HomeMy WebLinkAbout16-16963 � � CITY OF ZEPHYRHILLS
• • 5335-8TH STREET
(813)780-0020 169
BUILDING PERMIT
� PERMIT INFORMATION LOCATION INFORMATION �
Permit Number: 16963 Address: 3828 LAUREL VALLEY BLVD LOT�45
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class df Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: MAJESTIC OAKS
Est. Value: Parcel Number: 24-26-21-0000-00100-0090
Improv. Cost: 19,000.00 OWNER INFORMATION ��
Date Issued: 1/26/2016 Name: NHC-FL115 LLC (GENE SHELLEY)
Total Fees: 195.00 Address: 6991 E CAMELBACK RD STE B310
Amount Paid: 195.00 SCOTTSDALE AZ 85251-2493
Date Paid: 1/26/2016 Phone: (443)591-1708
Work Desc: WOOD DECK & SCREEN RM W/WINDOWS 12 ' X 30 '
CONTRACTOR S � APPLICATION FEES °
SUNSTATE ALUMIUMN INC BUILDING FEE 195.00
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- Ins ections Re uired • � "
FOOTER 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: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four fimes 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.
,
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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
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#10 SMS @ 12•'
O.C. INTO EX1S71NG
APPROVED SCREEN
ENCLOSURE MEMBER
d EXISTING APPROYED
_ SCREEN ENCLOSURE
MEMBEf?S. �
EXlSTlNG APPROVED
, SCREEN ENCLOSURE
MEMBERS.
,�10 SlvlS @ l2"
O.C. lNTO EXISTI NG
APPROVEQ SCREEN
, ENCLOSURE MEMBFR
' TYP. VFRTICAL 4 TRACK TYP. HORI�ONTAL 4 TRACK
IVO FES.
1. TNlS 4UlIYDBREAK HAS BEEN DESIGIVED !N ACCORDANCE Wl7H TNE FLORIDa -
BUlL.DlNG �QDE, 2004 ED1TlON .
2. THIS 'REMOVRBLE WlNDBREAK' IS AN ASSEMBLY OF SOLID VINYL AND ALUMJNUM
PANELS 11VSTALLED OVER AN EXISTING AP�ROVFD SCRFFN ENCLOSllRE. 1T SHALL ONLY
BE USED ON BALCONIES, PORCHES, TFRRACES, NON-HABITABLF SPACES, ETC. WHICH
ARE NOT 1NTEl�IDED TO BE GLAZED OR CLOSED !!V BY WAtLS, 8UT WHFRE A
WIIVDBREAK /S DESIREO. THlS W1/VDBREAK SHALL 8E REMOVED AND PROPERLY STORED
AT THE 'SSUANCE OF A TROPlCAL STQRM OR HURRICANE WARNING.
3. TN1S DRAWING APPLIES ONLY TO PGT PRODUCTS.
Revi3;ons Tolervnces Urtfess Nofed:
�f� U QtB nofes TNElNFORWVAON, OfS�CN AF 04TA q7NfAlf�'D
. --.--_. --._-- Froctions t �/64 yp�����ttbn£PRdPERTY OF PGT
Pecima!,C110'f .01 proU57AEs AND cbNSrot77m COh47DtN7A[
8) updote notes o�;mu�.ono t .aos AhID PROPRIETARY NO Aa4TlON Of�1115
Angular_ f J' pQLYIMENT AfAY BE USf'D GY2 RFPhbDUCfD IN
SerieS�'°��: '�"'���' �"�°`�'���5�°`��� IRIDU�TRIE�
l/ert 4T/Nor. 4T �urss7o,v aF�r rxDusm�s.
Materio7: Description:.--•— — --•--- — --.i—••�_ ----- -
Rcvsd By: Dote: Chkd By. �te: T . An ch o ra e fo r V4 T & SS 4 T
PGT N0: YENDOR NO: Scale; Sheat Drowing No. Rev:
Drorn 6y: Oa(e; �oP l 2043 O
� ' • �n����r� PageNo. of Pages
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SUN STATE ALUMINUM, INC.
6154 Fort King Rd. - _
� ZEPHYRHILLS, FL 33542 '
(813) 788-7308 . �
SUBMITTEDTO P ONE � _
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STREET ,�� ��
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CfTY,STATE and ZIP COD JOB LOCATIO �
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ARCHREC OATE OF PIAN JOB PHONE _
We hereby submit speciffca8ons and estimates tor
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�E QL01ttrAtt hereby to furnis , abor—complete in accordance with above specifications,for t���ym of:
1 ��� � doliars($ �� ��- ).
Payment to be made as follows:
All unpaid balances subject to 1.5%monthly interest fee.
AO materiai is guarantesd to be as specified.Atl warfc to be campleted in a warlmianGke �
manner accordirg to standard practices.My atteraHon ar deviaUon(rom sbove spedficatlons ---
involvfng eMra cosLs will ba executed only upcm written orders,and will become an e i
charge over and above tt�e esfimate. Ag agraements contingent upon strikes. a ' I
or tlelays beyond our cordrol.Owner to carty fire,tomado snd other necessary i , te:ThiS propOSal ma�be
Ou�woskers are funy mvered by Wockman's Compeiesation insucance. vv'ithdrawn b us'rf not accepted within da�
�CCP.�1t�I�CCE Of C�.OTCtrI��—The above prices,speciiications
and conditions a►e satisfactory and are hereby accepted. l�u are authorized Sign re
to do the work as specified_ Payment will be made as outiined above.
Date of Acceptance: Signature �
� ' 1lliiilllliilillliiNiPiilllllif IllllliliillllNIIIIIIIIIIII
' FBC Plans 20160@3432
Fio�ida &Engineering -. .. ,
�uilding 62T2Abbo#StatbnDr. � .
Unk101 Rcpt:17393R2 Ree: 10.00
Code ��������42 D5: 0.00 I7: 0.00
01/08/2016 E. M., Dpl.y Clerk
Permil hlo. Parcel ID No
NOTICE QF COMMENCEMEN7 �}
Slate of �i0![��+ County ot / �S G U
THE UNDERSIGNED hereby gives nolice that improvement will be made to cehain real property,and in accordance with Chapter 713,Florida Stalutes,
tFe foilowing information Ss provided in this Notice oi Commencement:
1 Oescription nf Property: Parcel ldentifiCalinn No. +��I� .»(n-a� - D OOD -'0(}�0 Q � �Q�Q
streetnddress: .�,�6 �Ccet�`a/ rl.t�e .� ��ulX ��l,�i�y7„�,(��'�(c ��»' .33SS"r�--
2. General Description of Improvemenl t.� ,_q�CJ'�coryPn /'-Grl�rh l�� f//A[`/ �/h�d�t.1 S'
9. Owner Mfomretion or Lessee informalion i(the Lessee contracled for tbe impravemenl:
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�aQ�'i/���,p��I��ea,� ,�f �T�/,�3io ed tfs c%IP ,,� �5�r t
Address City Slate
Interest in Property;�fwJh��'
Neme oT Fee Simple Tiqehalder:
(ff different trom Owner iisted abovej
Address �G ��� t/J._��� City Slale �
4, Cpn�reGtOr: lJ`- ,.��.k,�r ;
Name
G��s-y �� _ fCi�� /�� � ! � �=c 33 sY �
Address ^-! q(� �}3 (� Ci�y %�' Slale �
Contrectors 7elephone No. �f�� t d 6 " /3 �d '
5. Surety:
Name
Address Ciry Slate
Amount of Bond: S Tetephone No.: '
6. Lender. *[ �' �
Name ��►` �.� *
Address City Slate `�r� s t�
lentler's Telaphone No, � \ P
7 Persons within the State of Fiorida designated by the owner upon whom notices or other docoments may be served as provided by J Q
Sectinn 713.13{t){a}(7),Flodda Slalules: �_` � ,� P,,, • �
�♦ � � �
Name � i • "" o' �
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Address ' City State �q� � +���
Tetegbone Number o(Qesignated Person: ��A
&, In addi0an to himsell,the owner designates o(_ `�� � �r �
to recelve a copy of the Lienors Nofice as provided in Section 713.13(1){D),Ftodda Statutes. '}'� M T
Telephone Nomber oi Person or Entity Oesignatetl by Owner�
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8. Earyisratipn date ot Notice ot Commencemen((the es�irdtion date may not be betore the compietion ot wnS{nutlon and fnai Rayment to the � Z � Q� �
contraUor,bnt wlll be one yea�from the date of recording untess a di8ereat date Is speclfied): O � � � � J V
WARNING TO OWNER: ANY PAYMENTS MApE BY THE OWNER AFTER THE EXP(RA710N OF THE NOTICE OF COMMHNCBMENT � Z � O � _! r
ARE CONSIOERED lMPROPER PAYMENTS Uh'�ER CHAPTER?13, PART 1, SECTlON 713.13, F(.QRIOA S7ATU7ES, AND CAN � — U C/) O r
RESULT IN YOUR PAYING TWICE fOR IMPROVEMENTS T4 YOUf2 PRqPERTY A 13t3TtGE QF' CDMMENCEMENT MU5T BE Q O � y � Cy{� 0.
REGOROED RND POS7E0 pN THE JOB SI7E BEFORE THE FIRST INSPECTION. IF VOU INTEND TO OBTAIN FINANCING,CONSU4T �. (� h w
WITH YOUR IENDER OR AN ATTORNEY BEFpRP COMMENCENG WpRK OR RECORDIM�YQUR N4TICE OF COMtdENCEMENT � W ~
Under penatky of pe�ury,1 dectare that i have read the foregoi�g nattce ot commencement and thet tha facts stated thereln are true to tbe best � � _ � —� �
o(my knovAedge and heliel. �.. � I— Q �C Q
STATE'OF FLORIDA � � � � � U
couHrv oF Qasco � s ��t'i' °�
S� e of Qwner o essee,or e�s or l ssee's Authorized � ~ } � W'
ONcer irector/Partnerrtvlanager � Q � (� � � �
d�lr�rC9E/'C� S U C.}�
Sig�atory's TIt1eJOKce � � �.. � � � � V
Zhe/oregoing instrumenf uas acknowledged befare me khis„��y aE�:�,20��tby,���"'�� ��L��.GL1c.,;,�� � U- W � � �1 J
as �L�9.(.� � (lype of a�lhority.0.g.,o(fiter,IruSlee,BllofnEy in fOCQ COt � w 0 Q � a Z 1
(nam,e,/o(t�art�on behati ot whom insirv�,enf was ex wted}. i.R. (� � � O
Personally Known O QR Prpduced IdeotiGcallon� Notary Signatur��`..J''�(„��..r�_d L /L Y�{�L�"u^'� � � � fl �
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T y p e o f i d e n t i f i c a t i o n P ro d u c e d��Y� L�1�- Name(Print} Ll.l � Q J �
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;�• '� EXPIRES:dune28,2018
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: �Z,�.��5�� ��it�(.!�'t� �/1(�
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' Date Received: � � Z��
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' Site: c� Z�°3� �i�-G<-�,� '�GL .(�
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Permit Type: �`�� ���-'� `U S(.{�►'1 t�'�j?�'' 1 Z� �1!
� Approved w/no comments. Approved w/the below comments: ❑ Denied w/the below comments: ❑
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This comment sheet sha11 be kept with the permit and/or plans. ��
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Kal�in Switz�� Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
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s�3-7so-oo20 , i City of Zephyrhills Permit Application _ _ _ -_ _ FaX-s�s-7so-oo2�
' � '� ' • Building Department � ' � �
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Date Received �-!,� i ' - p _ /
Phone Contact for Permittin � o - _,7 3/ .� ,
TrITI-IT� �
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Owner's Name C 'r�- /`j[.LG � (/`-fNe S�P{� Owner Phone Number 5`�!3-�5' -
/+ / Scct�tsJol�I�4 2. J S�s'1 '
Owner's Address � (.G 6tG,C S'TC �3/ Owner Phone Number
Fee Simple Titleholder Name � Owner Phone Number
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Fee Simple Titleholder Address ,
JOBADDRESS �a 0 ��GC/"e� �/a `� ���� �S -�C• 33 sy2- LOT# �� �
SUBDIVISION � �%C ua-( PARCEL ID#�y'��o"�� -�DO�-��ad- Q°9 � �
! (OBTAINED FROM PROPERTY TAX NOTICE)'
WORK PROPOSED e , NEW CONSTR B ADD/ALT 0 SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION Q IBLOCK Q FRAME � STEEL 0
DESCRIPTION OF WORK �DI W'�c 1� l` v�'i�'�L��'1 Yh � I�l k�! � w/K�d!�
BUILDING SIZE �X 3 v I SQ FOOTAGE �� U HEIGHT
�TTI"IT�TTrtTI'TI�TIT1�1T1�TI�ITrITT1Tt�1�ITTT�IT1�Tf TTP'TI�TI�T1�
�BUILDING �1q pQO.d D VALUATION OF TOTAL CONSTRUCTION y�, � � t G✓
'�ELECTRICAL $ � AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ � � /
� GLY
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OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
�
QGAS Q ROOFING Q SPECIALTY 0 OTHER �
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO (�
2�-j�.
-1-i-1--F-1--1--f-I{-1-1-4-�1--I-1-1-f-i�-1-1-1-/-I-I-1--1--I-I-1-1--E�-i-f-1-f-I-1-{--F-�1-H-1-1--1-I--1-1-F-1-1-I-i-1-F-a-E--1-1-f-i-1-E-1-f-i-i-E- '
BUILDER � ' � ��OMPANY LllfS �Y�P �4!!�f/YIUk^
SIGNATURE I � REGISTERE� Y/ N FEE CURREN Y/N
Address c�l��/ ��•�G�7y � �lti`�S' �-� �3Sy y License# �Q�i2 0�� �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address I License# � •
PLUMBER I COMPANY
I SIGNATURE I REGISTERED Y/ N FEE CURREN Y/N
Address I License#
�
MECHANICAL � COMPANY I
SIGNATURE I REGISTERED Y/ N FEE CURREN .Y/N
I
Address I License#
OTHER l COMPANY
SIGNATURE I REGISTERED Y/ N FEE CURREN Y/N
Address I License#
1111111111111111111 �111111 '111111111111111111111111111111111111111111
RESIDENTIAL Attach(2)Plot Plans;(2y sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten.(10)working days after submittal date. Required onsite,Construction Pians,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 d�mpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
**"'PROPERTY SURVEY required for all NEW construction.
-�-*-1-i-I-�--4-I--1-�4-t-t..{..i-f--1-1-i t-(..t-1..{-1-I-1-L-t-t-{..4.i-{�i-{-1-�-{.�1-1-{..1-{..f-i-f-i�-I-{�{-1-f�-f-i-f-f�1-��-1-f..4.foi.�1-{�
Dlrections:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commenci ment is required. (AfC upgrades over$7500)
•* Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Seiice Upgrades A/C Fences(PlotlSutvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
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NOTICE PJF DEED RESTRICTI�ONS: The under.signed understands that this permit may be subject to"deed"restrictions"
which may be more resfrictive fhan County reguiations. The undersigned assumes respansibiiity for compliance with any
applicable deed restric#ions.
UNL(CElUS�D CONTRACTQRS AND COIVTRACTOR RESPOIVSlB1LlTlES: !f the owner has hired.a contractor or
contractors to undertake work, �hey may be required to be licensed in accordance with state and local regulations. If fhe ;
; contracfar is nof Iicensed as re�quired by law, bath the owner and contractor may be cited for a misdemeanor violation i
under state iaw. if the owner or intended contractar are uncertain as to what licensing requ'sremen#s may apply for the �
f Entended wark,fihey are advised to contact tha Pasco County Buifding lrtspectian Division—Licensing Section at 727-847- ',
8049. Furthermore, if the owner has hired a contrac#or or contractors, he is advised to have the cantractar(s) sign �
; portions af the "co�rtractor Block" of this application for which they will be responsible. If you, as the owner sign as fhe
' confracfor, fhat may be an indication thaf he is not properiy iicer�sed and is not entifile�d to permitting privileges in Pasco '
County.
- TRANSPC?RTATlON lMPACT/UTlLlTlES lMPACT AND RESC?URCE REC4VERY EEF�: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buitdings, change of
use in exisfing buiidings, or expansion of existing buiidings, as specified in Pasco County �rdinance number 89-07 and
90-07, as amended. The undersigned also unders#ands, fhat such feas, as may be due, wil! be identifed at the time of
perrrtitting. It is further underst�ood that Transpartation lmpact Fees and Resource Recavery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not invalve a certiflcate of occupancy or
final power refease, the fees musfi be paid prior fo permit issuance. Furthermore, if Pasco County WaterlSewer Impact
fees are due,they must be paid priar to permit issuance in accordance with appficabie Pasco County ordinances.
CONSTRUCTIC?N LlEN LAW(Chapter 713,F{orida Statutes, as amended}: lf vaJuatian af wark is$2,500.00 ar mare, !
certify that !, 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 Consumer Affairs. If the applicant is someone
other than the"owner", (certify that i have o6tained a copy of the above described dacurrtent and promise in good faifh to
deiiver it to the"owner"prior to,commencement.
Ct?NTRACTt}R'S/QWNER'S AFFtqAVlT: i certify that all the information in this app{ication is accurate and that a!I work
will be dane in compliance with a!! applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installafion as indicated. i certify fihat no work or insfaitation has
commenced prior #o issuance af a permit and that a11 wark wi11 be performed ta rrreet sfandards of a11 faws regulating
canstruction, County and City cadas, zaning regulatians, .and land development regulations in the jurisdiction. 1 also
� cer#ify that 1 understand that.the regulations.of o#her 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 buf are nofi iimited fo:
- Depar#ment of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmenfaiiy Sensitive
Lands,WaterlWas�ewater Treatment.
- Sauthwest Florida Water Management Dis#rict-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps af Engineers-Seawalls, Docks, Navigable Waterways.
- �Department .af Health & Rehabilitative Services/Enviranmental Health Unit-1Ne1(s, Vl/astewater Treatment,
Sepfic Tanks.
- US Environmenta! Protection Agency-Asbestos abatement.
Federal Aviation Au#hority-Runways.
I undersfiand that the following�restrictions apply to the use of fi1l:
- Use afft(i is not aliowed in Fioad�Zone"V"uniess expressiy permitted.
- If the fi(I materiaif is to be used in Flood Zone "A", i# is understood that a drainage plan addressing a
"campensating volume" wi!! be submitted at time of permitting which is prepared by a professianal engineer
licensed by the 5tate of Florida.
- If the fi11 material is to be used in �1oad Zone "An in connection with a permitted building using stem wa11
construction, 1 ce ify that�ll wi11 be used anly to fl1 the area within the stem wa!(.
- !f fill materiaf is to be used in any area, 1 certify that use af such �ll wi!! not adversely affect adjacent
praperties. !f use�of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of he building permit issued under the attached permit application, for iofs less than ane (1)
acre which are eievated by fiii, an engineered drainage plan is required. ;
1f i am the AGENT FC}R THE�ODUNER, i prarr►ise iri good faith to inform the owner of the permitting conditions sst forth in i
this a�davit prior fio commencing construction. ! understand that a separate permit may be required for electrical wark,
plumbing, signs, wells, pools, air conditianing, gas, or ofiher installations not specifically inciuded in the application. A
permif issued shall be construed to be a (icense to proceed wifh the work and not as authority to vioiate, canceS, aiter, or
set aside any pr.ovisions of the technicai codes, nor shali issuance of a permit pr�vent the Buiiding Officiaf from thereafter
requiring a correctian af errors in pians, canstructian or vialations of any codes. �very permit issued sha!!become invalid
unless the work authorized by such permit is commenced within six manths of permit issuance, or if work authorized by �
the permit is suspended or ab'andonetl for a period of six(6) months af�er the time the work is commenced. An extension
may be requested, in writmg,�from the Suiiding Officiai for a periad nofi to exceed ninety (90) days and will demonstrate
jusfifiable cacase for the extens�on. Cf work ceases for ninety{90}consecutive days,the job is considered abandaned.
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPRO�VEMENTS TO YCIUR PROPERTY. IF YOU INTEND T'O't�BTA1N FINANC1iVG,CONSt1L3'
WtTH YtJUR LENDER UR AN AT7'ORNEY BEFORE RECORDtNG YOUR�t�TICE OF CONfMENCEfVIENT.
Fi.OR1DA JURAT{F.B.117.03 � f
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OWNER CiR AGENT I l, f " .,�cn CONTRACTQR .._ f��_�
S bscribed and swom qr�affirm d� e ore me fhis J Sub crib dand swom to o rr�e,d befQ� ine this
! I o2. I ir by d'h J / 02 ! {, by �,�Q.tif''h c-� 1f�t t�z �_
a�stare personalSy kn, awn t me or hasthave praduced o is/are persona!!y known to me or�raslhave produced
as identification. as identification.
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