HomeMy WebLinkAbout15-16559 ,
' CITY OF ZEPHYRHILLS
5335-8TH STREET
, (sis)�so-oo20 1655
, BUILDING PERMIT
, - I
PERMIT INFORMATION ' - LOCATION INFORMATION �
Perr�iit Number: 16559 � Address: 7143 APPLEGATE 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: ALPHA VILLAGE
Est. Value: Parcel Number: 35-25-21-0050-00000-0020 ,
Improv. Cost: 5,000.00 f OWNER INFORMATION ',
Date Issued: 9/01/2015 Name: MCCLELLAN JOHN
Total Fees: 60.00 Address: 7143 APPLEGATE DR
Amount Paid: 60.00 ZEPHYRHILLS FL 33540-1402
Date Paid: 9/01/2015 Phone:
Work Desc: REROOF SHINGLE �
CONTRACTOR S " ' APPLICATION FEES ' -
GAVIN ROOFING RERO F RESIDENTIAL 60.00
� ` � p- � •J
��L' /
� Ins ections Re uired
DRY N R F INSP
TAPE JOI TS OF INS�'
FINAL � ��� �-l S
�
REINSPECTION FEES: (c)With respect to Reinspection'fees will comply with Florida Statute 553.80(2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe 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 Appli�cation.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
C�-
CONTRACTOR SIGNATURE - PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER � '
813-�eo-ooxo City af Zephyrhills Permit Application Fax-813-780-0021
Building Department
f �
Date Receivad . Phane Cantact for Rermtttin
i Qwner's Name �� N ��.�� 1L� � Owner Phone Numbar
Owner's Address 1 � FP �-- � Owner Phone Number -•
Fee Simple TIlleholder Name �� � Owner Rhone Number � �
�
Fee Simple Tltleholder Address
JOB ADDRESS /l7� �p P��� ,T� LOT# C„_�
SUBDIVIS�ON ��7/}" lOjl��'/'�� PARCELID# ��'�-�"'.�-!"�P1.�a,....�OG�N10— G��`L!�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW tdNSTR ADDIALT � S1GN � [� DEMOf.ISH
e INSTALL. 8 REPAIR
PROP4SED:USE , Q SFR [� GC?MM � � OTHER
TYPE OF CONSTRUCTION � CL.]� BLOCK "'+Q FRAME [-] STEEI, Q,
i
pE3GRIPTION OF WQRK �� ��p�"" �l� 3 q /�-S�/���1
BUI�DING StZE �� � SQ FOOTAGE HEtGHT [��
�Bll«����'" � � VALUAT101V OF TOTAL CONSTRUCTiON
p�
� QEI.ECTRtCA� $ AMP SEFt1/iCE Q PRO�RESS EhlERGY Q W.R.E.C.
, oP������� $ . �;
� � � � � {��,5 �
QMECHRNIGA� $ VAl.UAT14N C3F MECHANICA�ENSTALLATIQN
�
I QGAS Q'� ROQFING ..Q SPEGlAI.TY Q OTHER
�� FINISHED FLCIOR ELEVATIONS � � FLOOD 20NE AREA QYES NO
I �
�
, BUlLDE1t COMPANY
SIGNATURE REGISTERED Y/ N FeE cu�n Y/N
' Addrsss i License# � �
EIECTRICFAN COMPANY
SIGNATURE " REGISTERED Y/ N �e cUR�n �Y/N
Addre$� License# � �
PWMBER � � COMP.AN1f
SIGNATURE REGISTERED Y l N FEE CURRE� Y/N
r
Address Lice�se# � �
MECHRNiCAL. . GOMP I Y
SIGNATURE � REOISTERED Y/ N FEE CURREP Y/�N
i
Address� ` ' �icense# �! �
OTHER � COMP� G�"�1� ��r/�p
SIGNATURE� ' � REGISTERED Y/ N FEE CURRE� Y/N.
� ,
I Addre�s � b�X 3�0� � '�"'�'/� License# 1 �.-���E���� �
RESlDENTIAR Attactt(2}.PlotiPlans;.{2)se#s of=Bultding"Plans,°(1)set of Energ'yrFarrrss;R=0-V!l Permlt for new canstrui:tion,
, Minimum;kem(4.0)�working.,days_after,."submittal�date::Requlred:onslte;Constiuctlon Plans;Stormwater Plans w/Si1t Fence installed,
Sanitery FacillUes�8�r1�;dumpster 51te Work�.Pertnit.for subdfy(;sion's1la.rge,proJects• '
COMMERGIAL Attach(3}coinpiete sets of Sultdiing Pians ptus a'U€e Safe#y Page;{1}set oE Energy Farms.R-O W Perm1#(or new canstruc�on.
Minimum ten(10)working days after submittal date. Required onsite,Constructian Plans,Stormwater Plans w/Sllt Fence installed,
Sanitary Facilidas&1 dumpster.Site Wark Permit for all new`proJeots.-Al1 commercial requirements must meet compllanca
SIGN PERMIT Attacti{2}se�;of Englneered�Plans...,• `-�, � '
•""*PROPERTY SURVEY requireci for all„NEW construcdon. �
Dlreatlons: . .
Ffll out appi(ca8an completely. ,
Owner&Contractor sign back of applfcaUan,notarized
i if over y2500,a Notice of ComrnencemeM fis requieed. {/UC up�rades over i7500) ..
� " Agent(for the contractor)'or Power ofAttomey(fiir the owner)would be som�eone with notarized letter from owner authorizing same
aVER TFFE COUHTER PERMi7TiNG ; .f{Front af:Appll�ation Ority)-,�;��_�°>,...;�� �
Reroofs If shingles Sewer.s ;,Servlce.UP9rades.A/G.,'.,`°Fences'(Rlof/Survey/Foakage) , ` . "' -° - �- : , _ .,.
; ,, ,n .,, �,.,..:..:.;. ;%�, _� � �.;,;;<. ',,,� . << � "- ;
Drivewaya-Nnt over Caunter if on pubtic madways..needs`RQW'7'��'`' - ` ;;.`' ' ''� ,� � ' � `
:r_ n .. . . ..�.� ..�,. , >. . ...�. �' , , ,.' . . .: , , .'� ,7' .,
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N',OT10E OF DEED RESTRICTIONS: Th undersigned.undergtands:th�t:thls:,p�armit.may,be,subJecfi to,"deed"restrictiohs" �� � LL
which may be�more;r.estciative�thaln'Coun ��r+egulatlons:�The undersigned,assumes'responsibill'ly for"compliance`with'�any �
appHcable deed reshictions. ...., , ,.;.,... . ,-�:- - , � " �
UNLICENSED CONTIiACTORS AND CONTRACTOR RESPONSIBILITIES:�� -If the owner has��hired �a contractor or
contractors to undertake work, they may, e;r.eqttlred::to,;be;llcensed In.accordance.with.state.and_local regulallons: =1f the �
contractor is not itcensed as��equlced°tiy law, both the owner arid:`conUactor=mey�be�cited-for���misdemeanor violation
under state law. If the owner or intende ;contractor�are,unce�taln as tv aihat Iicensing.requlreRnents�'may��apply-+�for°the � �- �-
yr.�t .i,i.i�.
- .. .� . . , . . _- _....
intended wark, they are advised to coritac the=Pasco County Bulldingrinspectlon Division_-Licensing Section at 727-847-
8008. Furthermore, If the owner has lil ed a conGactor or contraotors, he�Is advised to have'the contractor(s),,sign
portions of the "contractor Block".,of this �ppllcation for which..they_will..be.r.esponslble..-.if you�-as-.the owne�`stgn�as the' ��
contractor, that may be an Indication�tF'iat he is not'.propeHy�licensed"and is not entitled to�pennitting p�ivileges in Pasco
County. `� `
TRANSPORTATION-IMPACTIUTILITIES� MPAC'1'�ANb RE30U�tCE RECOVERY FEES:�The undersigned understands
thaQ Transportatfon Impact Fees and.Rec .urse Recove.ry;Fees may�apply�;to�the•constructlon of new�bulidings„change�of�-' �
use in existing buildings, or_expansion.of-existin�g��buildings, as specifled in Pasco County Ordfnance number 89-07 and
e0-07, as amended.,,�,;The undersigned al o�understands� tha�t_�such fees�-:as��may��e�=due;;:wllb�be identified at the'time"of'
permitting. It is iurther understood that T �sportation Impact Fees and�Resource Recovery°Fees:.mu"st be pald prior to
re'ceiving a 'certi�cate.of-occupancy" or fl al powec�.release. :If the project�..does not involve;a�certiftcafe of occupancy or =
flnal power release�the.fees must be pai :prlor to permit issuence. Ft��thermore;�if_Pasco:County°1Nater/Sewec:lmpact ��_
fe�es are due, they:must.be-pald,prior to pe,mit`>Issuance in.accordance w(fh�appiicable.Pasco�:County�o�tlinances.
CONSTRUCTION LIENVLAW(Chapter 7 3� FlorJda Statutes�aa amended): If valuatlon of work is$2,500.00.or more, I.
certify that I, the applicant,_have•been rovided with a copy of the ".Florida��Constructlon L'len rLav�-Homeowner's
Protection Guide" prepared by the Flo�d Department of Agriculture and ConsumerA#.fairs. If the applicant Is someone
other than the°owner", I certify that,I,.have,obta(ned a-copy;of.the above..described�docu�ent°and.p:romise�in,good;faith,to .
deliver It�to the`owner".prioc�to�commence ent:"-'` � � � � � ' '
CONTRACTOR'SIOWNER'S AFFIDAVIT I ceitiGy,tFiat:.all:the�,infocmation (mthl�appllcation is accurat�and that all work
will'be done in compliance with ail.applic ble laws regulating constructlon. zoning and:land development. Appiication is
hereby made to obtain .a permit;..to.do_.... ork:.,and�installation as indi�afed:-� `I certify that no work°or ins�allatton �has
commenced prior to Issuance of'a permi and that�:all work will be pertormed to meet..standards of all laws regulating-
construction, County and City codes, zoning regulat(ans, and land development tegulattons-in the jurisdfction. I also
certify that I understand that the regulatlo�s of other government agencles may�apply�to the intended.work, and that it is
my responsibllity to Identify�what.actlons I ust take to be�ln:_con�pliance;. S.uch agencles include but are.not Ilmited to:
- Department of E�lvironmental'Protectlon=Cyp�esg��Bayheads, WeNand Areas and Environmentally Sensitive
Lands,WatedWastewater Tre tment.
- Southwest Florida Water �anagement• ..District-Wells, Cypress.f`BayMeads; Wetland Areas, Altering
Watercourses.
' Army Corps of Engineers-Sea Ils,+Docks, Navigable Waterways.
f - Department of Health�'8 Re,abllitativ.e,Ser.vtces/Environmental Heaith Unit Wells� .Wastewater��Treatment, '
Septic Tanks. � .
- US Environmental Protectlon gency-Asbestos abatement.
' Federal Avlatlon Authority;Ru ways:
i understand that the following.restrlctions ��pply to the use of flll:�
� - Use of flil is not allowed in�Flo d.Zone"V"unless expressly permitted.
- If the flll material is to �be u ed::'In.:Flood._Zone. "Aro, It. is understood that a drainage plan addresstng a
' °compensating volume" will b submitted at time of�permifting wh(ch is prepared by a professlonal engineer�
iicensed by the State of�Florida. .
- If the fill materlal�is to be us d'In Flood �bne 'A" in�connectlon�with''.a �permitted building using stem wall
' � construction, I certify th.at flll�:w Il:be used only.to.fill the area within the�stem Mrall.
� - If flll materlal is to be used n any area, F�certify that .use. of such flll will not adversely affect adJacent
, propertles. If use of flll Is fou d to adversely:�ftect ad)aEent��propertles,.the owner may be cited for violating
the condi#ions�of the building: ermit�1ss�ed-under the�'at�ached permit.applicatlon, for lots�less than one (1)
acre whtcfi are elevated�by flll;an engineered drainage plan is requlred.
If 0 am the AGENT FOR THE OWNER, I;p 'mise in good fatth to inform the�o.wner of the.permitting conditlon"s set forth in
this affidavtt�prlor to commencing constru�tlon. I undersfand thet a-separate permlt may be requtred for electrical work,
plumbing, signs, wells, pools; alr conditio Ing, .gas, or•other InstallStlons not.spec(fically inclu�led�in.the appltcation. .A
permit Issued shali be construed to be a'II n�e to,p�oceed wfth tFie work and not as.authority to,violate,:cancel, alter, or
set aside any provlsions of the technical. des; nor shal) issuance�of a.permit.prevent the Buildirig O#�icial from thereafter
requiring a carrection af eROrs in.plens,:�co struction or vlolatlons of any codes. Every permlt issued-shall-become�invalid
unless the work authorized.by such permt :is.commenced•wtthin sfx months of permit Issuance, or tf work authorized by
the permit is suspended or.abandoned for. :period,of�six E�)mon�s aRer the time the�work�ts commenced. An extensfon
may be requested� tn writing,_from the Building.Official for a period not to exceed nlnety_�(90) days_and_will_demonstrate _ ___�
- -justifiable cause for�the extension: If work eases:for ninety(90)cons.ecutive�days�..th�)ob�is.constdered abandoned.
WARNING TO OWNER: YOUR.FAILUR �TD.,,REC.OttD.A NOTICE.OF�COMMENCEMEMT•INAY�RESULT IN YOUR
PAYING TWICE.FOR:IMPROVEMEN.�S-: �O.YOUR:�.PROPER7Y. ;IF°YO.U=IN�END:T���BTA�N••F11d�ANE1NG;'CONSULT
WITH YOUR LEND@R:OR AN ATTORNEY�FORE�RECORDIN�_=1�OUR�NO'FI��'O�`CdMA1lENCEIVIENT:
FLORIDA JURA�•(F.S.11 Z.03} ' ' : ' '
�
OWNER OR AOENT /��.. CONTRACTOR`i��� ' '
Subscrlbed and swom to(or afflrtned)betore me this Subscrlbed'and'swum to(of afflrmed)'before me thl�
, by ,bY . ,
Wh'o Is/are personally known to.me or haslhave proddced Who Is/are personaltyknovm td,-me or haslhave�prodilced
as IdentlBcatlon. as IdenUflcaUon.
I � C �
'� Note Publi . Notary Publlc
Commissl No. Com e n�No.
� � ':""�•. JOEL E.BAC_ •
' .•''��'"'�s•: 'on#FF 137073
Name o Notary typed p, ' �7073 Name o1 No d �1s,
! . �� o mtssion#FF1 �. r'}��'� Fe.���e�B�85•7019
' "' Expires June 29,20 8 ;;��;�' BondedThNTro1
I �'.;� oq' BondedThru7roYFeininsuran e800�385•7019 ',��R
, ��R��`
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2P12524@220 08f31I2�15 S. t1. , Dpty Clerk
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I PR ALU S 0'MEIL,Ph D PRSCO CLERK & C019PTROLLEk
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PeRnitNo. Parcel ID No .3-�'"�c..�—'� ��-. d Q�� "" ����Q '° ���-�
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NOTICE OF COMMENCEMENT
State of ��f � Cou�ty ofl j�+'TJ�ll�
I
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement: � _
i Descrip#ion oi Property� Parcet ldentification No. ��.J`r� ��—�p��— ���Qf� — c�0�('�,
Stresk Address: /!!3 ✓/✓/'GCG"l�"7�"'
2. General Description oC improvement � "'!/�-��/�`�/✓G=' ��u-.S� �
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3. Owner Information or�essee infortnation if tlie Lessee contracted for the improvement:
���� /��G���•
�f�{3Name�}'�Y"L�-�R'i�- /Z�f'/����LG-S �L
Address i C+t� State�-7 r
Interesi in Property' ��'��G 2' • i .J�✓ ��
Name of Fee Simpie Titleho►der: �
(If different from Owner listed above) �.,
Address /I��!`J City State
Contractor U`' �OOr""�J�✓l
Na�,e 0 r� 3 �
u�. ,� K 1��` �/`��� �-���/ ,-��
Address � City �� Slate �,�„�
Coratractor's Telephone Na.• ��5� �5��`-58...3�• 3
� 5. Surety: �� (
Name �,,,__
Address �.. City State
Amount ot Bond: $ Telephone No.
� I i
, r--�''�'
I 6. Lender �
Name �' �
� Address ���_. � City State
Lender's Telephane No.• �
� 7 Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1){a)(7), F ' tatutes:
Name I
�"._
Address �_,._� i City State
Telephane Number of Designated Person: �
$. In addition to himself,the owner designates of
i
to receive a copy of the Lienor's Notice as prpvided in Section 713.13(1)(b),Florida Statutes.
i Telephane Number of Person or Entity Qesignated by Owner �I
9 Expiration date af Notice ot Commencemen#(Fhe expiration date may notj8e before the compietion of ca s ru ion and final payment to the
contractor,but will be one year from the date of recording unless a differenti date is specified): /� ��
WARNlNG TO QWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXP1RATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIt?�REO IMPROF'ER PAYMENTS L1tVDEf2 CHAPTEf2 713� PART 1, SECTION 713.13, F�ORIpA STATIJTES, ACVLl CAtJ
RESULT IN YOUR PAYING 7WICE FOR IMPROVEMENTS TO YQUR PROPER7Y A NOTtCE OF COMMENCEMENT MU57 BE
RECORDED AND PO�TED ON THE JOB SITE BEFOF2E THE FIRST IN$PEC710N. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WtTH YOUR LENQER QR AIV ATTQRNEY BEFORE COMMENGlNG WORK OR RECC1RDfNG YOUf2 NOTICE OF COMMENCEMENT.
I �
Under penalty of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and belief. �
�
STATE QF FLORIDA i f�
GOUNTY OF PASCO �—� ' � �'—�"'�
�� � - Sig ature at Owner o� essee,or Owner's or Lessee's Authprized
dfficeclDirectorlP artnerlManager
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4-C�rn p....�L
Signatory��i���R{��ce
\����� 1, ►!�// /'�' c�"y,��t ,,�
The foregoing instrument was acknowledged before me fhis,�^�ay o .���j �� � �o�r /'/ �1'� ��-�.'�c�"�--�
as `► .•1g814N�.A.� {t�, suthority,e.g.,officer,trvstee,at#omey in facf}for
� � �� � �(n�m �t�� on behalf of whom instrument was eacecuted). ,
°� I�� ` �%
Personaliy Kn n R Produced identification❑ ��t$ry Sign�fure
� • � �r• � ,�/
Type of identification Produced '��'�Pnnt)'1����'' ��"� � //�"`-" "
`�'i��•qq'�:;�+w��;.•�o��'°
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PpULR S 0'NEI�,Ph D PASCO CIERK 8 C4MPTROL�Eh
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PermitNo._ ' ParceIIDNO .3s"�1--����...�Q,�� - o0p00 - t0o.�9
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NOTtCE OF GOMMENCEMENT �
State o( J" �/' Cou�ty af__��..rC.lJ� I
THE UNDERSIGNEp hereby gives notice that Improvement will be made to cehain real property,and in accoidance with Chapter 713,Flodda Stalules,
the foitowing infortnation is provided in this Notice o/Cammencement:
1 Oescriptiono(Property� PatcelldentificationNo. .�S'"a-S- �./-.mO"'�0�.-{'J(�`QOQ I OD,'Z?J
Stree{qddress: /�(� ���GGU'"'���" i
2. General Description of Improvement �"'�p�/11�l.r' �"��l(.,f L{ � i
I
3, pwner Intormation or Lessee infortnation if lfie Lessee conlracted for the improvemenL• (
�'��n1 I�'I�G�lI,Ati/• �
�l..J�NamaA"7�G�"�ff'%6"- �E�J�{�lf�L��G.f /G'L
Address n G City i Stat��f�f�
Inlerest in ProPerty: 4r��'� � ,I [
i }
Name of Fee Stmple Titlehalder: �� '
(tf diNerant Gom 6wner tisted abave} ,,,,,_. �
�
� Address n Ciiy ^ Stale
Contractor. (/`/q�//✓ �OOi-"'/i✓�r
Name'—v l��
�0 �O o�r � �.f}f1�— GrT .-C�
Address l City 4 Stale
Conlractor's Telephone No. 3.��-Sp�5�,��/• � 3`3`s'�' ,
�
5. Surety: �
1Vame �� �
Address �, City ( State
Amountof8ond: 3 Telephone No,
6. Lender.
�' (
htame �,i^^ I
i
Ad6ress �,,,,_ City � State
4.ender's Teleohane No. �
I— uJ �
1 7 Persons wilhin lhe Slate of Florida designated by lhe owner upon whom notites or o,ne�documents may be served as p*avided by � � � (� �
Sectlon 713.t3(i)(aj(7�.pJvpaBs�awtes: � �� � � u',�, � U
�� �
Name �,�._ � � z {,.�}O ~ Q !-}-
I � �QS �L N � CL
Address �:,,, Ciry I` State � �� � � � Q
Teiephone Number of Designatetl Pe[son: � � � �
8. �n addikion to himseif,tkre owner designates I ol�— �"' fl� n � �
t-- � 1.L. CL' C.) L.7
lo recelve a copy of the Lienor's NoUce as prpvidi tl tn Section 713.13(�)(b),Florida Slatules. � � Q�
"'�.�' � F--' � � L!- �S
Telephone Number ol Person or Entity Designated by Owaer:
g. Expiralion date of Notice of Commencement(the e�iration date may not be befine the campteC�on at c s ru ion and finai payment to the v = �� �
conSractor,but wiH be one year from the date of recarding untes5 a diHerent daie is specified): i _� � I— � .,j —�
WARNING TO OWNER: ANY PAYMENTS MADE BV THE OWNER AF7ER THE EXPIRATION pf THE NOTICE OF COMMENCEMENT G� �' U tn (� LL„ U
ARE CONS7DERED IMPROPER PAYMEht7S UNDER CHAPTEft 713, PART i, SECTtON 713.t3, FLORIDA STATUTES, AND CAN � W � 2 Q _j•
RESULT IN YOUR PAYING TWICE FpR IMPROVEMENTS TO YOUR PROPERTY, A NOTtCE OF COMMENCEMENT MUST 8E � F � Q. d r W
REGORDED AND PQSTEQ ON THE JOB 54TE 8£FORE THE FlRST INSPECTION. IF YOU INTEND Tp OBTAIN FINANCING,CONSULT
WI7H YOUR LENDER OR AN ATTORNEY BEFORE COMMENCiNG WORK pR RECQROIttG YOUR NOTSCE OF COMMENCEMENT W � Q � � p Z t
Under penaity o1 perjury,i dedare fhat t have read the tosegoing�otice of commencement an4 th It the tacts stated therein are trve to the best U U 11'� �
of my knowledga and bellaL /�} I O � 0 � �j �
STA7E OF FLQRIOA r /� �/i �/'�p/,���„� � � w J � a�
COUNTY t7F PASCp � t^�1����� L �y
Sig ature ot Qwnar or essee,or Owner's or lessee's Auiborized Q � � �
OffitedDireclorfParinedManager � F"" S Q..' z ¢ �
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7he foregoing inslnlment�3a5 acknowiedged belore me tbis,��ay o �, r ��Lall� -l����'-/� ,P��O ��
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Persanally Kn n R Produced Idenlificalion❑ $`1p.t3ry Sign�ure - c / •
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