� , � -- �
)f 1 am the AGENT FOR THE �VNNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior.to commencing construction. I.understand that a separate_permit may be-required for elect�ical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application, A
permit issued shall be construed to be a license to proceed,with 'the work and not as authority to violate, cancel, alter, or� ;
set aside any provisions"of the technical codes, nor shall issuance of a pe�mif prevent the Building Official fro"m thereafter
requiring a correction of errors in plans; construction or viofations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is-commenced within six months of permit issuance, o� if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in writing, frqm the Building'Official for a period not to exceed ninety (90) days and will demonstrate°
justifiable"cause"fior the extension. If work ceases for ninety (90)consecutive days, the job is conside�ed abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
_ _ P_AY_IN.G_T_WICE..FQRIMP_ROVEMENT$�TO;YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSUL-T "�
WITH YOUR LENDER OR AN ATTORNEY BEFORE'RECORDING YOUR NO.TtCE OF COMMENG�MENT�
FLORIDA JURAT(F.S.117.03) � ` , ' ;. . � " � ,
. , ,,, , ,� .. . , �, . „ ,
OWNER OR AGENT r � � '- -_ -: CONTRACTOR� /�l� ,.- '. ,." •. - ' -
s nb�d and swom to affirtne )before me this S cr' ed d swom to(or affirmed),before me this ' � � � �
3 S by Bryan A Demnsey ����5 C� by,�yan A Demns� : ,, . . �
o is/are personally known to me or has/have produced Who is are�ersonally known t�or•has/have produced
as identification....�:�, ., as idenffication. � .. - - ,
� � "''� Notary Public �G�. ` � ��'�`-' —. Notary Public: �
Commission No�!" � ! � �,7 � ` ' � ' Commission No.�/����.� �d— �
Name f,f�7jL' pesi� r' ted or s am� pe Name of N aq��pa�'�.pri���r�+�c� BUTLER
_: ,a,;�-.. D��ORAH K BUTLER , - -
� � MY CdMMISSION#FF07??/? f�` ,�: MY COMMISSION#FF072272
i±�°Q`� �•.'.�,Fno*'��. EXPIRES November 21,2017
••?oF��`'.� EXPIRES November 21,2ot7
•••.........
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Pertnit No. Parcel ID No 1 1 �L(lJ��` ����������v�
NOTICE OF COMMENCEMENT
J State of_���c �. County of �Q��
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� � THE UNDERSIGNED hereby gives notice Ihat fmprovement will be made to certain real property,and in eccordance with Chapter 713,Floride Statutes,
E lhe fallowing infortna[ion is provided in this Notfce of Commen enC �7
�"� 1. Des�iptlon of Pro erty: Parcel Identificalion No. - " - ~� QD�B/�
� �M SlreetAddress: ��(� ��C/ /l U� Zep ,t�� /r 'S� �-/�
�~a 2. General Descript(on of Improvement����� .�I' �BG1� �IQ�/ �Cb� <J�5��
� E ve� e _ � �
a�a�
L�� 3. Owner Intortnation or Lessee informaUon if the Lessee contraded for the improvement:
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�,�� �u� k,.4 . ���
w', ��"Name pq �-�- W Y
o N Y 3s -�iGl��.notise.-F' erJSS �cYi� �aan5'�vi � Q Z V Q.' W
N M m Address City Stete O � w � � ,�J U
a\o Interest in Property: ��^' i U � � O = �J �-
�
a m Name of Fee Simple Tdleholder. � Z U � J � ~
(If different fro Owner listed ahova) N �
nQ.. c�9Q= Q � w
F- w
Address r-- City State O � = Z � � �
4, Contraaor. e C � e� O � � Q �
� �D ame � G/c� �(c��/Sr) �� 1}- W O O D U
Address �j 2� City -��i�f State Z 2 U �23
Contredot's Telephone No.:��J���7��;,I�l� O � � W� Q
5. Surety: ���' � V =�U U W
Name s(F- �- J Q J
p >- U [Op ti
Address Cily State LE- L!J � z O J
y Amount ot Bond: $ Telephone No.: a � � � = Q W
m 01 -1u10p z
m rj 6. Lender. � u_ J V � � Q
�� T Name �
�m»+ � � z � (�
„0 o Address Ciry Stete �a W
y „ , Lenders Telephone No.. S�- � w �, Z �
��"� 7. Persons withln lhe State of Florida designated by the owner upon whom notices or olher documents may be served es provided by Z-�- y � z F-
� Sedian 713.13(1)(a)(7),Flodda Statutes: t f 3 l--- 1- Q � n- m
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� N N8fT1@
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I �;m'�., Address City State �
�y�� Teiephone Number of Deslgnated Person: ��� � � * *
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8. In addition to himsel(,the ovmer designates of_ �
, to receive a copy of fhe Lienors Notice es provided in Section 713.13(1)(b),Florida Sletutes. -'y �' � °Q �
Telephone Number of Person or Entity Designated by Ovmer �`��1� • �,
— °° CO
� 9. E�iration date of Nollce of Commencement(lhe e�iretion date may not be before the campledon f con ruction and flnal paymeM to the � � - ,� � o �,
� contrador,but will 6e one year hom the date of recording unless a diHerenl date is specifie[�: � ' � e '�' �
' � WARNINO TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATI OF THE NOTICE OF COMMENCEMENT �� g"� �• e��g
= ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 7, SECTION 773.13 FLORIDA STATUTES, AND CAN �j
= RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE' OF COMMENCEMENT MUST BE �p
� RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
� WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT ���
� Under penalty of perjury,I dedare that I have read the foregoing nolice of commencemerrt and that the tacts stated therefn are Vua to the best �,�'
= af my knoxiedge end belief.
—� STA7E OF FLORIDA �C lll(Ja_'?c ]V�'+ ��--�v�
�N COUNTY OF PASCO �
-=o� Signeture of or Les`s'ee,or Owrers or Lessee's Authorized
—� O(�tticer/DiredodPaMedManager ..1_.
=N 1J1R-2�R- �.. �M..nc-dm,l9 ��5� f,,.
Signator�s TrtIelOHice �T
Tha foregoing insWment was acknovAedged befare me this 3��day of �C� 20 L,by 0- �b S r�1� �ULF4 R�
asUiRCc'Snr� 0� �Q4�G/ZAr3 t��5� �� (lypeoteuthorily,e.g.,of6cer,Wstee,attameyinTact)for
'�!a U Il� �4� ��L• (nam of party on hehal of whom instrumeM was executed).
� Personally Known�Q$Produced Identlflcapon❑ Notary Signature "�•� ,
Type of Identificatfon Produced Name(Print) r^A��1 � �A C�.�l�i�1,v1'�T4:i p1�.
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