HomeMy WebLinkAbout15-16616 CITY OF ZEPHYRHILLS
,�. ' S335-8TH STREET
< < V �ai3��so-oo20 16 6
BUILDING PERMIT
�
PERMIT INFORMATION ; LOCATION INFORMATION
Permit Number: 16616 Address: 5242 PARKER ST
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: LINCOLN HEIGHTS
Est. Value: Parcel Number: 12-26-21-0280-00000-0130
Improv. Cost: 7,874.00 ' OWNER INFORMATION
Date Issued: 9/23/2015 Name: HUBER ALAN & HEATHER
Total Fees: 75.00 Address: 1958 MANOR LN
Amount Paid: 75.00 HASTINGS MN 55033-3320
Date Paid: 9/23/2015 Phone: 651-338-4437
Work Desc: A/C CHANGE OUT 2.5 TON 14 SEER�
CONTRACTOR S I APPLICATION FEES
AND SERVICES A/C CHAN EOUT 75.00
i �
� �
,�
� — I
Ins ections;Re uir
DUCTS INSTALLED
DUCTSINSULATED
FINAL a�r�7 '
�LT
REINSPECTION FEES: (c)With respect to Reinspectionlfees 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 Application.All work shall be pertormed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
TRAC O IGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARDI FROM WEATHER
I
� !
� � is - i�o - �oz�
e��-�eo-oo2o City of Zephyrhilis Permit Applicadon Fa�e��-�eo�ooz�
: Bullding Departrnent
�, I
� � �^ � Dab Ree�Md -L 3� �� ' Phone CorMect tor Pirmtttln �J d1 —���2-
� ( /�
� 1 ' �.S I- �3 �-Y+t3
I p�yn�rs Nam� 1 1-1'v ( � Owner Phone Numb�r
Owmrs/Yddnss �a P��.K�e•�--s� I Owner Phone Numb�r
FN Slmple Tftleholde Nune u � � I Owner Phone Num6er
I
Fw SImpM 7Wehold� Address I
JOB ADDRE38 S�� a' �t'��1��--S� I LOT 8 �
SUBDM810N �VC3 � Pel —S PARCEL IQM 2-'2�"�'`'�a�0���� �Q �� �
(OB'iA1Nm FROY PROPFJtIYTAX NOTIC�
WORK PROP08ED B NEW CONSTR B ADD/ALT Q SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRU ON Q BLOCK Q FRAME Q STEEL Q
DE3CRIPTION OF W RK r� I C ��� �•�- �•5 �� ��{S i'�'�Ls� �'
BUILDINO SIZE SQ FOOTAOE� HEIOHT �
QBUILDING S VALUATION OF 70TAL CONSTRUCTION
QELECTRIC S AMP SER1/ICE Q PROORESS ENERGY Q W.RE.C.
OPLUMBING S
�MECHANIC l E VALUATION OF MECHANICAL INSTALLATION � �����
�'� �
QOAS Q ROOFINO Q SPECIALTY Q OTHER ���
FINISHED FLOOR EL AT10NS FLOOD ZONE AREA QYES NO /�1O('J
�v
I
BUILDER COMPANY
91GPUiURE REGISTERED Y/N �cutt�n Y/N
ndar.0 � u�se#
�
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/N �ECUaaB� Y/N
/yldnss I Lieense#
�
PLUMBER COMPANY
gIpNATURE r�oisrei�n Y/ N �cuaaa� Y/N
Addnas � Llcense#
MECHANICAL COMP� �� ��N�G�'S
g�pM�►TllRE REGISTERm Y/ N �cuaaer� Y/N
�ear� ��u a�Cv c�.�e�- �lv� I u��a CflC►� / (a�' 1
I
onieR. coMP�wr
SIGNATURE aecisr�o Y/N �cuw�n Y/N
Addras I LJcenae# �
rr� n�r r r ���-r_�.�.�_�.�_�._rrn-rrrrrrrri riT� n rrrrrrri rr�� rr�rrrrrrn �i��r�
RESIDENTIAL eh(2)Plot Plarre;(2)seta of Bullding Plana;(1)aet of Ene�gy Fortns;R-O�W PermR for new construetlon,
Inlmum ten(10)worMnB deye efter submittel date. Requlred onske,Conatruetlon Plena,Stormwater Plans w/Slit Fence Inatailed,
Hery FedlWea 61 dumpater,Site Work Pertntt for eubdhiielonalterge proJede
COMAAERCIAL (3)camplete seffi oi Bullding Plans plua a Llfa Sefety�Pege;(1)aet of Energy Forms.R-O�W Pertntt tor new consWdlon.
Inimum ten(10)Mroddng days aRer aubmittal dete. Required onsite,Constructlai Plens,Stormwater Plans w/Silt Fence Installed,
Mery Fedlftlea 31 dumpstaz.Site Work Pertnkior all new projects.All commerdai requirements must meet compliance
SION PERMR eh(2)setn of Engineered Plens.
PROPERIY SURVEY roquired for atl NEW conaWdlan.
Dinatloas:
Fllloutapplicetl comptetaly.
Owner 3 Con dor eign badc of eppllcetlon,naterized
M over i2500, NoUw oi Commeneemert Is nquirod. (NC upgrodesl ov�r i7500)
" Agent(ior the tractor)or Power oi Attnmey(tor the owner)woutd be someone with notarized letter trom owner authoribng same
OVER THE COU R PERMIITINO (Front of Appllcetlon Oniy)
ReroofB H ehfngles Sewers Servlee Upgrades A/C Feneea(Plo Survey/Foofage)
DNveways-Na over CouMer If on publle roadways..needs ROW
� NOTICE OF DEED RESTRICTIONS: The undersi ned understands that this ermit ma be sub'ect to"deed"restrictions"
'� 9 P Y 1
� which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
� t- •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 required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If 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 Countyl Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor o� 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 properiy licensed and is not entitled to permitting privileges in Pasco
County. I
TRANSPORTATION IMPACTNTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery 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 understoad that Transpartation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupancy'or finai power release. I If the project does not involve a certificate of occupancy or
final power reiease,the fees must be paid prior to permit issuance. Furthermare, if Pasco County Water/Sewer 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 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—Homeowners
Protection Guide"prepared by the Florida Department of Agnculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy o�the above described document and promise in good faith to
deliver it to the"owne�'prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
' will be done in compiiance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no woric or installation has
commenced prior to issuance of a permit and that all worklwill be pertormed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdictian. I also
certify that I understand that the regulations of other govemment 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, Wetiand Areas and Environmentally Sensitive
Lands,WateNWastewater Treatment. �
- Southwest Florida Water Management District-Wells, Cypress Bayheads, WeUand Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalis,Docks,Navigable Waterways.
- Department of Heaith 8 Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks. �
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways. I
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless�expressiy 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 pertnitting which is prepared by a professional engineer
licensed by the State of Florida. I
, - 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 fi,ll the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill wiil 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 pertnit issued under the attached permit application,for lots less than one (1)
acre which are elevated by fill,an engineered drainage plan is required.
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 construed to be a license to praceed with the work and not as authority to violate,qncel,alter,or
set aside any provisions of the technicai codes,nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans,construction or violations of any cades. Every permit issued shall become invalid
unless the work authorized by such permit is commenced wi�thin six months of permit issuance,or 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,from the Building Official for a Iperiod not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
o dy5 o No'p
WARNING TO OWIdER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR K
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBT N FINANCING,CONSULT �o c
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y R NOTIO�OF CO ENCEMENT. '°,oa o�r0
FLORIDA JURAT(F.S.117.03) I
���o
OWNER OR AGENT CONTRACTOR ^�� m
Su6salbed end swam ta(or e(firtned)before me this u scri d a d m to(or a� ed)be me s N � ��
by V��by Yh�S�T�� =3 U��
Who Islare personelly known to me or heslheve produced islare personally known to me or haslhave produced �,
as idendfication. as fdenWication. a>o � �
N� �u,
�m m
- a,m m
� �
Notary Public � _ Notary Public m T
G ��(n��� m �
Commfsslon No. Commisslon Na. o Q
�(Y�Wc�—�s 1� ��t.�•A—,2—`9� d
Name of Notary typed,printed or stamped eme of Notary ed,printed or stamped
. -,� Tei:818-145�4818
5935 To1:727�195-747�
� PRQPOSAL T�:352�45,8-4181
O� 7e1:883-226.5588
N .
Q 's'"e '� � �i�i'��J' Y6YlYdlndueWeu.com '
� ,� A4CqN�bY� .Ph+Mhp .EYcMCY SOntaCf�nM1YlIYiPAt.COm
r GC��pa%vGNfl�tl.lF�wmw1
pCuslamarname• ,,q �tA� . Da�a:q�1'1—t
a � StrueladdressWJoCixatbn: S��— qf1�Ca� ��r.2 4���4,;1 � ro�33S`� '
� Pnrttary Dhone: \� ..�Y3 7 Otl�er vnone: Email:
�
� ❑Fectary�niatched Heal Pump Syslem QP3ctary-metched Alr Condltioning Systam ❑Fadory-�nalched Gus Fumece Sysiam
�
Cl O timum# ❑ Premium# C�F'f3�eluxe# � Econom #
' +Upm:OSBER r UptcIeSEFA � UD�aNSEER � 13SEER
J 1DYearNIPe� + t0�earMPaM1 � tOVa�rhllPan + tOYparAtlAMWartert/
� CompreeWC Lifa Tlme 1YermNy � 10 YCar Cortp�ouo!WLIeMy � 10 Year Camp�a9Baf Wetterqy � 5 Yea1 Cppp�sor WaneNy
.Or. • '• •• • faRotobnfsh duC cleaning Supply 8�Relums �
N CI�.Wfwfe Houae UV 9terlllxaGon System i�:�p ❑Wttole Fbuse M.E.R.V.Fillrations Syslem
�1 � � � • • • � • ' •
r
Q ephacemant ❑Ado-an Ae ConCidaninglHeatlBoth �1-R"�lacement ❑Add-0n Air ConditiomnglHeatlBoth p
N Q,�l��G'€ir -and�er 1Furnace�_ Q Vertipl �izanfal E7 Heat Pump C1�}AirC.bndlibnar C7 Package Unii
� �'Rew DigBal Thermostat ❑Non-Program. ClLProgrem. ►fL��tans� SEER _BTUH
(V ❑ New Digdel Programmable Thertn.with Mumfdiry Control �..ModJe J
� 0 Rolacale trom ro �rricane Pad ❑Plastic Pad
� �. _.... --'�--
Q 0 , ❑ Relocale fivm !a i__..__ .�. .--
❑ New AHU S�entl: ❑Me�al ❑Custom � New salety disconnect ewilch
❑ Fplration: Q Permanent Washahle Fitler ❑Grille,_ L7 New 10096 coppar,tlehydratad refrigemat piping
❑ fdew safety diswnned switch �Surge Protec�on � Fully insulale suction line plping
O New wire from Meaker panel lo aquipment ❑ New wator ttght eleCtrical wMp
❑ VenUFlue: �Complete new QJse e�dsting O _.
--- -- -- � u � � •
❑Englneered ducl system for tons ven4s ✓ Alllabar ...��... ....
O Ewnomy ❑Mti�Miaobial S � Oblaining pa�mils(where required)
❑NOW-PIBERGLASS-100%Rust Resislant Gaivanized Sbeet '� NewAlC circuil protection Braod=
Mete7 Dud Syslem,Energy Saving Insulalion Includud. ExiUng slze is:�_I�Change to:_�l
�7 Roams requ'ving addi6onal aiAlow; ✓ Healirg and CooHr�q routine maintenance fa, years
l7 Now suppfy venl W: _,,,,_,. _ '� Cherk enUre eyslem tor safely end etticiency
❑ New retum venl to:T_,_,_ � � Shoo covers,mats entl tlrop cbths lo be used as necessary
❑ ._ __� �_ ,_ ✓ Remo�o exrsU�g equlpmeN irom premises
�tic anC seal alt leaking Jolnts _ `� Clean up
O Ducl Sanitizin9 ....-_--�.---
� • �
O 24Houi Ffx It o!Hotel QuardaM6:Ud'dco mont oompanles,we are a servica wmpany.We have a slelf of a��#aervice techNdans that
ara Urere m snrro you In Ne unlJcaty e+ent your sysinm has e pra6Wm.So our guarantee to you is Net whan wo erriVe,we guaran�ee thet rre wlll
have yow SyStem up and running witl7in 2d houre�oi oiu artrvd af we wIN pUI yW up M1��e IOCaI ErtNa9sy S4ites fof N8 nigN.
♦ (-aw Pr/ce Guarantae:Anyorw ran make sometl�ing cneaper by cuuing mrrwn a��d pridng n Iorless.So.ns impatant lo knav rArat iv ana ts
no1 induCeA in any heatlng end caoling sys[em you choose br your I�ame.Out Price Guarantee is our promise to you Ihat you cannW find a r.om-
" peretlb;nalallauon Iw less. or we'll pey you a E50.0o Donus over me aefeter.ce.Atl wo ask IsYhat it he a publisned'apples-to-apples'congrari•
son,aithin 74 eays d purchase.and have�he sanewduan'sistallation apecAfcadas av CN.
♦ lttata!!atlon WO/Iff119n�171p GlJelatltea:Ou in5ta0aGon Iett7niclan5 e�e Iha bosl ln skill,eWtUdH nnd v.arkrtiansNp.The�+Il care(or your
home ana comple�e the joD WiN speed arM prac�sion.They wear(tow savero,dean uD�en Ney are finiahea ane laka personat responsldllry tor
your saLSfacGan.Tney w4i not smdce ar swear In your name and tliey we DoNe anC courteous.M,when ihey have linished In your Ifome,Iney
nmre nW pe�fomwd'm acco�danw wIM�hese ttigh standur�,we71 refund wha�everartwunl of tlre purtliese pnce you feel W De lalr.A!I we ask Is
u�at our onku ba notmed of eny levet of aissatisluuion befae Ino Iacnnidans leave C�e Mme so thet any tssuus can 6e a0dressed acwrAirgly.
♦ .ExCleJdlV@"No Larttofl9"Guerantea:It Ne Compresear(i�e hr�ut af your syatem)in you�Ait ConNlbner talis durng Ihe Arst fne yeat5 0l
ovmeiaMp rs wil remove lhe enike unit,raiher fhan Ihe componeM,and nsteu a camptetely neW one if youYe ever AougM e�non'belore,
you Uu1y appredate aur mmmnment w your bngdurm aatisfacllan. j�"
♦ No Moltl Guaranfoe:We are so�ronfiCent ln our ACvanwA I.A.�.UV Stenfaation 8 M.E.R.V.EWaGons syatems aDihty 10 kaep your syslem
�tean Not we guaraNee witl�p�opur annual melntenanoa your system w31 De molG Nae far life w wx wW peAorm any�ceseary�eaning to ttw air
naM7ar W�rrtredy the G�obtmo ut ow ahperGe.
• •
� ,� 7otaglrnostment S�g�� (-)Paner Company Rebate 5 ___(-�Servica Repair Retund$T,_
� Net Tolal Irweslment After AllOiscounts Mdudng Power Company 8 b9arw(aaure rehaLas S
� Thfs+l-ligh EKciency Haatie Comlort 5ystem is availeble wilh 100%Dank Gnancing wlth rw money dam tor S per manfh
t.;m�+dw aoaai
GN Represenlafive Date of proposal____! J
— ��`�r.� —
From: -10/�4/20�5 09:31 #279 P.002/002
; , s� �«ri««�����i��i�«i 4��«�►���r�ii�il���ii�����ii����i«i�
' ,� 201515746
Rc�st:1716934 Rec: 10.00
b5: 0.00 I'F: 0.00
1 r/�/,� NOTICIEOFCOMMENCEII�ENT 09/30/2015 J. G. , Dpty Cierk
Pertnit No. 1 1e�L '�
PAULq S 0'P:EIL,Ph D PASCO CLERK E� CUMPTRO�LEP.
Propexty IdendBcation No. 1 oZ-�P'o�� ' ���Q ���-'�l 5J 09/30/2@15 01:13 m 1 of 1
I OR BK 9`��� PG '�'C�
THE UNDERSIGNED hereby gives natice thai improvements will be made to cectaic►real property,aad in accordancx with SaKion
T13.13 oft�e Florida Statutes,ihe fotlowing information is provided in the NOTICE OF COMMLNCEMENT.
1. Descriptioa of properhy(Jegal des�uo n:} L..1+•�c c�(� {-)c,i,�,�i,,�5 S�.6 P� 13 PG I t 3 L��f i3
a� saeec naaress: �a`i�. r����2 s; �-�',�c�,�h,�.:�L s
2. General descriprion of improvemems I`
f��C G�nAL3�� „_.. _
3. Owner Infocmation /� ` � f - ,
a) Name�d address: f 1� A J t-t�.c.b��- "�'�n� �{,� �Pr r�.�C'fl s� �� 2�j1��S'
b) Name and address of fee simpl4 ddeholder(if other than owner)
c) Interest in property �,s� c�c-_..)c� � ..--
4. Contract�r Infomoation {� �_ .
� ' � 1=(. 33b f t
a) Name and address:_.'t'q,j'�3�R�1!_t('Q S �a�O � C.0 f�(.�- �[P ��1-�-ff� .,. f
b) Tcl�phone No.: '13 W`I S +-i�I� I Fax No.(Opt)
5. Sw+ety Infoimation
a) Neme and address:---ti%r �
b) Amount of Bond• I
c) Telephone No.: I Fax No.(OpL}
6. I.end�
a) Name and address: �}fl
7. Id�tity of peison within the State of Florida designated by owner upon whom notices or other dceuments may be seivvod;
a) Name and add�ess• t.3, l� � ` ,.
b) Telephone No.: I Fax No.(Opt)
8. In addition to himSelf,own�desi�the foilowing p�son�to ceceive a capy of the Lienor's Notice as provided in Sectioa
713.13(1)(b),Florida Statutes•
a) Name and addness: � �� ,
b) Telephone No.. I Fax No.(Opt) !
9_ E�Qation date of otice of Commen�eat(the expiistion dete is one yesr from the date of recording unlcss a differc�t date is
specifted):-- -- - y}-p�,1�2 �20��.n I
�
WAItNING TO OWI�IER ANY PAY14�1VTS MADE BY THE OR'DIEB AFTEB TEIE EXPLRATLON OF THE NOTICE OF
COMMENCEMENT ARE CONSIDEIt�U I11�ROPER�AYMENTS UNDER CHAPT�R 713,PART 1,5EC'I70N 713.13,
FWRIDA STATUTES AND CAN RFSOLT IN YOUR PAYING TWiCE k'OR IPROVEMENTS TO YOUB PRQPERTY.A
NOTICE OF COhIMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB S1TE BEFORE TRE FIRST
QTSPECTION.IF YOU INT�ND TO OBTAflY FINANCING,ICONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COl1fl►�IENCII�iG WORIC OR RECaRDING YOU NOTICE OF CO C�MENT.
6TATE OP I�I.ORIDA /i 1 1 �
COUNIY OF PASCO /`i`�'�•-�
SiBnahrse OF Ownd-or Owne�s Avthori�d OffiarlD'ueaor/PacuiadMt�uger
' Print Name
�fongomg i�eot�Yes ecknowled�Bd bCfOt+C IDC 1hiS�d8y of�P/1'ti'+ijE.2- ,Zp s {�y. j�j 2(�j'P(L
�A•� �-�C.c��._. es V`1.��,�"�—�L_ I (type of authority,e.g.ofbar,trustee,�torney in fsct)far
�p,\�t,..k�e,�.. (name of party on behalfofwbom instna�eent w�as ex ).
PessooaUy Known___,_OR Produced IdeatiScation X Nmary Si�shue l
Type of IdentiScatian Produced 1- �-'�L-• N I(print) m�'12 �-r V S f�'i.../A�Z f
Yer'sficatian ptusv�t to Section 92525,Flarida Statutes_Und�penal4es of perjiuy,I declare that i have read the finegomg�d that the fac.ts staLcd
m it�+e ws to tha best of my kaowledge and belief
FOAMS/HOC.frsdm0'7
S3grueeofNand VasmSigioQ A6o�e
�ip�P�ey_ Notary Public Siate oi Florida
_ � Mary V Stewart
`� �c • p p8y Commission EE 216630
�: �?�.n,o� Exp�resaTn6noi6
I
�