HomeMy WebLinkAbout16-17819 CITY OF ZEPHYRHILLS
� • 5335-8TH STREEi'
(813)780-0020 8��
BUILDING PERMIT ,,
PERMIT INFORMATION LOCATION INFORMATION
Permit NumE�er: 17819 Address; 38704 EVELYN LANE
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Ciass of Work: A/C CHANGEOUT Township: Range: Book:
Propos�d Use: NOT APPLICABLE Lot(s): Btock: Section:
Squa�e Feet: Subdivision: OAK CREST ESTATES
E�tt.Value: Parcei Number: 02-26-21-0230-00000-0030
Impra�r. Cost: 4,900.00 OWNER INFORMATION
Date�lssued: 1013112016 Name: HILL JULIEANN
Tot�l Fees: 60.00 Address: 38704 EVELYN LN
Amount Paid: 60.00 ZEPNYRHILLS FL 33542-1690
Da�te Paid: 10/11/2016 Phane: 813-782-9426
Wor,k Desc: A/G CHANGE OUT 3 TON
CONTRACTOR S APPLICATION FEES
CRADDOCK AIR CONDITIONING &AIR A/C CHANGEOUT 60.QQ
�
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ins ectians Re uired
D TS IN ALLED
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DUCTS(N�5U�,4TEQ
FINAL �
REINS ECT`ION FEES: (c)Wi#h respect ta Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
locai overnment shatl impose a fee of fonr times the amaant af the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTIC�: In addition to the requirements of this permit, there maybe additional restrictions applicable to this properly that
may b faund in the public recards of this county, and there may be additiona( permits required from other governmental
entities such as water management, state agencies or federal agencies.
"Wa�ning to owner: Your failare to record a notice of cammencement may result in yaur paying twice for
impr vements to your property. If yau intend to obtain financing,consult with yaur lender ar an attorney
befare recording yoar natice of commencement."
Complete Plans,Specifications Must Accompany Application. All wark shall be perfarmed in accordance with
C[ Codes and Ordirtances. Nt?OCCUPANCY BEFORE C.O.
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NO OCCUPANCY BEFORE C.O.
�f V f ��L�
CONT � OR SIGNATURE PERMIT C►FFI R
PERMIT EXPIRES IN fi MUNTHS WITHUUT APPR4VED INSPECTION
CALL �OR INSPECTION - 8 HOUR NOTICE REQUIRED
PRt)TECT CARD FROM WEATHER
� � VAC �E�VICE ORDER
��' � H � I1�IVOICE ` 2 4 3 4 8
�-. ' C��dd�'s Air Conditioni�g �,��..;.�w.�W����,.,;�,,,;;��_ ,�.,. .� ,,�w�,,-,�,:�, u.� � �, ..-k . . . . . cHECK;�is
� � METHODpOF�PAYMENT'�;�;x }��W s, ;� �+ �UNIT�•;�� f 't,' '� ` ,UNIT" ��'�' � �
� ` 10736 US Highway 301 ��CASH, L �'„�`" :n.��,���. .��,..��. :�+: r1 �: �. ,,, , , � , . ,.� ,,
MAKE MAKE � COMPRESSOR
' . Dade City, FL 33525 O CHECK DRIVER'S LIC.NO. �SUCTION
{. �f ap MODEL MODEL �HEAD
�; �81�� /�2'94L6 CREDIT CARD ❑MC ❑VISA ❑AMEX �VOLTS
' SERIAL NUMBER � SERIAL NUMBER �ELECTRICALCONNECTIONS
EXP DATE �CONTACTS TIGHT 8 CLEAN
� � ' �'�� ' ' �' ' ' '� ` �OILLEVEL&CONDITION
�"� , .;r cc No. ,. � : `�ENVlRONMENTAL CHECKLIST" ,':' �. .� � CONDENSER COIL
�I T� r � ' J �CLEAN COIL&CHECK FIN CON
NAME ��, CONDENSING UNIT aTY TYPE/DISPOSITION
� �� , � �ENT. °F LVG._
STREET' DATE ❑RECOVERED � REFRIGERANT
��� �! Q (, ►1A/ � �Q ❑RECYCLED ❑LEAK ❑CHAROE
�� � . �iT, PR MISED� ❑ FAN AND MOTOR
�� ���x ❑RECLAIMED ❑VOLTS AMPS_
�'q '*u�^ �' PHONE�(HOME) PHONE(WORI� SCHED. �'A.M. RETURNED ❑ELECTRICALCONNECTIONS
TIME � ❑CONTACTS TIGHT 8 CLEAN
0 P.M.
'�� ,�I TECHNICIAN ❑DISPOSAL ❑FAN PULLEYS(ADJUST BELn
i , � �CHK,LUB BEARINGS 8 MOTOR
.A, . �,� �,f,�.(,1�,.�JV�,� ❑,DISMANTLED � EVAPORATOR COIL
� � WORK TO BE PERFORMED
❑CHANGED OUTIREPLACED ':TOTIAC$ _ ❑CLEAN COIL&CHECK FIN
�; } . '" .' •c. , :. .. - . . • -. ❑ENTDB �F LVGD
+ , QTY'�'MATERIALS�&.SERVICES UNIT:PRICE 'l�MOUNT- ❑eNrwe aF LVGN
: �o y � ` � � , i-`"' ❑ CONDENSATE AREAS
� � �O � REFRIGERANTR- LBS.--- !� � ❑INSPECTB.CLEAN-ORAIN�PAN
, .. �f __ ❑INSPECT&CLEAN DRAIN
�f ��5:�5�.��?��9r�t".�Ys� r�r"''"r''"',;,c.�.%p.. ' `:"�?s'.r'a„. ��>'�'�' � AIR FILTERS
;b�',"�% DESCRIPTiION OF WORK �`'�:��5 "�`�r�' �` "��.r'� �,,,, -��r�'tl `r FIITERS X X `` � � 0
�� �' y��??,?::;:�'",' %�"' �yp., .".—- �CLEANED �REPLACED
�%� �"�a�.P,� - _ � . ., ..., ,,,..;��;.�.:��; .��. ,c'y�., , --- —'—"'--_.-. '------'--- -----�---
� �^ FILTER�SIZE
i _ , . �:. ... " , �. . � 1 ,�ICGV .�� �— � ❑ HEATINGASSEMBLY
'.{ , =��--�.,'1 C�-�(�--������ ' i
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� ..; _ � _/ J�._ •, ���-- �',. . }� ❑FUELSUPP Y&P ESSUREER
�,f:.. ,:� ._:�,�r_.r_._C.a_n...i,�:�-�C.-c��- i r-l�l��['s.�_3=-- ��---�O cs�. ._��J S__.��.R.cS------_._.----_____------.._..---- -------------- ---------i..__._____'___
❑
�--- �PILOTASSEMBLY
, � • ��•��� �_ (_ ❑'FLAMEADJUSTMENT
�I '��_CO-� 6l:l. � iL C ��� . IL^(_l.� � i-L'LS— — ❑
'^ � PRIMARY RELAV 8 RUE
, �� '1 � � q � I I ❑FAN 8 LIMIT SWITCH OPER:
!'-�: i � w� Pr1'_lbti.�� ��_.— �_�._.�.�.—- -- --'---------'-------- -'- I—. BLOWERASSEMBLY
�5�'� ___.iJ.��� � �_�___.___..� ❑
��, - " ^ � j �.RV VALVE
' F'!/`� ��=Y' ����� - � ❑STRIP HEAT
�� � " = " TOTi4L• MATERIALS � ❑DEFROSTCYCLE
� � _ — ,' : ;� ', , '- . ,. ❑ ELECTRICAL COMP'TS
� 'HRS �, �'',LABOR ' �' RATE `�- AMOUNT'. ❑,Reu�vs p coNracro
'1 _ � - ❑OVERLOAD ❑�PRESS.SW
, � I � ❑ tHERMOSTAT
F - -I— - ❑O.K. ❑REPLACE
� - i� ` � �RELOCATE
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'! � , : ,,. , ;TUTAL SUMMAR
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'���� ' ^r�+`:�l6t:��"-^R' ' ,�"� �'�'''�TERMS ' ' ;
' RECOMMENDATIONS: '.:� �' +'• TOTAL LABOR TOTAL MATERIALS
. ' ,��°:•�'.., i
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LIMITED WARRANTY:All materials,parts and equipment eie warranted by the TOTAL LABOR
I manufacturers'�or•suppliers'writtenwarrantyonly.All�laborperfo�medbytheabove .
� named company Is wartanted for 30 days or as othenvise Indicated In wdting.The
� ' above namad company mekes no other warranties,express oc Implled,and its TRAVEL CHARGE
� , agenls or technlcfans are not authorized ta make eny such wartanties on behali ot
�' _ _ .�—__T_�..._�.� --- IheveaulhodrytooMerlhe'workoutllnedebovawhlchhesbeensatlslaclorilyc0mpleled.legreethet� �Q�� BdCOm d0.
. CI�; SellerretaUistitletoequlpmenVmetedalstumisheduntllflnelpeymentlsmetle:Ifpaymentlsnotmade . ' T�
� � � �as:e iee0,Seller ran:remove'saltl e menVmaterlels aFSellere e ense endlor Impose e 2% �
,,;D a '� ❑REGUCAR ❑WARRANTY
i �IlqulAauon fee on the en amount �teined in the SellerBuyer tiansacUon.My dartiege resulting .
`� F I Irom sattl removel ot be Me re nsibNry of Seue
U.+
; _ — `^� � ❑SERVICE,CONTRACT
, o,�l - � �� ' � Thank You TOTAL �Q
a I C O SIONATU DATE
Oct 11 2�16 04:30PM HP Fax page 1
, . . .
I,IC#: CAC1816730 Phane• 813 752-9426 Fax• 352 437-4849
Octaber 11,2016
To Whom It Mav Concern:
[,Kevin Lambert,owner af Lambert Air, Inc.,hereby give permission to Will'tam to Stewart to obtain
Mechanical Permits and other necessary documentation for permitting on behalf of Lambert Air, Inc. or
Craddock Air.
Thank You,
� � ,
�� �
Kevin Lambert
727 235-8002
STATE OF FLOR[DA
COLJNT'Y�F � `..�_ )' _ _ .
i, �
The foregaing instrumeni was aclmowledged before me this ��day of ��,20�
/� / ! �� '+
� % � � ' � i 1
� , ��, " � : ;' c_!�°:�=�
�gfiature of Notary Public—State of Florida
r,r���,.,, KRISTiN CHASE � ,"' .
�` �°'y� Flottry Publls•Stot�01 flarida
_•� •c 114y Cptrtm.6tplltis JUR 1�.40f1 �� �' � � � �� ? �L`4 � � � a �
�,d� Commission N FF 157a3d Name of Notary Typed, Printed or Starnped
��'�R����`' Bandedthra�N�ian�NaqrY� PersonallyKnown �•- ORProdacedIdentification
f
8�s- saoozo City of Zephyrhills Permit Application Fax-813-780-0021
_ ,. . Building Departrnent
, �
Date Receive /D �J Q Phone-Contact for•Permlttln � � ,
Owner'a Nam I J I�-1 1���J,�Q_ Owner Phone Number d i3 ���` q�/a�O
Owner's Addr ss g D L' lj✓L, y�� �Owrner Phone Number��
Fee Simple Titlefiolder Name Oweer Phone Number "
'��d '
Fee Simple Tit eholder Addre�� �
JOB ADDRES 3 �"7 d '� �1��� � LC� �� LOT# �
SUBDIVISION - PARCEL ID# '
' (OBTAINED F,ROM PROPERTY,TAX NOTICE)
WORK PROP SED • NEW�CONSTR ADD/ALT -Q SIGN' Q Q DEMOLISH
�B. INSTALL - REPAIR ��
PROPOSED:•U E Q SFR Q COMM ' Q -OTHER
TYPE OF CO 3TRUCTION � Q �' BLOCK ' Q FRAME ��] ,"STEEL Q
DESCRIPTIO OF WORK h.Q� ,Q� (r�l. I
BUILDING SI � SQ FOOTAGE � . HEI,GHT �.
OBUI DING $ VALUATION'OF'TOTAL'CONSTRUCTION � '
QELE TRICAL $ - . AMP SERVICE PROGRESS ENERGY W.R.E.C.
0 �
QPLU BING , $ '
. � � _ �. � ��19
QME HANICAL $: ]�G� O D d VALUATION OF'MECHANICAL INSTALLA7'ION
l / � .
�� Q ROOFING Q SPECIALTY � OTHER� - I
FINISHED FL OR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY� �
SIGNATURH REGISTERED Y/ N FEE CURRE� Y'/N
Address 5 ' Gcense#
ELECTRICIAN_ . COMPANY -
SIGNATURE � REGISTERED Y/ N FEE CURRE�` 'Y/N
Address ' � . ' . LlcenSe# ,
PLUMBER ' COMPANY , , . .
SIGNATURE` ' '�' ' ; REGIST.ERED YJ-N., . , �e cuRRE� Y-/N • ' `
Address � � License.#
MECHANICAI: � � � - t � U -
'�J��/ /,� C.OMPANY C��.�.O–�C S
SIGNATURE �C�V s�/�L � REGISTERED Y./ N . FEECURRE�. Y/�N
Address.� . . ,, ' - . � � ' f License#�
OTHER " ' � �- . � - ' " �,_COMPANY. �
SIGNATURE- �"`� - '•'"' � � ' • ' REGISTERED ' 'Y/ N..,. FEE CURRE�• Y/N
Addre�s -:�¢':y F� � ;t Ucense# �
RESIDENTIAL'- . .Attacfi'(2).,PIotiP.,lan`s•(2)s � ' �� � �
,: ets�.of�Building'Plans;'(1)set of Energy Fortns;R=O=W Perrnit for new construcUon,
- ,, Minimum�,ten�(t0)workingfdays;after_subrrmiEfal dat"e.<<:Required onsite;_Constiucdon:Flans;�Stormwater Plans w/S(It Fence installed,
�� ��SaniteryFaclltUes-&;1;;dumpste_r..$Ite,Work;P,ermitforsubdiyisions/large:p:rojects _ ' ` '
COMMERCI Altach(3)�coinpleEe�set`s'oYBuildtng Plans'plus a'�Llfe Safetji Page;(1)set of Energy Forms.R-O-W Permit for new construcUon.
— __ Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stortnwater Plans w/Silt Fence installed,
Sanitary Facilitles 8 1 dumpster.Site Work Permit for all new;projects.All commerclal requirements.must meet compliance � �
SIGN PERMIT Attacfi`(2)"sets ofEngineered=Plans.;:•; •��' �. • . , " `
.... @Q --- - ,.,_
PROPERTY SURVEY r^_ uired,for all_NEW construction.. .
Dlrectlons: . . �- �- - '
Ffll out ap Itcatlon completely.
Owner& � ntractoc sign back of appltcadon,notadzed
If over;2 00,a Notice of Commencement is required. (A!C upgrades over ST500)
� ;.,-;,;.,,.;:., �
" AgeM(for the contraotor)`or"Powe�of Attomey(for tFie owner)would be someone with notarized letter from owner authorizing same
DVER THE CC�UNT.ER,PERMITi1NG•- --- (Front of-Application Only)- `'
Reroofs if shin les Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Drlvewa Not over Counter if on public roadways..needs ROW � �
r . �
�I . . �r _.
NOTiCI��OF DEED.RESTRICTIONS: The undersigned,under�tands:th�tjthis:p�rmif�.may be..subJect to�°deed"rrestricttons":_r t.,. "` `
which may tie:m`ore�.r.est�(ctive=th��`County�+regr�lat(ons:��The undecslgned°assumes'responsibiltty`for'compliance`witli`a'ny �`-"��'�
applicable deed restrictlons. ,..: . . . � .. __ ; -.. -_.._ .. _ ....�. '_ `:' .- . '`�
UNLICENSED CONTRACTORS AND CONTRACTOR•RESPONSIBILITiES: °If-ttie�owner�has'��htredy�a�ctintractvr or
contractors to undertake work,-they may:bs�rc�quire.d�_to:.tie_;Ilcensed In accordance.with:state.and;local.,regulations:-1f>the•-��° � ���
contractor Is�not licensed:as�requlred.`,by law�.tiotti the owner and�cont�acto��may be��cited�-for�a�misdemeanor violatlon
under state law. If the owner or Intended;.contr;a�tor;,ere,;uncertaln as to arhat Iicsnsing,requirements,zmayy�applyz�for�-the°�� _���-���
intended"iniork, they are addised'to aoritact:tfie�Pasco County,Bulldtng.:Inspection,Divlslorp=,-Licensing Sectton et 727-847-
_ ._.. .._��..__ _.._. ..�. ,_. . . ,._
8009. Furthermore, If the owner'lias'hlred��a conVacto��o�contractors, he is �dvised to have ,the contractor(s),_;sign_ _
,.._:_,:,,..._ . .
portlons of the "contractor Block" of thistiapplicatlon.for,which.:they, will_be=.responsible.�=1f:you,��as•.the owner'sfgn�as'the"' �
. _ ......__.�_. :.,..
contractor, that tnay be an indication that'tie�'Is�not.properly'Ilcen"sed"and��is�not`entitled to perniitttng privlleges In Pasco
County. , r.��_; ;��, .___, I
TttANSPORTATION.IMPACTIUTILITIESrrMPAC'I�ANb°ItESQURCE RECOVERYfEES:'The�undersigned"understands
that Trarisportation Impact Fees�and.Reco.urse.Recove.ry_Fe�s rriey��appiy.�to�tf�e;constructJon_of new.._bulldings,?change=of��,r '�-���'�:
use in existing bulldings,�oc:;ezpansi��r�of�existing�+buildings, as specifled.in Pascv County Ordinance number 89-07 and
90-07, as amended.;_�he undersigned also:understa[�ds, that:�such fees��,a�:tnay:�e::due;:,will.-be identtfied at the��tihie�of-� ��� � r
permitting. It is furtfier understood that Tra�sp�ortation Impact Fees and,Resource.Recovery��Fees,.must be pald prlor to
receiv(ng a_'certiflcate of�occupancy"or flnai�power;[elease: :If��the project.does.not involve4a=.certificate of occupancy,�or�_`"� - � '�
final power release;:the-;fees mu�t be paid.pcior to,permit issuance. Ft��thermo�e;.If:Pasco,County'Water/Sewer,=;Impact = ��.�,•:°�
� , :. .. �. . ,
fees are due,.they�must:be=pald:.prior to permit�-lssuance-ln accordance wiEFi�applicabte_Pasco'�County=ordinances. •
CONS'TRUCTION�LIEN�LAW'(Chapte�T13� ElorJda Statutes�as amended): If valuatlon of work Is$2,500:OO.:or�more�:i - : -�•�,::
' certify that I, the applicant,:have-been provided �with--a-�copy�of:�the:�"Florida Construction� Lien law=Homeowner's
Protectio� Guide" prepared by tHe Florida Depa�ment�of Agric.ulture and Cvnsumer:Affairs. If the applicant is someone � , _
other than the°owner", I certif�►�.that,l�.have;obtained�a'copy.of,the:abovs:describedtlocument�and.promise;�in,good'faith�to -
deliver it to the.�'owner":pcior�to�commencement:' ' � . � - � - . -
CONTRACTOR'S/OWNER'S AFFIDAVIT: I.ce'rtfty.:th;et.-.ail��#he�informatlon in�thi� applicatlon is accurate.�nd that all work
,;
will'be done in com Itance with all.a �Ilcable laws re ulatln constructlon zonin and:�land�develo ment. A Itcation is
P pP 9 9 � . 9 _ _ .P_ PP ., .
hereby made to obtain .a pecmit:#o do��vuor,'k;,.and•installatlon as indi�afed:�>.•�1 cectffy that no workpor (nstaliatton iias
commenced prior to Issuance of a permif"and that�.all work will be pertormed to meet standards of all laws regulating-
construction, County and City codes, zoning regulatians, and land development regula8ons=tn the�jurisdtction.- �I�-al'so _
th t t r overn e e c e
certify that I unde�stand a he regulations of othe g m nt ag n i s may�apply�to the.intended work, and that it is
my responsibility to identify�what.acttons I must�take:to,be�In:.can1p11anca:;.Such,agencies include but=are.not Iimfted to: ;
.,.::.
- Department of E�lvironmental>�Protection=Cypress�Bayhead�; Wefland Areas and Environmentally Sensitive
Lands,WateNWastewater Treatment. " � -
- Southwest Florida Water Management� .District:VVells, Cypress.�Bayheads,-'Wetland Areas, Altering
Watercourses. - , �• - . �
- Army Corps of Engineers-Seawalls, Docks,Navigeble Waterways.
- Department,of..,Health;;& .Rehabilitative,Setvices/Environmental�.Health Untt-Well.s� Wastewate�a Treatment,
Se�tlo Tanks:_.: '��. ' � - - �: �
- US Environmental Protectlon Agency-Asbestos abatement.
- Federal AvlationAuthority,-,Runways. , '�
I understand.that the,followin`g:restrictlons apply to the use of flll:�
- Use of flll is not allowed in:Flood:Zo,ne"V"unless expressly_permitted.
- If the.�fill'mate�fal=1s 'to be used.`�In.:Flood Zone. "A"� It is underst6od that a dratnage plan addres�tng a
°compensattng volume"will be submitted at time of��permitting which ts prepared by a professfonal englneer
licensed by�he StaCe of`Fiorida: � �
- If ihe flll materlal-is�to be used in Flood Zone 'A" (n�connection�with:a��ermitted building using stem wall_
' construction, I certify that fill:wall:be'used only.to.fill the area within the�stem Mrall: _ -
- If flll material is to be used In any area, I �certify that .use. of"such flll will not adversely affect adJacent
properties. If use of fill is found�to adversely:�ffect adJac�nt��pcopertles�.the owner may be cited for violating,•
the cond�ions.of the building;permit issued.under the:'at�acfied��ermtt appl(catlon,,for:lots�.less°.than.one (1)
acre which are elevated'tiy flll; a�r englneered dralnage plan is required.
If I am the AGENT FOR THE OYIlNER; I;.�romise in.good falth to Inform the owner of-the permitting conditlons set forth in
thts affidavtt"prtor to commeraoing constructlon. I understand thet�a:aeparate permlt may be requtred for elect�ical work� . ,
� plumbing,,signs, wells,.pools;. alr condttioning,-.gas, or:other insfal��tfons not•spec�iaally included�in the application. .A , �
; permit issued shall be consfiued to be�a'license��to•proceed with tNe work and not-as:authoHty:to:violate;'cancel, alter, or
, set�aside any provistons of ihe technical.codgs;�nor shall issuance�of a.permlt.prevent the Bulldirig O#ticial from thereafter
� requlring a coRection af ercors in.plans;-constluction.or violations of-any codes. Every�.permit-Issued"sliall�become�invalid
unless the work authorized.by such permit:�is-commenced•withln six,�months of�permit issuance� or if work authorized by
the pe�mit is suspended�or.aba�doned:f.or:a:period:of�six:f8)-montt'is,:after:the ti�e the�wo�k�is commenced. An extension
may be requested, In writing, f�om tHe�Building,Official for a period:�not.to-exceed=ninety(90) days and�-will'demonstrate
justifiable cause tor:the extension� If work ceas�es.for n(neqr.(90)cons.ecutive day.s,..th�Job�is considered aba�doned. "
IMARNING TO OWNER: YOUR..FAILIJRE�T4,REC.O�tD_A.,NOTIGE AF�•COMMENCEMEMT:.MAY�RESULT IN�YOUR
PAYIPIG TWICE;FOR.IMPROVEM�N'�S�Tfl:YOUEt•�PROPER-'iY: •IF°YO.U.�IN�TEIVD'�TO"�dBTAiN�FINAwE1NG;°C.ON�ULT
WITH YOUR LEND�R:OR AM ATTORNEI�$EFORE��RfCOR�71N���1(OUR'NO'FICE�?OF=COM111�ENC�E�(l� �`
FLORIDA JURA��(F.S: 1.17.03} �' , .. , , , • . , -_
� - - ---- --- -- ---.--= -— — -
~C6wry�i€-tT��t�itA17'-- -- - ---- --- - CON7'RhC'TOR -
Subsarlbed and swom to(or aRlrmed)before me thls Subsc�lbed and'ew�m`to(ot afflrmed)�befote me�ttil� ,
by ,•by
Who Islare personally knovm to.me or:has/have produced Who.is/are p.eraonallyknoxm•to me�or haslheve•produced • I
" as Identlflcetlqn. ' - � as IdentlflcaUon.
Notery Public . � Notary Public
Commisslon No: Commission•No. - ,
Name of Notary typed,printed or stamped Name ot Notary typed,printed or stamped
_ ,
� �