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HomeMy WebLinkAbout15-16509 I � CITY OF ZEPHYRHILLS : � 5335-8TH STREET (sis)�so-oozo 16509 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 16509 Address: 5230 2ND ST Permit Type: ADDITION/ALTERATION ; ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: NOT APPLICABLE � Lot(s): Block: Section: Square Feet: , Subdivision: CITY OF ZEPHYRHILLS Est. Value: ; Parcel Number: 11-26-21-0010-12600-0150 Improv. Cost: 7,300.00 ' OWNER INFORMATION Date Issued: 8/12/2015 ! Name: PETERSON HEATHER E Total Fees: 112.50 Address: 5230 2ND ST Amount Paid: 112.50 ' ZEPHYRHILLS FL 33542-4026 Date Paid: 8/12/2015 ' Phone: 813-377-9538 Work Desc: INSTALL SMART JACKS � CONTRACTOR S APPLICATION FEES L.R.E.CONSTRUCTION SE VICES,L BUILDING FEE I 112.50 � � � � f� � i�� �� P � � �� . ��- - I � � ,, � Ins ections'Re uired F OTER 2ND ROUGH PLUMB MISC INSULATION CEILING FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. 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. i NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property 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. � v ' ��J - �- CONTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER e�a-rao-floso CitSr of Zephyrhills Permit Application Fa�c-613-78d-0Q21 BuUdlnB Gepartment � Oate Received phane Confad for P�itt{�g T'T1'7'TT I-TT-7�7 Ownefs Hama J1'�r1 /"""�'%��f D� I Owner Phane Number �1.��7f r� Owner`s Addtr�ss Sf��a a Q � ' � �Li .33 Owner Phane Number � � Fee Slmple 17Ueh�lder Name � � i t)wner Phane Numher �!� � r Fee Simpie T{tieho(derAddresa � �oe aonr�ss 5"�3� 2��' �T•'2c .0 d:/ff �J,i 33sya La�,� /.,�-i'6 sosuivis�oH � � Paac��.in� Gjl''o2��I�O�DrO�-1���-� olsz? � toaraNm Fae�e veoP�en rax�nc� WQRKP�ROPOS�D e NEwCONSnt� AdD1AE.T �� SIGN Q [� DEMOLI8H INSTALL REPAiR PROP08ED USE [� SFR [� COMM �[� OTHER TYPE OF CONSTRllGTTGN Q RLQCK Q FRAME i� STEEL Q OESGRiP7TON OF WORK -�/�3'T�� S��6IT" tT.�`4'4`�.1; HUILDlNG SIZE ���r� SQ FOOTAGE�,,,,� HEIGHT ��,� � [�8Ullb1AlG � ����.��� VALUAT1diV OF i OTAL CONSTRUGTkON QE1-ECTRICAL $ AMP SERVICE (I Q PROGRESS ENER�Y Q W.R.E.C. QFLUM8IN� ($ � , ��4� �.�.____ � � OMECHANICAL 3 r VALUATION OF�MECHANtCAI INSTAELAi'ION � [,�j�,as � Roo�ir�� [� sP�cu��nr, � on�E� FINlSHED FLOOR ELEYATIONS ��� FLOOD ZO�tE AREA QYES Ft0 � . . . . . . . . . . . . . . . . . . . . . . . . . . . HUILDER GOMPANY L•/�Cd��•+�GCr,w,u.f J�`FiPL/f«J �' C StGNATURE ___-__!� r�GRST�ED Y! N �E CuRREn Y!N Aaa�s v �d Da�3 ,��U,r's�%I 3 ' u�e# C'r�c�a s�3 9d'` �� �__.._.,_._., � ELECTRICIAN COMPANI' StGNA7URE REGISTERED Y! N t'EFCURttEr Y/N /�dfCSS � �./C@t1S9# ���`�- PLUMBER � � COMPANY SIGNATURE REGISTERED Y! N �cu�en Y!N Address � 13cense# � � MECHANtGAL � � COMPAHY St�NATUR� Re�lsr�o Y! N �CUwten Y!N Address I Lfcense# t � I OTHER ���� CQMPANY SiGNA'ti1RE REDISr� Y! N F�CUft�n Y/N i Address License# ��� Iiltli / IIIIt / t # 1111l1li1t11 / / i1 / Ittiiti1 / 11 / 11f11 / ! ! 1 ! M ! ! lIJIl / 1111 --- R�SIDENT1Ai. Attaah(2j Piaf Ptans;(2}sets oi 8utt�ing Pi�ns;-{1}set of Energy Farms;R-4W Permit far new construcUan, Mtnimam ten(10)workirtg days after sobmiita!date. Requi�ecl ansite,Canstntctbn Plans,Stormwater Plans w!S[It Fence installed, Sartfitary Fac111tlas 8�1 dempster,Site Work Peanit for subdlvlsionsllarge ptajects COMMERGtAL Attach(9)campteta seYs ai Buifding P�ans plus a t.ife Sa'Fely Page;(1}set of Energy Forrns.R-O-W Pertnit for new consUuc6on. Minimum ten(3Q}worldrrg days after submlttal date. Requ(rec!ansite,ConslrucUon Plans,Stormwater Pians wI Sllt Fence installed, SaniYary Facilifiss 8�i�dumpster.Site Woik Permlt for all new projects.Al!commerclal requiremems must meet compliance SlGN PERMIT Aftech{2)sets ot Englneered Plans. ""'PROPERTY SUR1lEY requlred for al!NEW cotuU�uctian. ._�. . .� . . . . ._. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DlteCtlons: , .. Flt out application canpletely. ' �. , Owner b CanVaator sfgn bac�cc o1 appilcation,notar¢ed � � f If aver 52500,a NoUoe oi Cammencement ts requCred.,� (AI�Gupgrades ove7 57306j . ; � ... ' Agent{tor the c�tractor)or Power of Attomey(tor the owner)'iwould be someone with noterizal lerier from owner aufhoiizing same . ;'''Eaa QVER THE CUt7NTER PERMI'FTfNC (Front cf Appticatlon Only) i -- - . .-.�� ..., . -. :? Reroofs if chingtas Sewers Service Upgrades.;AlC �Fetice's(PloUSurveylFoata9ej : ,.,.,�... =_: �. � , � :t •I , , ;�. . ls,,�., , t:� x Driveways-tJoi over Caunter if an pubtic roadways..tteeds ftOW . i , , , - �. _ `� o x � � _ I ;� .. � , �:; - - � ,. . .. . � . ._.." , � .�. _ .< ,_.. . ,.. ,....,�.,�..,.,.. ,..--._. NOTlCE OF DEED RESTRICTIONS: The undersigned undersfands that thls permit may be subjeck to"deed"restrictions° which may be more restrtctive than Caunty regutations. The undersigned assumes responstbility t'ar campliance with any appNcabis deed restrictians. UNLICENSED CON7RACTORS AND CON7RACTOR RESPONSIBIUTlES: if the awner has hired a contractor or , confractars to undertake work,they may be required to be licensed in accordance with state and local reguladons. If the contraator is not licensed as required by law, bath the owner and contracfor may be cited for a misdemeanar violation under state law. !f the owner or infended contractor are uncertain as to what licensing requiremerrts may appiy for the lntended work,they are advlsed to eankact the Pasco Counry Buliding lnspection Division--Licensing Section at 727-84?- 80q9. Furthermare, if the awner has hired a contractor or contractors, he (s advised to have tF�e confractar(sj sign portions of the "contractor Biack"of this application for which they wiil be responsibls. if you, as fha awnet sign as the contractor, that may be an(ndication that he is not properfy licensed and is nat entltled#o permit�ng privileg+es in Pasca Caunty. TRANSPORTATION IMPAGTNTILITIES IMPACT AND RESOURCE REGOVERY FEES: The undersigned understands that Transpo►ta�on Impact Fees and Recourse Recovery Fees may appiy to the construetion of new bulldings,change of use irt exisfing buildings,ar expanslon of existing buildings, as spec'�'ied In Pasco County O�dlnance number 89-07 artd 90-07,as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permit�ng. It is furth�r understood that Transportatian trnpact Fees and Resource Recavery Fees must be paid prior ta rec�iving a °certfffcate of occupancy°or final pawer release. if the pro)ect does nat involve a cedificate of occupancy ar �nai power release, the fees musk be paid prlor ta permlt issuance. Furthetmore, if Pasco County Water/Sewer Impact fees are due,they must be paid prlor to Permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LiEN LAW�Chapter 713�Fiorida Statutas,as amended); If vaivatian af wortc Is$Z,�OO.dO ar rnare, 1 certify that 1, the appltcant, have been provEded with a copy of the "Fiorida Canstruction Lien Law--Nameowner's Protection Guide"prepared by Rf�e Fla�ida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the"owner", I cerdfy that I have obtained a copy of the above described dacument and promise in good faith to deliver it to the°owner"prior to commencsmettt. CONTRACTtaR'S/QWiriER'S A�FlDAVIT: !certify that all the informatlori in this appllcatian Is accurafe and that a!!work will be dane in compliance wlth a!!applicable laws regulating canstructlon, zoning and land development. Application is hereby made to obtain a permit to do work and Instaliatian as indicated. I certlfy that rto wark or instattation has commenced prior ta issuance of a permit and fhat a11 work will be perFormed to meet sfandards of aii taws regulating constructiop, Couniy and Gity cades, zonIng regulations, and land development regulatians In the�urisdlc�on. ! also certify that`I anderstand that the regulatfons of other govemment agencies may apply to the intended work, and that it is my responsibitify fo.idenfify what actions I mus#take ta be in comp(iance. Such agencies include but are not limited ta; , Dapartmenf af�nviranmenfa� Pratection-Cypress Bayheads. Wetland Areas and Envlranmentalty Sensitive Lands,WaterlUUaskewater Treatment. - Southwest Florida Water Management pistrict-Wells, Cypress Bayheads, WeUand Areas, Aitering Watercourses. - Army C�rps of Engineers-Seawelis,Dacks,NavigabEe Waterways. - Department of Health & Rehabilltative Services/Environmental Health Unit-Wells, Wastewater Tr�atment, Septic Tanks. - US Environmental Pratection Agertcy-Asbestos abafement. - Federa!Aviation Authority-Runways. !understand that the fallowing restrictions apply to the use of fill: - Use of fill ls not allowed in Flood Zane"V"unless expressly permitted. - If the fi11 materia) is to be used in Ftood �one A", It is understaad tttat a drainage ptan addressing a "compensating volume"wili be submitted at dme of petmitting whlch is prepared by a professiona!engtneer licensed by the Staie of Florfda. - If the fitl material is to be used in F(ood Zone "A" in connec6an with a permitted buiiding using stem wall constructian,I cer�Eify thaf�It wi11 be used only to flll the area within the stem waii. - !f fil! materia! is #o be used fn any area, l cerUfy that use of such fill wi11 not adversely affect adjacent properties. !f use of fill is found to adversely affect adjacenk properties,the owner may be cited far violating the conditians of the Du(Iding permit issued under the attached permit applicatian, for tots less than ona (1.) acre which are elevated by 8f1,an eng(neered Qrainage ptan is reqe�ired. If I am the AGENT FOR THE QWNER,i promise in good faith to inform the owner of#te permikting conditians set forth in thIs affidavlt priQr to commencing construc�on. I understand tha#a separete perrnit may be required for electrical work, ptumbing, signs, wells, pools, air condit(oning, gas, or other instaita6ans not specfficaey included in fhe applicatian. A permit issuad shall bs constr�ed to be a Ocense#a proceed with the woric and not as authority ta violate, cancel�8IC8[f or set aslde any pravtsians of the techntcal codes,nor shall issuance of a permit prevent the 8uilding Official from thereafter requiring a correction of errors in plans,canstruction or violations of any codes. Every permit issued shatl6ecame invatid unless the work authorized by such perrnit is commenced within six months of permit issuance, or if woric authorized by the permit is suspended or abandoned for a period af six(6}months after the firne the work is crsmmenced. Art extension may be requested, in wdting,from the 8uilding Officfal for a period not to exceed ninely{90)days,and will demonstrate justifiable cause for the extension. If work ceases far ninety{90)consecuGve days,the Job is considered abandoned. -.. WARiVING Tt}t�WItitER: �Y{lUR"F�►ILiJRf TO REG�RD A-P00?'IGE-QF-�OMMENCEMENT_MAY_R�SULT_IN YOUR�__ _ PAYING?WICE F�?R IMPROVEMENTS 70 YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCWG.CO�NSULT ` WITH YOUR LENDER OR AN_A170RNEY BEFOR�RECORDING YOUR NOTtCE�F COMMENCEMENT. FLCIRIDA 3URAT(F.S.1 i . j OWNEit OR AGENY � CONTRAGTBR � Subscrlbed and sao affirmed} oreb,�� Subscrlbed and fo(or af1lm�ed�betore me lhis by by Who islare personaNy own ta me or hasJt►ave produced Wha Isfare personatly icn to me ar has/hava produced as Idenfiflcadan. as Identifiq�on. Notary Wsblic Notary Publk Co " Commiss �: Commission#FF 137073 ��a'�y�Y D;t�f �� .� y � JC.. Ns � Narne Nota oristamped �,�o�n`•: �Y a�n ce8M�395d018 • ' , , iu,:� ��'r��t*��Q' at . .r{i!9 n , w.9lMS/V�.rr�+ m11f ���ntw�. �4,.�°-:'�; ' -r�,r.,,_� 2 +�!a ��j , __ ::.,/ _` �. .+:i,'11l � `j.� �`'} '� -o` `�(il �'!- - 1�!-------�-�J-- -->`,`�.... _._.,_........_.,........_._ _...�.e..._��...._._.,-.-�...._.--_-_ .-� � - -- -_.,.-..-.....e.e.._..__.�».�_.... �,�_. , � .._.�_� -----�-.. _ , . � _.. �.. � .,�. �}.�.. , . ............ ... ... _ _ __ _ _. _..,� . . ..,:. .._ ��, _'!, - - - ,� . �... -"'"` __.-.,�.�.--v-^= � July 29, 2015 � Hillsborough County Development Department ! 601 E. Kennedy Blvd. 19�h Floor Tampa,Florida 33602 � Reference: Authorization for Use of RE&A Foundation Stabilization Plan by LRE Ground Services�Inc. For the Peterson Residence 5230 2"d Street Zephyrhills,Hillsborough'County,Florida 33542 RE&A Project No.:2828-15-058-ER i To whom it may concern: ' I Ramos Engineering and Associates, L.L.C. (RE&A) has developed crawlspace foundation stabilization plans for the Peterson Residence located at 5230 2"d Street, Zephyrhills, Hillsborough County, Florida 33542. These plans have been developed for the exclusive use of LRE Ground Services, Inc. on the referenced ;project. RE&A here by grants LRE Ground Services, Inc. the right to use the referenced�plans to obtain construction permits and for foundation stabilization at the subject property. , i RE&A appreciates the opportunity to be of service. Should you have questions and/or need additional information do not hesitate to contact us. �0111 I I Ill// Sincerely, e,�0!\� .�� //�/ , Ramos Engineer����`�� , ,I�.C. . � �; e i , ° , ` � � . � * � � � e 1 e � � I Gilb o amos,�� '1VI.A E, LE�`� ; Florida License I�d��'���� �� ` �� 6�`4,� ON `��'���� ; cc: (1) file �/�����ae (1) LRE Ground Services, Inc. ' (1) Ms. Heather Peterson Enclosure: Remedial Crawlspace Stabilization Plans for the Peterson Residence I 2825 minuteinan lane, brancion, florida 33511-9504: phone 813-453-0935 fax 813-653-1792 www.Ramos�ngineering.com ' � � O � � �� i' ���@ '�w,. ���� v�,, _..-_ S"�t�!%1, i�� _• \ ~' - f� I �� ��� i?r) :'.�.,v� �u� -��i� �:� � '�3� . _� J, ---�__ .: _.__---�._.__.,... _� _ .-.- . t� I�*1 �°�� �, ,_.., - .. _�.��:� - - - - - ,. ,; __ . . _ , _ �. .....,.:_.. . _ �.... . , :.._- _. ,� . _ ._: ,. _.�_. , _.:::. ..�.. pir 0 - . o �'"�--�,...�' ' July 29, 2015 Heather E. Peterson � 5230 2nd Street � Zephyrhills,Florida 33542 � i Attention: Ms. Peterson , ; Reference: Alternate Crawlspace Foundation Stabilization Plan Peterson Residence � ' S230 2nd Street Zephyrhills,Hillsborough County, Florida 33542 RE&A Project No.: 2828-15-058-ER i I Dear Ms. Peterson: Ramos Engineering and Associates, L.L.C. (RE&A) has developed a remedial stabilization plan ' for the crawlspace stabilization of the Peterson Residence located at 5230 2°d Street, Zephyrhills, Hillsborough County, Florida. These plans have�been developed as the repair measures based on our site visit on February June 19, 2015. � � Per your request, RE&A has developed an alternate remedial foundation stabilization program tl�rough the use of crawlspace stabilizer piers. The program uses six (6) Smart Jack crawlspace stabilizer piers within the area of the crawlspace foundation. The crawlspace stabilizer piers i utilize a 2'x2'xl'-4", steel reinforced, cast-in-pl'ace concrete footing and steel pier assembly to replace existing piers or unsupported floor areas: It needs to be noted that this remedial process does not seal off the top of the karst limestone or minimize the ability of the overlying soils from raveling into the limestone. The crawlspace stabilization does not address the entire floor system, it only addresses the perimeter foundation system and interior slab exclusively at those locations that are stabilized. � 2825 minuteman lane, brandon, florida 33511-9�04: phone 813-453-0935 fax 813-653-1792 www.Raillo sErigineering.com '� f -� Alternate Crawlspace Foundation Stabilization Plan July 29, 2015 � Peterson Residence RE&A Project No. 2828-15-058-ER RE&A will monitor and inspect the crawlspace; stabilizer pier installation process during the construction phase and upon completion of these operations, RE&A will issue a final report, signed and sealed by a Licensed Professional Engineer in the State of Florida, summarizing the ' remedial process along with an as-built plan. i � RE&A appreciates the opportunity to be of ser'vice. Should you have questions andlor need additional information do not hesitate to contact u's. Sincerely, ' � Ramos Engi��eering and Associates,L.L.C. � \O���p�f����/BB � �-' ��s'-`�o /� � . '-, � �-• � / . I D a� � C ' p er a ' Jones, E.L �� Gilberl��nos, �. � �EED AP Staff En ineer ; Florida�����e Fo. 485�4,% 3�G�� , .� '�.,L�JR,o.-' � GR/cj � ��°����`��ON�`����� � ��lPIB1110 � cc: (1)file � (1) LRE Ground Services, Inc. � (1)Hillsborough County Development Department Enclosures: 1 -Authorization for Use of RE&A Foundation Stabilization Plan, letter 2 -Remedial Crawlspace Stabilization Plans for the Peterson Residence I � � I � i . IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 2015129159 i Rept;1705093 Ree: 10.00 DS': 0.00 IT: 0.00 08/12/2015 T. S., Dpty Clerk Parcel ID No 11'26•21-0010'12600-0150 s Permit No. , � I w J NOTICE OF COMMENCEMENT � � � a Staleof FLORIDA Countyof PASCO V�N ives notice thet improvemenl will be made to certain real property,and in accordance with Chapter 713,Florida Statutes, �aM THE UNDERSIGNED hereby g , x the following infortnation is provided in this Notice of Commencement: � � De5U1p�0�01 PfOperty: PefCCI Id¢ntifiCetiO�N0. CITY OF ZEPHYRHILLS PB 1 PG 54 LOTS IS 616 BLOCK 126 OR 8725 PG 3431 �.�a 0 Street Address: 5230 2ND ST ZEPHYRHILLS FL 33542 " E � i a�� 2, General Descriplion of Improvemenl Crawl Space Stabilization � o i a mN � �� 3. Owner Infortnaqon or Lessee infortnaqon If the Lessee contraded for lhe improvemenL i �m Y Hea[her E.Pe[erson N N m N 5230 2ND Sf Name ZEPHYRHILLS p� 33542 ��o State � Address Cily i a m Interest in Property: O�ER ' i I Name of Fee Simple TiUeholder. Qf differenl trom Owner listed above) Holiday , Address City � State 4. Contractor. FRANK VITALE-LRE GROUND SERVICES.INC � Name BROOKNILLE FL 34603 PO BOX 10263 Address Ciry , Slate a � U � ConVador's Telephone No.. 352-796-0229 Z — �� w � (' � V- = 1,J U 5. Surely: � V � � J y. Name fA z U (� F' �� � Address City i State � � Q = Q N � � Amount of Bond: $ Telephone No. � W w ~ � a 6. Lender. � O � F- Q Q Q Name j � W LL � U Address City State � _ � � LL Lenders Telephone No. I = ~' � Y 7 Persons within lhe State of Florida designated by the owner upon whom notices or other documents may be served as provided by o = O U � Seclion 713.13(1)(e)(7),Florida Stalutes: � Q � f-- J Q J p ?- Ump � V Name � A[ LL" W = Z O J � � � 0...' LL = } w J W Z . Address City State � U � Q } Telephone Number ot Designated Person: ' � � 8. In addidon ta himseif,the owner designates I of— � O z O � 111 Cn Q J Q to receive a copy of lhe Lienors Nollce as provided in Section 713.13(1)(b),Florida Statutes. r � W � �4? Telephone Number o(Person ar Entily Designated by Owner• z � F.- 9, Expirelion date of Notice ot Commencement(the e�iration date may not be before the completlon of construction and final payment lo lhe cA � � O � n¢. m contrador,but will he one year from the date of recording unless a different date is speGfied): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT � � ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES. AND CAN � � �• � RESULT IN YOUR PAYING PMCE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE �, RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF'YOU INTEND TO OBTAIN FINANCING,CONSULT � 9 ' �'� WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT g� � �a � �i o Under penalty of perjury,1 declare lhat I have read lhe foregoing notice of commencement and thal lhe facts stated therein are lrue to the best `sg" `m� � of my knowledge and belief. ! � =,, � o o � � �. STATE OF FLORIDA � Y' COUNTY OF PASCO � �' �'�J� - • �' � � Signature ot Owner or Lessee,or Owners or Lessee's Authonzed v � 'M� � •� _ Q, O�cedDirector/PartnedManager x • �m ��r�n o� ���y �.� Signalory's TitlelOKce � �l �`'� �Q� � �t The foregoing inslrument was acknowledged before me this�day o(��20�y � ( ��_�' 'YQ� � • �Cr as �-�^�� (type o(authority,e.g.,afficer,Wstee,attomey in fad)for e����.�!��C.. (name of party on behal of�,wh'o,ml instrument was executed). Personally.Known❑OR Produced Identification[� ` Nolary Signature �' v v I Type o(Identificatian Produced �'L �`� lan� 1!P e,�1n.{ Name(Prinl)��!g ��J Q�J i ��'��iky+� ROBPROBUS :' { � MYCOMMISSIONYFF095805 ���(ti„'F BaiMedlThruSNotvyPu60rycUnde�riten wpdat albcslnolicecommen cementyc053048