The URL can be used to link to this page

Home My WebLink About15-16091 CITY OF ZEPHYRHILLS _ - � 5335-8TH STREET � �sis��so-oozo 160 1 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 16091 Address: 6741 NORTH LAKE DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: . Square Feet: Subdivision: SILVER OAKS Est. Value: Parcel Number: 03-26-21-0150-00000-0130 Improv. Cost: 10,000.00 OWNER INFORMATION Date Issued: 3/16/2015 Name: CORREIA FAMILY REVOC TRUST Total Fees: 85.00 Address: 6154 FORT KING RD Amount Paid: 85.00 ZEPHYRHILLS FL 33542-7521 Date Paid: 3/16/2015 Phone: Work Desc: REROOF SHINGLE CONTRACTOR S APPLICATION FEES AVIN ROOFING REROOF RESIDENTIAL 85.00 �� - 2 � �- 1 � �� Ins ections Re uired DRY IN ROOF INSP TAPE JOINTS ROOF INSP FINAL 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 performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFO C.O. �� ONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER s�s-�sa-aoao City of Zephyrhills Permit Application Fax-813-78d-Op21 Building Department Date Received:= Phone Contact for Permitting — Owner's Name 4...0 � �p7NG1� ��S� Owner Phane Number Owner's Address G� �T l ll�� Owner Phone Number � � Fee Simple Titleholder Name � � Owner Phone Number � � Fee Simple Titlefioider Address JOB ADdRESS lv��lT��!� LOT# �_._� SUBDtVIS10N �It>>I�,� fiJ/�l-f' � PARCE�IQ# 4�:.�-�l-r t91�"�-•dpfJ�7- �L� (OBTAINED FROM pROPERTY TAX NOTICE) WORK PROPOSED e NEW CON5TR 8 ADDtA�i' �� SiGN Q Q DEMO�ISH INSTALL REPAIR PROPOSED USE Q SFR O GQMM � OTHER TYPE OF CONSTRUGTiON Q BLOCK Q FRAME �� STEEL Q DE3CRIPTiON OP WORK � �9Ao� Q Gli��r L�II�� /� rJ� � J��* ��Jr��L .S}/I`/.CfiC� BUIl.DtNG SIZE �� SQ FOOTAGE�� HEIGHT �� B��Q��G � � "` VALUATIOR!OF T4TA�CC}hISTRUCTION [�ELECTRICA� $ AIt�P SERVICE Q PROGRESS ENERGY Q W.R.E.C. QPLUMBlNG � � ,...., c�� QMECHANICAL $ VALUATIQN OP MEGNANtCA�INSTAILATIQN �iU� � QGAS ROOFING Q SPEGtALTY � OTHER FiN15HED FLQOR ELEVATIQNS �� FLOOD ZONE AREA [�YES NO BUf�DER COMPANY SiGNATURE REGIS7ERED Y/ N FEE CURRE� Y/N Address ticense# � � ELECTRlCtAN ' CONtPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C� � PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address � License# � � MEGHANIGAI. �p�ypl,wy SiGNATURE , REGI57ERED Y/ N FEE CURRE� Y/N Address License# � � StG ATURE �_,,,. COMPANY �f��/1� �plO.�fJ��' REGISTERED Y/ N FEE CURRE� Y/N Address �� ,.3 ,�/f�j1�` �G�1 �L License# �pZ ,'.�� RESlDENTIAL Attach{2)Plat Plans;{2}sets of Buifding Plans;{1)se#af Energy Forms;i2-Q-W Permit for new construc6on, Minimum ten(f0)working days after submittal da#e. itequired onsite,Constructian Ptans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster;Site Work Perm(t for subdlvisfons/large projects CQMMERCiAL Attach{3}camptete sets of Buitding Plans plus a i.ife Safeiy Page;t,1}set o#Energy F��ms.R-O-W_Permlt for new constrvction. - - - _ - � - , Minimum ten(10}working days after submiktai date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence lnstalled, r Sanitary Facilities&1 dumpster.Site Work Pertnit for all new proJects.All commercial requirements must meet compliance StGN PERMIT Attach{2}sets of Engineered Plans. "**PROPERTY SURVEY required for all NEW construction. Direatians: Fltt out apptication completely. Owner 8 Contractor sign back of application,notarized tf over�2500,a Notiae of Commencement is requir$d. (A!C upgrades over�T500j '" Agent(for the contractor)ar Power of Attomey(for the owner)would be someone with notarized letter from owner autharizing same dVER TME COtlNTER PERMITTING:, - :{Frontof�Application Only} .�.-µ. ._.. _ , ._ _..x� �..: _.... ._. - Reroofs if shingles Sewers � Senrice Upgrades i4/C ,.Fences.(PlobSurvey/Faotage) � - � - � - - , } � �� , , -„ r .�. _.,. . � _ • . , ;'L - �'k Driveways•Not over Counter if on pu6l3c roadwa}rs:.rieeds ROVtt:.. _. ._ ._ �. _- • ., „ ,.. ,�. .,. . , .. „ . ...,,_ , �, ..,,. .. , NOTICE OF DEED RESTRICTIONS: The undersigned understands that this,permit may be subject to.°deed"restrictions" which may be more restrictive than County regulatlons. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED -CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: 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 requlred by law, both the owner and contractvr may be cited for a mfsdemeanor violation under state law. If the owner or intended contractor are uncertain as to wrhat Itcensing requirements may apply�for the intended work, they are advised to contact the.Pasco County Building Inspection 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 thfs application for which they will be responsible. If you, as.the owner sign as the cont�actor, that may be an indication that he is not.properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands � that Transportation Impact Fees and Recourse Recove.ry.Fees may apply to the construction of new buildings, 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 Recovery Fees must be paid prior to receiving a "certificate of occupancy"�or final power release. .If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Fucthermore, if Pasco County WaterlSewet impact fees are due, they-must be paid prior to permit tssuance�ln accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW(Chapter 713� Florlda Statutes�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 ConsumerAffairs. If the appl(cant 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"owner"prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I ce'rtify�that all the information in this application is accurate and that all wark will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain .a permit to do work and Instailation as indicafed. I certify that no work or instaliation has - commenced prior to issuance of a permit and that.all work will be pertormed to meet standards of all laws regulating- construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. ( also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be,in:.compliance. Such agencies include but are.not limited to: - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. - Southwest Florida Water Management District-Welis, Cypress. Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalis, Docks, Navigable Waterways. - Department of Health & Rehabilitative Services/Environmenfal Health Unit Welis, Wastewater Treatment, SeptiaTanks. � _ - US Environmental Protection Agency-Asbestos abatement. - Federal Aviatlon Authority=Runways. I understand that the following restrictions apply to the use of flll:� - 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 be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florlda. - If the fill material is to be used in Ftood Zone "A" in�connection with a permitted building using stem wall � construction, I certify that fill will.be used only.to flil the area within the stem wall. - - If fll material is to be used in any area, I _certify that use. of such fill wiil not adversely affect adjacent properties. If use of flll is found to adversely.affect adjacent properties, the owner may be cited for viofating the conditions of the building.permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fllt, an englneered drainage plan Is rsqutred. . If I am the AGENT FOR THE OWNER, 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 electrical work, - plumbing, signs, wells, pools,-air conditioning, .gas, or other installations not specifically included in the application. �A permit issued shall be constnaed to be a license to proceed with the work and not as authority to.violate, cancel, alter, or set aside any provisions of the techn(cal codes, nor shall issuance of a.permit prevent the Bulidirig Offfcial from thereafter requiring a correction of errors In plans, constructlon or violat(ons of any codes. Every permit issued shall become invalid unless the work authorized by such permit:�is-commenced within six months of permit issuance, or if v�rork authorized by the pe�mit 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, from the Building.Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety,(90)consecutive days,.th�job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO,RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR P.ROPERTY. IF YOU INTEND TO OBTAIN•FINANCING��C.ONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF=COMMENCEMENT: FLORIDA JURAT(F.S.117. � ' ` -� ' • ' - /� �' OWNER OR AGENT (/`�— CONTRACTOR��`� Subsc�lbed and swom t (or aiflrmed)before me this Subscribed and'swom to(or aftirmed)before me this . by �bY Who Is/are personally nown to me or has/haye produced Who Is/are personally known to me or has/have produced as Id tlficatlon. as(dendBcaUon. �/ ota Publlc Notary Publtc ry Commiss n o. Commissi o. �\�� 41I� 1111II ,•s.m rry�.; JOEL E.BACON ,•��i::y,�y JOEL E.BACON '� �:'= i n F 1370 3 ''� '�= Name otary � • ' o€�e 29,2018 Name o N tary typ � �;r E�ne 29,2018 '•�-,°,Ri��``�` BondedTlwTmyFenUuvenw80U�3BS7019 ��'�',p��0.��` BondedTlwTrayFainlnsuranee600�385-70t9 f . ' I 11111111411fi111111111l11111111111111i1i1111fllilil� , = 2015031893 t 'Rcpt;1664333 Rec: 10.00 � DS: 0.00 IT: 0.00 03/03/2@15 K. G. , Qpty Clerk Permif No. Parcel ID No �13�.�-�I—�/So��Dfl��-Ot� NOTICE OF CQMMENCEMENT State of ��ol+`f' County of �/f�� ' THE UNDERStGNED hereby gives no6ce that improvement wili be made to certain reai property,and in accordance with Ghapter 793,Florida Statutes, the foitowing information is provided in this Notice of Commencement: y� /� 1 Description of Property� Parcet Identificafion No, ,� .�'"'�.�v �,1 "��° ��i/^"' Q`�7,� Street Address: �P�71 ��"tj�"' 2�T rlY_/�- __1��._ _�. ��s 2. ; General Description of fmprovement Ji� ',��//'��" ��-J� 3. C}wner infarmation ar Lessee informakian if tfie Lessee contracted for the improvement: �Q.��,�,�t �}- f�1M,4� �2�ts`9 �I�'� Na�T /<<��- �'[.�K/+ �=-c.+T�ylL-JA'/(,�""�' �L" Address r Git� St��s„� (nterest in Property� tlYr��✓�� Name of Fee Simple Titleholder� (If different from Owner listed above) Address ,/.1�� a�J�� City State 4 Contractor: ��q� Name�.,f� �t�� l'� .�Ci -7 {� Git State�� , Cant actor's Telephone No. � �� "^��! r �.+a�� Y � � 5. Surety { Name ,------,-- � Address City State ; O �� Amount of Bond: $ �� 7elephane No.: , �W v, �" . ' i ��t� 6. Lender m m Name �—^�""�`. - - �� Address City State F..1�? p �� ,�W Q Lender's Tele hone No.- :�J � 7 Persons within the State of Florida designated 6y khe owner upon whom notices or other documents may be served as provided 6y � � Section 713.i3{1){a)(7},�lor'sda Statutes: � o �^--`..___ C1�-•� Name ' � � .�.� , ;�a � � �,� Address �'';` City State '�►-�o Telephone Number of Designated Person. �� ,� � 8. in addition fo himseif,the owner designates of � �� to receive a copy af the Lienor's Notice as pravided in Section 713.13(1){b),Florida Statutes. � � Telephone Number of Person or Entity Designated by Owner� �'� 9. Expiration date of Notice of Commencement(the e�cpiration.date may not be before the completion of,c ns uciian and TinaS payment to the contracfor,but wii4 be one year from the date ot recording unless a different date is specified): %4� � WAFtNiHG TO OWNEa: ANY PAYMENTS MADE SY FHE 4WF�ER AFTER TiiE EXPIRATION O THE NOTlCE OF COMMENCEMENT ARE CdNSIDEF2EC7 iMPROPER PAYlViEfVTS UNDER CHAPTEF2 713, PAf2T 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESIJ�T ItJ YOUR PAYiNG TWlCE FC?R lMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMEIVCEMENT MUST 8E RECORDED AND POSTEO ON THE JOB SITE BEFORE THE FIRST INSPECTIOIV, iF YOU iNTEND TO 087AIN FiNANCiNG,CON5UlT WITH YOUFt LENDER OF2 AN A7TORNEY BEFORE COMME�CtNt'a WORK OR F2ECORDlNG YC?UR NCTTICE QF CQMME[JCEMENT. Under penalry of perjury,1 deciare fhat i have r8ad the foregoing notice af Commenceme�t and ihat the facts stated therein ara fnae to tha best of my knawiedge and beNef. - ..��==--�'�`-� STATE OF FLQRIl7A �_ _`„�"'�"�'�"°� GOUNTY dFPASCO - _ 's Authorized Officer/Director/Partner/Manager y/; Signato s TitielO�ce � Theforegoing i�sttumentwasacknawledged eforef�this;,�day-af-- l%�,_ ,_20��i�.��fe""� �_ _ _ as, ��/'"/ (type of authority,e.g.,o�cer,trustee,attomey in fact)for � (name of y.pn�haif of who in menf wes exe uted}. Personally Known OR Produced Identification❑ Notary Signature " Type of Identificafion Produced Name{Print)_�,_��6�:....G�� /�• J.l��i ? ! �`"' � ' ' „zqt'�'r°X:F,�.;, SHIRDEN K.pEl CpTfO =xe •k= MY CCPAPAfSSIpN#EE 198857 ��;;�.•�� $ondedx hro Nohdry ubiic Und 1arwriters . wpdatalbcs/noticecommencement pc053048 ' ' ` • � . .- - --_� � ' � ��p_`�� Page No. of Pages II �� 8�� ; � -�- ��ais$�,� ��ga�a� 5��r �9�4 �" �� P.�. �ox 1�.�as ,� "°3 � 1 /y- i�ade Cify, FL�3526 �% ��2��6�-�934 '"� 9�d� � c�� 62�;� � �'�ac &ea� Ev�r�ar�y= I PROPOSALSUBMITTEDTO PHONE DATE �� D /��:� STREET JOB NAME /�� ' �7�'1 0��-��i� , CITY,STATE and ZIP CODE JOB LOCATION �-G�� l�Ls �/ ARCHITECT DATE OF PLANS JOB PHONE I We hereby submit specifications and estimates for ,� r'j�,�/� 9.�':'- f-lit/� �('/�—�O d�-2 .�0�� '� f� 3D�1/r� i��E��-G,�.��5 .�',�i.��, �/�y i;� c��T� �-- �3� �-�r �✓cve �-,�.��- D�� rr'�-��y �i�T.��, �i�E , ��/��SN�N�s �-,��p /zrO�-G- r/Gti"TS T'� t3E ��.5�/�'GG�.D, ��/�r- �� 3E�E�,�� , � .,� ��'/ �Z�ro,L��.4-7L—! uJOe� ctl��/t �"� ,�� ,D�� a� Pr2oo�2 N�r-��.� �J ', �-s ,��c—��—..�-��— ��-s�%` r� ��- 1��0 , , � i P � � � I y- � , I . �� P �CII�JIISP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: T�� m��-S�'�� dollars($ Payment to be made as follows: �� 0.��%�7 E�(J � All material is guaranteed to be as specified. All work to be completed in a workmanlike � manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon writfen orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be , Our workers are fully covered by Workman's Compensation Insurance. withdfawn by us if not aCCepted within � dByS. �CCP��IIT�P 0� �rQ�OS�II —The above prices,specifications �� (��yt� /��'�� and conditions are satisfactory and are hereby accepted. You are authorized Signature �l �- iLL to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature � r I IIIIIIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII • 2015031893 ' Rcpl:1664333 Reo: 10.00 DS: 0.00 IT: 0.00 03/03/2815 K. G., Dpty Clerk Pertnil No. Parcel ID No v];�P`/��"DIS��OOOvV�OIJ// NOTICE OF COMMENCEMENT ,/ '/�/� �i9S'e0 Slate of r G�2////Y County of THE UNDERSIGNED hereby gives nol(ce thal fmprovement will be made to certain reai property,and in accordance wilh Chapler 713,Florida Statutes, lhe tollowing informalion is provfded in this Notfce of Commencement: /� 1 Description of PropeAy: Parcel Identifiwlion Na. �.3<zli —.Z� —O+ISD— ODDOp— 0/�?� StreelAddress: k%7 NO/�/�L/}' � Z� /�- ��j L �'3s . 2. General DescripUon ollmprovement� �mf//✓� /y� S�' 3. Owner Infortnation or Lessee in(ortnalion if lfle Lessee contraded for fhe improvement: LV ��lT f��ILY T�.f/ / • F�-7 Na�T �//�lr /(.Gc �!� /[.-/r�� L Address City State /,�5 InlereslinProperty: �U�/✓El�. `3J'sy`, Name o(Fee Simple Tillehofder: (If diHerenl from Owner lisled above) Address �,.+A�� 2�0 f/�� Y Slale 4. Canlrector. ,,y, NameP(7 a�/� ��P 3 ��Q� Cl/Y �li �, Address City Stale3�� Contractors Telephone No. �� `S�� 5. Surery: Name � m� wa State � Address �.^ ��Y ' �m a Amount of Bond: 3 Telephone No.: �W N �-. 7t N�o 6. Lender. ...m Name �--T� '�lfl r. AOdress —„ Cily State ��S ,� 1� * Lender'sTelephoneNo. �� ° � Y J 9 7 Persons within lhe State af Florida designated by lhe owner upon whom notices or olher documents may ba served as pravided by d ai �� e �� I Section 713.13(t)(a)(7),Florida Slatules: �3 � ��' ♦ �1 Cf�+r �+^ Name • m o �a". �� •�..►�� ., h a � '� •1� � � °�' -,�} m�, Address �` �� City Stale ��,.= yy � �� Telephone Number af Designated Person: _ A � A,� ` �� ' ■r+ 8. In addition lo himself,lhe owner designales ��--- � � �:, . � � lo receive a copy of the Lienofs Notice as provided In Sectlon 719J3(1)(b),Flodda Statutes. � j �j,s .�� Telephone Number ol Persan or Entily Designated by Owner: �' �� / 9. Expira[ion date of Notice of Cammencemenl(the expiration dale may not be before lhe completion of cq�s c�ion and final payment lo the i � 1 � n// 7+ contraclar,but will be one year from lhe date of recording unless a diHerent date is specified): /✓/ � WARNING TO OWNER: ANY PAYMEN7S MADE BY THE OWNER AFTER THE EXPIRATION O THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13 FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE' OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE 7HE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. � W Y a V � w Unde�penally of perJury,I dedare lhat I have read the foregoing notice of cammencement and that the faUs slated therein are due to the best � W � J ol my knowledge and belleL � � � O = �J U STATE OF FLORIDA _ � COUNTY OF PASCO � � � = Q N � � � e:s Aulhorized �. � w OKcedDirecloqPartriedManager �, w � (n Q., p I � O Z ? J � Signato s Tllle/0lfice � � � ~ � ¢ O �� „�/� .ZO� y� ...�� I � _ � � Li" °�j � The foregoing instrumentwas acknowiedged efore lhis day af G�. ��'`� �/� � � F— �' IL � Y � as ��i� (type o(aulhority,e.g.,oNcer,Wslee,atlomey in(atl)for � � � 0 (name of y pn b hall of who in ment w s exe ted). (, _ � U C] w Personally Known QR Produced Identification❑ Notary Signature `Q ~ I— J Q� � i, � � l.}L W � � � U Type of Idenlificalion Produced Name(Print) � z O _1 ' (:J � � � Q QW .� w00 0 _ :�,M��t SHIROENKD�.00iTO �- c.� c.> a � �t: .= MYCOlAAUSSIONtEE198857 �' � � Q Cn � q EXPiRES:duna 2(t,2p16 0 �" Z (� i,Th,•,eabeatnn,NOtaryvucficuiWemrflers 'LL! cn Q � �- w � z� g wpdatalbcs/notice:ommencemenl_pc053048 � � Z � � } I � � � 0 � a C� ,