HomeMy WebLinkAbout16-16893 CITY OF ZEPHYRHILLS
. ' S335-8TH STREET
� " (813)780-0020 168 3
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 16893 Address: 39233 9TH AVE
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: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 12-26-21-0300-00000-0010
Improv. Cost: 5,375.00 OWNER INFORMATION
Date Issued: 1/12/2016 Name: ROGERS KAREN M
Total Fees: 65.00 Address: 39233 9TH AVE
Amount Paid: 65.00 ZEPHYRHILLS FL 33542-4715
Date Paid: 1/12/2016 Phone: 813-312-3101
Work Desc: REROOF SHINGLE
CONTRAC.TOR S APPLICATION FEES
RYMAN ROOFING INC REROOF RESIDENTIAL 65.00
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Ins ections Re uired
DRY IN ROOF IN P
TAPE JOINTS ROOF INSP
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 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 performed in accordance with
�I City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
i NO OCCUPANCY BEFORE C.O.
�
� �
Q� �bo ,
C - NTRACTOR IGNATURE PERMIT OFFI R I
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION �
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
,
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
. Building Department �
� •-
Date Recelved " phone•Conf�ct for-�Permlttln '�' �•O I 3 ���� -UJv_I �Xt•���..
Owner's Name Q��I� � �f 5 Owner Phone Number U��-�3►a-3��I
Owner's Address � �3� `l,� f"I�, �h1��.S 3� Owner�Phon�Ndmber � ' '
Fee Slmple TltleholderName ' • Owner Phone'Nu'nber �
Fee Simple Tttleholder Addresa • u
JOB I�DDRESS � l�3� ' !�� Je. �h� II s �I 3 35 a � �oT# �
SUBDIVISION ' PARCEL ID# - � '
(OBTAINED FROM PROPERTY:TAX NOTICE)
WORK PROPOSED� NEW CONSTR' ADD/AL'P - Q` SIGN� Q •Q DEMOLISH
, e_n. INSTALL �B ', REPAIR: - � , .
PROPOSED>.USE -;_�a- Q SFR Q� COMM ' Q - •OTHER E= 4 - �
TYPE OF CONSTRUCTION � Q ` BLOCK' ` Q FRAME ,. [� " 'STEEC " 'Q � _
DESCRIPTION OF WORK� eC�r O� �e-roo� ._]g �ar e s 0•C� as I�a.P+ 5 h�n�IC'S
BUILDING SIZE' � � 'SQ FOOTAGE.�; ;. , .,HEI.GHT�� .. • �
QBUILDING $ ��� �- VAI:UATION�"OF',•TOl'AL'COyS�RUCTION�53�5" ' '
QELECTRICAL $ • � • �AMPSERVICE �""Q PROGRESS�ENERGY Q W:R.E.C.
. ,� -
QPLUMBING "$ - � � `�C�W�
, �
[�MECHANICAL $ VALUATION.OF;MECHAfVICAL INSTALLATION.
QGAS , •Q ROOFING :Q SPECIALI'Y..Q :. OTHER� . _
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES. ,NO
BUILDER COMPANY' ` � � _ . . . -- �
SIGNATURE REGISTERED Y/ N � �FEE CURREK �'Y/N�
Address ; - -, , � License#�
ELECTRICIAN; - - � - " 'COMPANY ' - " - . . - _
SIGNATURE ' ' REGISTERED Y/ N F�:Cu�n�' ' `.'<�Y�/•N'• ` ' �
Addresa - . ' ... . .. License;# ��.
PLUMBER C.OMPANY: � :. . :T: •t.�, .::: ., • '
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SIGNATURE'"` � , ; .REGISTERED. Y:/-.N.,;. : =,:FEECU.RFtE�; :Y•LN.
Address � ., _ �,'ycense,#,� . , : � � ..
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MECHANICAI: . � � � � � �COMPANIY � . . -� . ,
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SIGNATURE• � � ` � ' RE�isTEReD Y.:L:N. . : „ Fe�Cur�En... : . Y:/N' _
Address' _ - :`- ` . • ' � • � � � � . License#� -
OTHER . ' �D . . - :.COMPANY C4� (�U�:�.. ..�' . �
SIGNATURE' .. '`^�" ��' ��� � REGIS7ER�� � - Y/ N:.� �`FEE CUR � Y/N
_ . ,. . I i . , .
Addresg� :��. •�-�;:5�...,5. :,.�y � h::f_!��I l-. � �3Sy) . .� u��se# CC�3�55t�S � _ -
F ' _'"� � ' �. -F'.�t' � . ;',;yr�. . : •
RESIDENTIAL;',;�::�Atta;cli'(2)„PIot�Plans';;(2)sets;of�Buildfng:Plans;`(1)'"seE;of�Eriergy=Foirns;R-O=W�Pertnlffor.newconsfruction, _ � ''
- _., .. .. . .. . ..
...;�.,_ � � . � .. , _ � ,:, . -_ . , _ . , . _ , ,�
�,;:Minimum�ten;(.1A�;uyqricing2deys_;after„submittal'date:,`Required'on`s'ife,�:�onstiuctlon�`Plans;`StortnwaterPlenswfSllt=Fencelnstalled, °
�"�Senifery Fadlldes;&;1�dumpster-,Site=Work:Permitfor;subdiv,islonsAarge.pr_'ojects.,'•�';_.r�;,�:: _ _ , �
COfNMERCiAL Attach(3)roomplete sets of�Building Plans plus a Life Safety Page;�(1)set of Energy Forms.R O-W Permit for nevit construcUon.
Minimum ten(10)working days after submittal date. Required onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Fadlides_&�1 dumpster..Sita Work Permit for all nevrproJects.:All commercial,requirements must meet campllance •
SIGNPERMIT Attach(2).'sets�of�Engineer,ed;P::lans::..�:.,3�,�-; -_. =- - ��' '
••••PROPERT.Y.SURVEY recjuired fur all NEW:consWctlon. � . - ' • � ` •• •- � - - .
Dlrecdons: ,._ • - - � � . . -.
FIII out applfcadon campletely.
Owner 8 Contractor sigm back of applicatlon,notarized "
If over 52500,.a;Notice of,Commencement is requlred. (AlC upgrades�ovec$T500) _ . „`� - �, ' = � .
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Agent(for the�contractor)or'Power of Attomey(for tFie ovmer)would be someone with notarized letter from owner authorizing same
- : ;: ...�... , �t:.
DVER THE,CQUNTER�E�,M�T�NS',T;,�„„,,;,�;,(Front'of•AppllcaUomOnly)--"�- ' �� ���`' �
Reroots if�shingles �;4`$eweF's"�-- ;$eivice Upgrades WC Fences'(Plot/Survey/Footage)
�� �'s t�<,, ., , i ._ � . -,�d,: �• ;g .:i: - � - , � - , - , _ � --- _---—• ---���p .. `_u`
�? Dridewajra-Not over,Counter:iFe���p,utilic�yy'roadways:.needs ROW' j.,}-� -�,;�,_ . '•,�s '���� ,__i.�}� � �� t(�
�� . .��v��i .i+:. "�SL'L ��^-.:�a.e.' �� 4� ,�ti�a�i� ,�i,:? 1! ,..- l��� „ i r,`..:i,'/' . :F�
,�'.�_.. ........... .. .... .ti+-.. "'-'- .'—_ _. .._ `�� , ,�.. „ .,�.,� � : i � • - ��iql��I+'�.�
w.a�.+K.s,M�r•.•ti:.... .w.. <,.i..-wa�•.iy.nq.w+a.---,R,,,,, ' ;�,. 1: _
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EED REST.RICTI0INS: The undersigned.�under�tands�;th�t:thl��p�rmt��may.be,subJect,;to,"deed"resVictio�is" "'
,,.
NOT'ICE OF D. ... . ,. ,. ,._:.. .,,_,,-. - = �.; �a� Y..��
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.�,:. �-;. . ,_ °. . : ; ;..� ;.°:, ,.�`°;k I . .unde d`assumes��res,�onsitilli_:�'for-'compllarice=viilth�any� ., .
which may,�be>more•r.estf.lctive than County c+�gr�ati�ons�'��Tfie�� 'al�ne _ p ty '����° �A��'
applicable:deed�restrictlons. . . �" ' . • _ .. -., ..-. ° `�� � .::-'` `=' ,'
.,.-:,;.;,;���:;;:;:�..i._,,;�.;c.:��. :. �
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UNLICENSEd=�CONTR/1C.TORS-A�ND�,�CONTRACTOR RESPONSIBILITIES:° �-ff'°ti�e�•owner'has�'htred���a-`conh�ctor ot
contractors`to undertake,work,.they..may:be;.r,equlir;e;d,,to:�be;licens'ed:.ln�accordance:with:�state�:and,local_regulatlon.s..:��If�the'3.- a_.. .
�-.-:,;_�,..�,. ...�.., �, .:.
cantractor�ts�not��ltcensed��as'requir�d,;by law, botir�the owner'and�contracto��may��be:�cited�fora misdemeanor violation
under state law. If the owner or Intendedt,,c,o:n„tr;a�tor;;ar,e,:uncertain as�.to what Itcensing._requlremenfs 3may�apply3`for�tiie���:=,. •�°����_
Intended work,they;are:advi§ed to'contact the Pasco County_'Building;In"spectton DIvlslon-Licensing�Section at 727-847-
.. ,.... . . .
8008. Furthermore� if the owner'`Fias��liired a con&actor o�conUactors, he Is adviaed�to have�,tlie contractor(s);.sign,. ..p._:,
portions of the "contrector.Block"..of...#hls�apQllcation.,for.whlch.they,.:wlll,.be,r.esp.onsible:,:.lf�:you,as:the o'�wner slgn''as"'tfie" ��''- -
. , ., -.r.., .. --.y •
contractor,'that•may�be�an Indlcation'that`Fie�'�s"not:properly`Iicens�`'antl��is'�HoYentiNed"to pemiitting pri�ileges�in Pasco
. : , ��:�c..: .
County. � - ' - _. �.. .}. , , .
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TRANSPORTATION�IMPACTIUTILITIEShiNII�kC'i'�ANb�RE30UItCE RECOVERY�FEES:�The un�erelgned understands
that Transportation Impact_Fees;and.Reco.utse.Recovery,Fees may��epplys�to•t�e,construct(on of new:bulidtngs,:change��of'>�:'�����•�;
use in exisfing buitdings, or�,expanslo���of=ezisti�'�btiildings, as specffied.in P�sca�County Ordlnance_number 89-07 and rt
90-07, as amended�.,,The� undersigned also.,urtderstands; tFi�it°such fees;-as��maj�_be;due;::wil�Y�e]dentifled at the�tiine�of�°�;-�T�.-'` .;�, 4.
permitting. It is iurtFier understood that Transp�ortatlon Impact`Fees and'�;Resource;,Recovery::Fees�.must'be paid prior to ;
receEving a"certf�cate:of�occupancy"��or��flnal=.power,celease: :If�the.proJect:does;not involve�a��certfficate��,of occupancy.<o��������'-��_�,_�° .
flnal powec release;:?ttie�:fees'.mu§t tie paid:;pc�oc.:to,per,mit Issuance. Ft��thermore;°If:Pasco�a.County'.Water/Sewer--�Impact;�.� ����=_.=r
fees are due, they must:be�pald;prior#o„permit,lssuerice:�n.accordance.with;appllcatite�Pasco'�Cou�ty,ordinances.
CONSTRUCTION'LIEN'1:1�1W(Chepter 713� Elodda Statates�as amended): if valuatlon of work is�2,b00.00�ormore�I �.�.....-.:a�� ,
certify tHat i,-�the.�applicant,-have:be,en-proyi,ded��with��-a=cio�yr-of`�the=�.".Florida�`Consttictlon;llen.:Law—Hom�owner's�
Protection Guide" prepared by,tlie FloFlda Departmer�t�of Agriculture and ConsumerAffairs. if the applicant Is someone,.. , ;, _ .
other than ihe'owner", I cert�y►,th�t�l�h�re,o�,tained�'a4copy.of..the�abQva•aies,crlb�ed;�docui�ent�and;promis��in�,good��faRtt.to _, ,�; .
�� - ..,.:�.,,..,.�4•,.,.;.. ...
deliver It to::the�'owner"�p�ioc-to�cornmencement:`"3''." . �` ` +..`. , r - - ... • � .
CONTRACTOR'SIOWN�R'S AFFIDAVIT: I.c,ectf[y:.tli�taall.�the��lnf.ormati�rr:i��thl�:appl(cetion is accurate.and that all work�
will�be done in compliance wtth all.app8cable laws regulating constructlon, zoning and�°land�'development. Appltcation Is .
hereby made::to�obtatn.:a:permit:,to;;_do:;wmtk;,,�nd;dtistallatlon as indi�afed:�:�-..I� certf�i that no work�°or Installatton has- ,.
commenced p�lor to Issuance �f a permtt�and that':all�work wlll be pertormed�to meet_standaTds�.of�all laws �egulating�
constructlon, County and City codes, zoning regulatlQns� and land development regulaaons�tn'the:Jurlsdlctlon:� I::at'so _
certify that I understand that the regulatlons of other government agencles may•apply�to the,.lntended.work, and that it is
my responsibllity to identffy•what.actlons I must�take:b;beFln:.compllance,:,Such.�gencles�lnctude but�are.not IfmKed,to:,� �
Z�r. .1� ri�•.':.,:_
- DepaRment of Er�vlronmental>Pi+otectton-Cjrp�ess.�Bayli�ead�;�V11eN�and Areas and Envlronmentally Sensftive
Lands,WaterlWasteu+►�ter Treatment. _ �
r�_.•s.
- Southwest Florlda Water Management: .I�Istrlct:Wells, Cjipress. Bayheads�; Wetland Areas� Alte�ing �
Watercourses. � � �
- Army Corps af Englneers=Seawalls�.Ddcks� Navlgatile Waterways. .
- Department,�of__Health�;��,;.R�1�ab.Illtafhre��,SenttceslEnvtronmenta0 ,H�alth.,Unit:Well.s; VlFasteVitater-Treatment; � �
� Septic Tanks:. � � - . ..
- US Envlronmental Protectlon Agency-Asbestos abatement:..: •
- Federel Avlatlon,Author,ItyJ°Rurnvaye:"� , ' \ '
1 u�fderstand that the.follouving:.�esirlctlons apply to"tfie use of flll:•
- Use of flll Is not allowed tn',Fl,00d:Zone"V"unless expressly pennitted.. � ,
� - If'the�fiU mateMaf`Is'�to�ti.e used_�In:•�flvod �Zone. tlA", tt Is underetood °that•a•dralnage plan�addressing a
°compe�sating volume".�will be subri�ltt�d at#lme of�permitting whlch ts prepared by a professlonal engtneer
Ilcensed by`tlie�:�taCe of`Floflda:. � ,...:� j...J �� . �
' - If th� flll materlal.ts�to=be�u�ed In Flood Zone 'A" tn�connectloh�•wlth:a•��ermltted bulldlitg using stem wall
� constniction, I certify-that f111:wall>be.used only.to..flll the area wlthln�the�s#em�watl.
- If flll mate�lal�Is to be used In any`area;"I`�cenlfy that .use of such flll wlll �ot adversely aftect adJacent
propertles. If use of.flll Is,found,to.advets�ly.,�ff�ct ad)aEent`'p�pertles�.the owner may be clted for vlolating.
_, _ , .
the-cond�ions�.of the b�llding�:permlk-Issued�under ths`at�achedepermlt�appltc�tlon� for:Iots4.less°:ihan:one (1)
�cre whlcFi are elevated`tiy fllt; a�r englneer�ed dralnage plan Is requlred. �
�.•,,.,
If I am the AGENT FOR THE�,OWNER�;,.I;promise In,_good falth to Inform the owner of��the permitting condRlons set forth In
this affidadtt'prlor to commeracing conatructlon. I undetstand thet.�a aep�rate permlt may be requlred for elecMcal work. . , _ _
plumbing, signs, wells,.pools;. alr condlttoning,-.gas;,;o�:otMe� Instaflg o;ns not�spec�laally lncluded-In.the�application. .A , - '
permlt Issued shall be construed to be°`a�'license'�to��proceed wlth�tFie wo�k and not�as:authoNty:_to,vlolate�.�cancel;_alter, or �� �'
set aslde any'provlsions of the.teclintcal_codes,;�nor shall Issu�nce�of a.permlt.prevent.the Bulldlrig O#ficlal from thereafter_. �
requlrin.g a coRectlon,af eRors ln-.pl�ns;conshuctlon..or,vlolatlons o�any codes,, .�very,p�ermtt�;lssued sfiall become�lnvaltd �
unless the;work authorized.by such permlt:�ts-commenced•wlthtn sfx,months ot�permlt Issuance� or tf worlc authoNzed by
the permlt Is.suspended�or;aba�doned�for-a:perlod.�of-elx:�)�monfFi`s::afte�:the�tlme the'wor�k�ds commen�ed. ,An extenston
may be requested,,ln writing;�from tFie.�Bullding,Otflc(al for a perlod=�not to_exceed'�nln'sty�(90)�days a�d�=wll(demonstrate
justlfiable`cause for�the extension�. If work ceas�s:tor nlnety_(90)cons.ecutive:d�y��..the Job�ls consldered aba�doned:" ____
-- -- - — - -- -- --. - ,-•- --�–_. ---- ___. -_— � __ __:---_-____ __ , . - -- –
WARNING TO OWNER: YO.UR;FAILWRE_.Tb,R�E�ORD.A:.I�OTIGE:;OF�.�C>OMIVIEMCEMEMT;MAY°.RESt1LT IN:�YOUR -
PAYING'NYICE.FOR,.•IMPROVEMEN3`8•TO:Y,,OUF��.:PROPERTY:z41F°.YO.U�I�'�EK1D�?�TO�'�TAIN��FIN�fipE1NG;'C.ON3UL'T �
WITH YOUR LENDER:O1t AI�A�'TORNEY�EFaR��R�OR�IN��sYOUR�NOTiC£'OF-x�dl�Al111ENCE�f�T'= '
FLORIDA.JURA'�-(F: •.117.Q3} ' �• . . : - � = •• - ���
OWNER OR AOEN � ��f.�CU� . CbNTRACTO �Q- �I � �
Sub bed and evwm to(or�fflrtn d)befo' me thls S' ed'end'swom��o( t a�tnned)�befo me�tti
► 1 by i�laG/� v,wo .by.. �A-nqP.l� . Hr�/uwca��
Wlio Islare personalty,k own b.me. haslhave.produced o'.I are p.etaonally�cno. •to.me or ha ve.•produced � -
� ae IdenBBcatlqn. � a�`'tdentlflcaUon.
_ o�ry Publlc _ Notary Publlc
Com Isalon No:``" Comm s1on.No._
' ��„��",,,•. RYMAN
Name ot Notary typed,p, , ame oi Notery typed,printed or stamped _=.� '':
�a �., :� �_ Commission N FF 905017
,-`.►"`°�:': KELLI B. RYMAN 's, � n My Commission Expires
�.° '..., �:
:f�.9 Commission q PF 905017 ��'%:`,,;;;;,:�`� July 30, Z019
:,�;t�� ,;? My Commission Expires
'��ah;•�•� JUIy 30, 2019
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^ 2016004310
' ' Rcpt:7739981 Rea; 10.00
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` @1112t2@26 K. Ra �5., DPty Clerk
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la-a�,a1- b3oa -oc�a-c��o �,�
Perm2t No. PatCeY 3D Rto �N N
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NOTICE OF COMMENCEMENTI/�J/� �m�
! l..i.J`lJ f+`m
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State o{ Caunty of Wp�
(j�S
THE UNOERSIqNED hereqy givea noUce lhat Improvement will be mnde to ceAeln ree{propeAy,end In accorclance wllh Chapler 713,Flar(da Statules, �..f�p
trie follouving Intomistlan Is provided In lhla Notice ot Commencement;��_� ! /\ }� ��a
t. Ossutption M Properiy;ParcBS identiflcatian No. �` � v��� �u _w�� 3 0
Street Address:. v 1� Ue- h h�i�s F 3 S 1� c�i,..�
2. Generat Descr{pflon of imnrovement ��Q!�� C��� • �
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3. Ovmer tnlorsnailon or Lessee informatlon if the�essee conhactad for the improvemenR: A I
q.rtn rs
�q�'�e Q`u��u�.. (hi I I 5 � 3 5'I a. ����cn`� w �
State }-
I Address �i� 'tdf'Z U fJ���� t^y
Interest In Property: �Q O � Q �y� � �
F}ame ot Fes Slm pte Tttiehoider. �
(if difterent irom Owner psted abpve} �,t„ ���t t? � �7 i
Address
City State ��� �Q �
4. Conttactar. �n � n ���' LL. GL'C� U
� , �,a 3 1��#1 3 S 5� 'C�.�v�h�1��( 335�1� �=Q a� as
C� 2n+'� Q ciry�`�T! siaie � F—>-w�- Y
AGontredo�s Teteyshons No.. Cl�.J'"�Ud-�D!� � C9 =��Q� LLI
1 �' 5. Surety:_ '� ~ F" --� -U
� Neme � L}i.. W�'Z CJ � �
( Addrass G{ty State , O�R' � ti= Q 13.!
Amounl ol9ond: $ Telephone No.. � U O � } p O
6, tender.
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f Name , Q�� �� �,� tjy '�..�
� Addreas City State; W � 1d ,J W g
! Letsder's 7etephone No. 1,
h�- 2 �z� Q �-
� Peraons wilhin lha State of Florida dosigneted by Ihe owner upon whom ryolices or ather dor,umenls may be served as provided by � � r p?> � m
Sectfon 713.13(1)(a)(�,.Ftorlda Slelutes: -
Name �
Address Ctty State `��� �t � . �[
Telephone Number of Designeted Person: ��� • � a,
8. In eddlUon to himselt,the owner deslgnetes °�---- �r� ,.•• ��,
to rece4ve a copy of the Lienor's Nfltics as prevldetlln SecUon 713.13{t)(b},F4ocida Statutes. ` � .y � Q
Telephone Numbar ot Person or Entity�eslgnated by Ownar. �' �� h � � '
a �O �
9. Expiratlon date ot Nattce of Cammencatnesrt(ttle explratEon date srtay aot be bet4ra the co an nt ca2nsttucr/iyan antd�final payment to the � � o �1
contraclor,6ut Wilt 6e one year from the dafe of recordl�g unlesa a different date Is epecifiedj: �7� lJ���lR �` L"t� �
ARE CIONSIOER DE MP OPER YPAYM NTS�N ER-CliAP7ER 7�PART 7,�SE�ON 713.13,HFLqR DA�57ATUTES'�ANDMCAN �� � �'�j�
RESUIT 1P!Y4UR,PAYfNC,lVNCE FOft IMPROVEMENTS TCS YOUR PROPEf2TY. A NOTtGE O�CON+MENCEMENT MUST B£
RECOROE�AND POSTED ON THE JOB SiTE BEFQRE THE F1RST 1t35PECTtON. 1F YOU{NTEND TQ CIBTAiN FtSdRNCING,CONSUI.T
WITH YOUR LENDER QR AN ATTqRNEY BEFORE GOMMENGING WORK 4R RF.GORDINO Y4UR NOTICE OF COMMENCEMENT. �y�!�� 0 � �
Uraler penaSty ot perjury,i deciare that i have tead the foregoing nntice of ommencement and t the lects stated lY�ereln ere Irue to lhe besl ��"�� * �
af my koowiedge and 6elfei.
STA IDA ����yy�p �
���'&���f��� Sign ure of Owner or s ee, ec's ar s.aee's Authorized
�• COtM3f1��9fF f FF 912555 � Officet/DlrectodPBAneNManager
My Comm.Ertpdn�Aup x1,2019
• � SCI1dAdtl�oialkitkldMoUfYNsn.
signatar}�s Tltletaffice n
Tha foregoing Instrument was adcnoHAedged before me lhis t!tlay of��n�,20��hy �`��� �`�"h��
ea (iypa of authnrity,e.g.,otticer,trustee,ettomey in faG)Por .
,_{n e at part n n e a!!af'wv,00m,lnstntment was BJtecuted},
Peraonally Known�C,�g Produced Idanlliica/tl�o� Notary Signelure ��� WQ«���
Typa nf tdent114caAlan FrWuced �L LJ�-- Nome{PrinQ � Q ���� �d�
wpdafalbcstnoitcecommer�cement„pcQ63048 ,
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