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HomeMy WebLinkAbout16-17378 CITY OF ZEPHYRHILLS ��� 5335-8TH STREET , � (813)780-0020 78 � BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 17378 Address: 5541 ANNETTE ST '� � Permit Type: DEMOLITION ZEPHYRHILLS, FL. '� Class of Work: 636-DEMOLITION Township: Range: Book: �, Proposed Use: NOT APPLICABLE Lot(s): Block: Section: ' Square Feet: Subdivision: SIXTH AVE � Est. Value: Parcel Number: 12-26-21-002B-00500-0000 Improv. Cost: 200.00 ' OWNER INFORMATION Date Issued: 5/24/2016 Name: SIXTH AVENUE LLC C/O MHC OPERATI Total Fees: 75:00 Address: 2 N RIVERSIDE PLZ STE 800 Amount Paid: 75.00 CHICAGO IL 60606-2682 Date Paid: 5/24/2016 Phone: 813-783-4823 Work Desc: DEMO TRAILOR 14 X 56 CONTRACTOR S - � APPLICATION FEES HOMEOWNER DEMOLITION 75.00 " ( � Ins ections Re uired FINAL ,... 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 properly. 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. �Ul,�, C,�l,�,��� CONT CTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-q020 Cital of Zephyrhills Permit Application Fax-813-780•ooz� Buitding Department ' • . Date Recgived . � - � , ` -- - , :�:':Pbons_CocitactFfbr'Parmittin �r' V . flwner'�Name { . C'� �C.� t3wner Pbon�Number . _�t.. ���,'"J�� Owner'a Address - � �� O�rrner•Phone Numtisr. � � O , Fee Slmple Tltlehalder:Na�me � �• � " " -� � � Owner Phone Number � . _� , . ��--- . - , . Fee Simple Tltlehalder Addre�s ;, f" '{,; ,. � " - J06 ADDRESS ��`""( ����I�.� LOl"# �� SUBDIVISIQN �5tW1`���,� �� �� � PAR'C�LJD# _ ' ' � � ,� . • " � - - . - �` _ � ':"�(08TAINED FROk1 PROP.ERTY TAX N0710E) = � WCARK PFiqPOS�D '- NEW CONSTR• w` ADD/ALT � �S�GN -Q [�� DEMOLISH ,., ,_' e INS7'ALL 8�:' REPAIR , . /•—' ' ��o�os�u.usE � , C::] ..sF�a � °C] conn�i�A � o�rt�r�,��= - . _ . .- , . . . :. . . . TYPE OF C4NSTRUCTION,;;_'Q' ' BLOCK�' ;Q; " ,FIZAME � ..STEEC Q ...- - - � DESCRIPTION OF WORK ' �iJY1._ BUiLDING SIZE"'�'�i X �� � . , ;. _� - ' ` SQ FOQTA�E �, .;;HEICiHT•. �: -. .. OBiJIt.DlNK`s ��-7�s?7t.� �;, -'"�,=�.,_- ..i��:. . . .. �_ . ' 'y ' +tv^"-.-,-'_ i `VALUATION dF TlOTAL'CQNSTRCiGTION —,�"-'•�) . QELECTRiCAL � � 'AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. QP1.t1MB1NG L.._ 4�,, . ... � - : � � ! � - ,' �~737� QMECFiANICAi� ' $ ' � , VAl.tJA7'ION.OF MEGHANECAL INS'FALLAI'!QN - C��� ;C� �ooF��v�.:,.p • sFEc��.r�r � a�rs��t� FINI$HED FI.00R EI.EVATIONS r'�� FLOOD ZONE AREA , �]YES. .t �70 �/ L � � - - �t-�- BUitDER rl�,� �,^�..�,�. ca���nr .. .::,.� .,.:: SIGPIi4TUR� "''�-Z��'� REGISTERED Y/ N. ` �e CuwtEn' ,� , .Y/,N. _ ;,,; , ,. , � d . .-.-_.. ..l � . Addree� - -, - - . ClCense# l I EIEC"fRIClAN�.: . �- ` ° �, CGiMP14NY "A� , "` _ � . " SIGNATURE �' REGISTERED Y/ N FEE CURREA. " ".Y/'N , ;. ,_ ; , .,.1, , _ . , � 4 Addresa � , , _- L•Icense:#:�� � ' � PLUMBER ` � . . - CQMPANY�: . : - _. ,. , SIGNATURE � . , . ., ,lt�G15.7�xED „ u�Y/-•,N , ;FEE:CUR�n' ', -Y/'N_ qddress �. - . _ . . . . � .l:icense#,�� � � � M�Cl1APt(CAL'.;� - . - ,.. .. .�. ' .. _GOMP/;�NY .. .,+:,;' _ . ;- ,_ _ _ SIGNATURE "'": . , , . � • ' ttEGIS7ettEDs: ,Y./°N:- ;��E.Cuwten . �Y�/N_ ' , ,; , ,t, w� , _. �""� . .,. �ddress' � , .. __�,. � , � _ _ . . " - . .License# ��. �-. •:�. , .�� � . � OTHER , ��•- . ., r'.��:. -- �•�''rv . ' COMPANY. - , . _. - , . , . - . . :, , . _ � SIGN�TURE. . , .. . . . . ...:.:. •. ,, .. .. �,�• . REGI87ERED . �Y'/-N.�. : r f��'Cu�n� ,_YJ.N:�. Addr��s ����: _ "-�.s --?:�"us�r-i ". - ,.. < ,. . _ '~ r Lliu,fiSe#'��`{— . � ' _ _ _- _ ;�r� _ .i�..,y- ��t "`�._ _ _ .L.,�:..,._,: , ,tis,e:��_r. ..-.. ,. ., � . RESIDENTi�At: �°Attai�i��2 ,Pl"a".t:P..,lans�;2:sets=oFBu1ldi'n�'Plan's;,�1s set,'of.�Ene �Fortns;'R�O={tV;Rerinit:forn�w;:construc�on; - �::. ".i t } .� ,t ) . 8 {.) r9Y :;. : ; .: ..... : -. ... ._ ... ,. .. • ...... , . `: -Mlnlmumrten;(�1,p);worktng;days;,atte�.:sutimiEtal=tlate:;;Requlred orislte;�ConstnicBon�Plans;�8tormwater�Plans'w/'SIIt.Fence Installed, . `. Sanitaiy Fact�ktles&�1#clumRster�Stte?Woiic�Permltfor subditiri'slo�isHerge'Rrolects'.:::�-_..,w�' ��:� , r - " ,. '., � .; _ C.OMMERCtAL Attach(3)cdmptete sets of'Suilding Pians�ptas a't�fe'Safety Page;(1}set of Energj►Farms.R q-W Permit for new cbnstrvc�on. _ Minimum ten(1 p)working days'after submfttal date. Required onsite,Construc8an Plens,Stormwater Plans wl Sllt Fence installed; Santhary Fat�tttles&,1_dumpste[.Sfte_Work.Permtt;far.a0'new pioject�„Ail'commerciai.nequfrements-mu�t meet cosnpilac�ce . , SiGN PER[YIIT Attach(2)sets=of`�ngi�eered�f'ta'tis,r;y:�;»r�`�-� - , ._. . . . `. � . , -. , . . •"*•I'ROPERTY,..SURVEY;requir�scl,for,„all NEW;cansWctlon;...�;,...� ,. ,- �. - ' -. . . ..�>. �.. Direatlons: ;ti;._�z„ . , ,,k� .. ...,..._.._.,.� . _ .. Ftll out applicaUon cqmpletely. Clwner 8�Contractor slgn bacK-of appllca�on,notar�zed If over 52500,,a Notice,of,Commencement is required. (AIC upgrade�over 5750Q),___, . �.� , �f t`:E.,:','u$�,n'F3s!i�.1T�.,.' . Agent(far tf►e coatra�to�);or:Fower`of�Attomey(fai#hs`owiiscj waald be someone wr(th notacized tetter,trnm owrier authodzing same - - ,.:;,.�,.:...s :.,._ _ -_ . _ , , DVERTHE=COUNTER:PERIWITTING�=-;=:_::{Front�ofAjiPiicationOniy)::',."� �:-� ' - . Reroofs If shingles Sewers y Sen►ice Upgrades A/C � .�Fencesc.(PIoUSurvey/Footage) . � - ;- ; _...,__.__- _-:..._ . ..�_�......_ _ , ,-_;.;:--:;�i;��;;,;: _ ., - Drlveways-Not aver Gounter if on•pubfic roadways::needs ROW y'� ,; � � - �_-- � I I ' ( IOTICE OF DEED REBTRICTIONS: The:undersigned.;undergtands,�:th�t#his;:p�rmit,may;be:�sutiJe�t.to;"dee�"��rest'Ictlons?:,,,,._ r rhich may�be�more<"r,estflctive=tii�Fl;:Go�inty ireg�lat�ot�s:`��The}=unders1gned��a��umes�espon'�Itillttj�for compliance with��any �pplicable�deed,restrictlons. _ - ;s;,�.�•;.,�,�,;�:::n- _ ` . _ - - :'<'�'$-'�:"- I INLICENSED:=`CON�CI;ORS:"AI�D �CONTRACTOR RESPO�I�SI�IILITI�S::��=�l�=�he�ouime��has�+htred��'�'coritractor or fi , Antractors tv undertake work;,:the �ma�.:be;r,.�q�i�d:�to��e;lice'ns�d.in�accordance:with_state,:and"�local�reguFatlons:>`.:If`�the��'« � . . Y _. .Y �rt�,... ......:..w. ontractor�:ts�not�:licenaed`as��requlred:`tiy law; both�the�owner�and:>contrector�may�be�-�cited for���misderr�eanor�violatlon �nder state law. If the owner or Intended�:a�n�ato�r;-ere;;uncectaln.as to whatyiicenstng_requirements;:'ma.y,h_epply��o�:the=��.z �r,�� � - rtended work;�they�are advised'to:aontact the Pasco CouptyyBuilding'liispectlon Dlvlsion--Llcensing"Section at 727=847- _. ._„_..,._..._� _,... t.,- .... ,. - .._:.:: .,�: �. : -- _.. 009. Furtherrrio�e;=`If�=fFie ownar-has`fiired�a�contracto� or'contraators; he is advlsed�to� ave:the contractor(s .rsBn,..,._ .... - � ._.. ;�-;;.s,;.,_...,..,+,,,�., .�., .., ortlons-of`the"contractor Block°.,.of`ythis,eppli�atiomfor_;whtch_they.:wlll_.be�r.e.spo�slhle. 1�you;�as=_the;oviinerrslgn�as'the ' ' ontractor, that�niay be•an'indtcation�(h�t he�Is�t�ot`�•prope�ly-llcensed�and:"ts�noY�enfided to``per'niltting-p�tvileges:in Pasco . � ;ounty. ; .._ --. � ' - . - :._ ._ _,:._. � �� ._ M �•.,� ,: , . . - - : _ . �. _. _...------�- -.-.. __ . 'ftANSPORTATION�IMPACTIUTIL�TI�S�IiNPAC'1'�At��;{�ESO�l�tCE RECOVERY�FEES:`TN��nnd'er�igned�:u,nde�stands �'� �at Transportatbn Impact Fees:and.Reco.ucse Recovery.Fees_may±:epply:.#a�;tF�e'construcNon,of;newibuildings;:=changeFof"-r�•'�==" '` �� . .t-,,. �: �- � , - ,. se in existing-bulldings;-xr�;�expanstbn�::of��zisN`�;�li.�iildings;as specifled.in Paeco Couotji Ordinance number 89=0.7 and 0-07, as amende.d..��h�.undersigned also�urtderstands, thalt'suchfees;;as�ma�r��e::�.d�e„:�n►111:�De identtfied at thes=time"of�`- ���''��` - ermitting. It is furtfier�understood that Tran�portatlon.Impact-Fees�and��Resoutce Recd�ery��Fees:musti be paid prior to �cetving a:"certi�cate..of occupancy"��or fln�l�=powsr:�lease:',�:If��the proJ�ctr,does..not�involve:ae.certfficafe of occupancy or��' � °-=�" � , .,. _ nal power;;refease�=the�:fe.e..s`:must=:tie`paid;;pcior_to;permit issuance. �Ft��thermore;,�ff.Pasc�;County:VVater/Se.wec:�impact���° �, �.• : � jes are due,,they_must be,:pai�pNor to;permiC;Iss4ance�n accord'a,_nce..wit�.appllcatife.Pasco'•.County'ordinances. ;ONSTRUCTION"LIEN"L'AW��(Chapt�r 713�Florlda Statutee�as amirnled�; (f valuatlon of work is$2�500:00.<or;more;,l� � � .- fy , ppP y ,en::provideil.:with�-a=�copy,_.;of`�the°:"Florida���Constructlon;�Lien�:Lau�Homeowner's erti that i�_the.a_ .Iicant,._�iave.-be �rotection Guide" re ared b�'tlie°Florlda�Dep�rtment;of Agric.ultt�re and Consumar�ktfairs: If the epplicant is someone. .- ther than th�"owner", I certify„th�t�l;h�v.e..obfainetl��a"copy„of.the above:.descrl�ietl'tnicuii�ent:and:pror�ise�;in;good:f�ilh•to . _ , eliver it to-:ihe;"owne�'�:p�orj-to�commencemeritc . - ' , . ,. ` , . _ .�� ..=._. ' - -- � _ , �ONTI�d4CTOit'S/OVIONNER'S 14FFIDAVIT: I.certify;,�t�i�k.alk�th�:lnf.ormatiqn:.ln+thl�;application ts accurat�:�nd that all vvork rill'be done in compliance with all applicable laviis regulaHng construction� zoning and_�land;:development. Appltcation is ereby made to obtain ,a permit;Co..do>wotk;tand"In�tellation as indlgefed:�� �:I;ceKifji�tFiat'�no work';or Installatton�fia's - ommenced prior�to'issuanc� of a�pemiif�and thaf.all`work wilf be perFormed�to meet-_standgrds>of:all laws regulating- onstniction, County and City codes, �.oning.regulatians, and land development regulations`�'In�tFie::Ju�isdiction.�•�=1�al'so'� ertify that I u�de�st�nd that the regulations.of ot�er�government agencies may�apply�.to,the_intended,work, and that it ls iy responsibility to Identity•what.acttons.l,must•take�;to be�in:.00mpliance::,S,.u�h agencies include but�are�:not Itmite.d.to: :� - , 5:-.4 ,.,,.�. . _.. :. � }.�. - Department of E�vironmental.'`ProtecH�ri=Cypress'Bayhead�; Vflf�tland rAreas and Env(ronmentally Sensltive Lands,M/aterMlastewater Treatment. , ' ' � - �outhwest Florida Water Management:..:Distrlct 11Vells, �Cypress.��:Bayii`eads;• -Wetland Areas� Altertng � VVatercmurses. - . ` � ' � ' - Army Corps of Engineers-Seawalls;��Docks� Navigatile Waterways. - Department of_Health:.�.r:ReMabilftafive.:Servtces/Emrironmen#al :Ne�alth.Unit-llVells;�Waste.water�Treatment; - Septla Ta�ks:.'.�� . - � . _ - US Environmental Protection Agency-Asbestos abatement. � .Federal Avlation�AWMori ;Rumvays: ;;�= � � � , . � t!!-,. . . understand that the.follow�ng�restrictions apply fo the�use of flll:• - Use of fill is not allowed in'Flood;Zone"V"unless expressly.pertnitted. - If the_=fllltmateri,al�is:`to:�:be.�;used=.in �Flood-Zone. °A"� 'IE Is understood that a dralnage-plan address(ng a "compe�sattng volume"wlll.be submitted at time of-permitttng which is prepared by a professional englneer° Iicensed�by=�he�;�tate�of;Flotida: � - . ' . . - If ih�.flll�ni�terlal`�ts�,_to:;be.ilused tn �lood Zone 'A" In5 conn�ction�wlth:a��ecmitted building us(ng stem wall � constrvction,_.I,certify th..at,fill�.�iall.be used only.to..fill ihe..area within=the.:stem:walL .-- - = • - - . t w:- �, . ___...._ - 1f flIF�mate�lal��ta�to �tie�•used°'in any area;1=�certify that use. of such��flll w111�rtot adversely affect adjacent properties., if,use:of fill.is found to advetsely.,�ffecf�adJaEent��prc�perties,.the owner may be cited for violating the cond�lo�s'of�tFie ti�iildirig�;p�rmit issued::under the=�at�scfied_penttit-;�ppllcatio�� for-lots_less than:one (1) acre wrhhich�a�`�elevafeil'liy;illl,:act englneered dralnage plan"ls requlred. • . 9 �m the AGEN.T..�FOR�THE_O.YMNER;.�I,�romise:in good faith to�inform the�owner ofi�the_permitting condft�ons set.forth In ds affidavlt'�pr(or to�corrim�ncing'construction�"'f�understarid that a;eeparate perinit may be requlred for elect�ical work,_ , ;-;� lumbing� signs, wells,..po,ols;.;alr_condltioNng,..gas;..or,otheG..lnstai���itlon§ not.spec�fically included�in.the application. .A . �; ; n> :•,, :> srmit lssued shall be�con.'stci�ed to lie��a''license�to proceed with ttie.�wortc and not�as:authoHty�to:violate, cancel,.alte�, or , st aside any provislons of�tti`e�teoliolical:codes;�nor shall issuance�of'a.pe�mlf.prevent the Bulldirig O#�icial from thereafter :quiring a conectton af ertors�in�.plans:;;cons`truction,or vlolations�of°any�-codes: �ve_ry-p�srmit�.[ssued�shall�become invalid nless the work eutho�iied:by�sucli permit:is-commenced�wlffiln,�bc�months�of,:permit issuance. or if work authortzed by ie pemnit is suspended:or.eba�doned�far�a:;p�rtod;of*six:f8)�mon�s;,eRe�flie time the�work��s commen`�ed. An extension �� iay be requested, tn writing� irom the Bullding;O�Icial�.�for a pe�lod not to-exceed ninet'y{90)-�ays�a�d.wlll'.�demon"strate :�, stiflable cause for.the extension� If wor.k ceas.es,for ninety(90)cons.ecutive:day.s...the)ob:is�constdered abandoned.� ,.. _ . ,., ,.' .. ., . .::�� . .:... .: :. . .. . :. - - :,; fARNING TO OWNER: ''YOUR::FAILWRE TC1.;:REC:ORQ;:At;NOTI.GE,;`OF-:COMMEMEEMEPtT�aMAY�RESULT�IN�YOUR. - ' i AYING TWICE:FOR,IMPROVEMEN.�'B;.,Tfl::YOUi�:�.PR�PERTY::.�IF.:YO.U;I�I'.F.EK�D"�TQ`��lB�'�AIN��FIN�NEI�IG;'C.0�19ULT IITH YAUR LENDER�OR AN�A�TORNEY'$EFdR�+l�COR______AING XOU�QTIC, "OF'CO;�ENC�EAM�NT��� ' = — - - — —� - .ORIDAJUFtA�',(F.S:i17031---=.-- - ----- - - - —_ __.._ : . : � NNER OR A��N7 � C�NTRAGTOR. ���'C�r ��1��Q,rli"v'-� " . ibs«fbed a�d�wom�t�-(or aHIFm ' efo me'thl� 1 Su�iecrltied.'�rid'sarom`to(ot afli ed)�before me�fhtg. , 5-�Y d6by v �' 1G�. _dtic-t�o�. j - z:/-/� �bY ' ho is/are p�allx k�nov�to.m or haaA�ave prcduced Who ts/a p.etsonalIy,Icnownrto me.ochaslhave:prodiiced • I �'✓rt�GE✓Gr C�as�IdentlflcaUpn. ° - � ��+ �Y�i L�?r l�+�Pi�,� as Identlflca0on. /� �� ofary Public . uXX�Z2 Nofary Publlc �mmiss No: .,������•. ES Comratla lo .No ,•. ;*�� �'•°�; Commission#FF 150422 ��= Y�"�`;: Commission#FF 150422 - 12 2018 ime of Notary lyp ; .d� �pRE�oy Fain Insurence 800�385d019 Neme`oi Notery ��$ �f n ef � �R „°,.`� Bonded ThN Troy Fem Inawenaa 800•9A5•701i . i � IdenCficalion Number, Year — Make—Body— WT-L-BHP — Vessel Regis.No V— TRIe Numher — � , I�� t;T,� � 6012660� 1972 KENI HS 56' 5308239 ' } � RegisteredOwner: �. Date of Issue 01/27/2016 _ � 7 i q . Lien Release a MARY EYVONNE UNDERWOOD Interest in the described vehicle is hereby released i 5547 ANNETTE S7 � j ZEPHYRIiILLS FL 33542 Trtle { 1 Date ► .� IMPORTAN'1' INEORMATION i • 1 When ownership of the vehicle described herein is j , transferred,the seller MUST complete in full the ! �e T.ransfer of Title by Seller sedion at the bottom of � '�'• ` the certificate of title. Mail To. r; • � ` � , � � 2. Upon sale of this vehicle,the seller must complete � I�9ARV EYVONNE UNDERWOOD �: " the notice of sale on the reverse side of this form. ( 5547 ANNETTE ST °a , 3. Remove your license plate from the vehicle. , ZEPHYRHI LLS FL 33542-6824 = � 4. See the web address below for more information and � . the appropriate forms required for the purohaser to � � ' %- - title and registerthe vehicle;mobile.home orvessel: j �����ii�����I��n����i�������nl�t�inl����n����i��in�i��ill , �, httpJlwww.flhsmv.gov/html/titlinf.html ,a� � Y; ( � � ` � � ''� �n,�D 6;(! :^;Rir . . ty.- •:?. •:;tyi„i�" .G , � '�� tEiST»"•ti; .�i��' ,;�. :����:�.��.� � �. � . �.. �.� .a ±, 'gM�i*Y,�q ��\,� / �•r.'� 1 � 'W `�:%: _ ; .•.%' %i ' •�::' '^i• fi:.y. - ' - h��' " i��-.a.".J�r;.:" . __��k'..C�z: �.4irK.'. ."e..�__ - t\:'.:i� - -•^,t4:.i 'F:.' <V:� - - � _ - '�� � _ 4,�.n,;-a .<'.�.`��' -:."titi"fr—,'. �r��s;:. _�6'.;,,:� ,y,� _ _•t. 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I_ :�' , .._.. . . : ..: . _ � �- - . , . , , . .- • :Registered Owner � V.•�. ;:..�.. ; ` , . .. - . . , :: � ' �MARY EYVONNE UNDERWOOD ' 1 " �,' 5547 ANNETTE .ST � � � - :,� , . ' "`.ZEPHYRHILLS' FL 33542 ' - " ` -- Y i ._. _ .., . ,�.,A ' t ' - _ ' � ' ., ` ;�� ` ', . �' ' �,�• � , . 1st.Lienholder ' , ' . . . . ia ' • - ' _ � � . =.,. ,. - ��� � NONE - �' � .o•. ' , � DMSION OF MOTORIST SERVICES TALLAHASSEE F10RIDA bEPARTMFM OF HIGHWAY SAFEFI AND MOTOR VE}IICLES \ � ' ��y/�'��, K Gontro]Nucriber ��R�. � �� " s 123�,72��,_�.. � ��: ; Rabert:R.Kynoch ' , . - ` . -, Terry,-L Rhodes� ' =' j Executivz Direct'or • OF= � Directoi ; , ` ,' . \ � ,'. .' � "TR,4NSFER bF SI7LE BY SELLER - is.section mu'st be coinpleted at the(ime of sale.) � .�� Federal endlor slule�hew�equire laat We seller state theimilege,piqch:�seds.p�e;selliug.price snd dete sold in rnnnection with tEe trmsferu£owne�sLip. -�- � ` Failiaf Ib complete drproviding afnlsc stetement may resvlt in Hues and/or.impiisonmenl ���o�" � ' Ttue title ie we�xanted tn be free�from eny liens exceptas�noled�on tAe fsee of the-ceRificete and ILe molorvehiele o'r vessel d"esmbed ie hereby han£vied m: �yg°„ � SeflerM�iztEvierP�ach;tsereN�e: " � ' Addiess: - :��, � ,� . 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