HomeMy WebLinkAbout16-17824 ;
, „ CITY OF ZEPHYRHILLS
` I 5335-8TH STREET
(8i3)7so-oozo 17824 '
; BUILDING PERMIT
� PERMIT INFORMATION � LOCATION INFORMATION
Permit N;umber: 17824 Address: 5045 18TH ST �
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Propos�d Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 1-26-21-0010-21400-0040
Improv. Cost: 5,000.00 OWNER INFORMATION
Date �ssued: 2/20/2017 Name: PARSON, ARTISTE R.
Total Fees: 90.00 Address: 5045 18TH ST
Amou;nt Paid: 90.00 ZEPHYRHILLS, FL 33542
Date Paid: 2/20/2017 Phone: (813)788-7824
Wor6c Desc: METAL REROOF
!I CONTRACTOR S APPLICATION FEES �
HOMEOWNER REROOF RESIDENTIAL 90.00
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I Ins ections Re uired
DR I ROO S . •
TAPE JOINTS ROOF INSP
FINAL I�
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 properly that
may be found in the public records of this county, and there may be additional permits required from other governmental
I� 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."
Compl'ete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
� City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
V� NO OCCUPANCY BEFORE C.O.
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' - 'iCONT �' TOR SIGNATURE PERMIT OFFI R
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�� PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
j CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
�I PROTECT CARD FROM WEATHER
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s�saao-oo2o City of Zephyrhills Permit Application Fax-813-780-0021
I' + .: Building Department
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Date Received � _ / po�
1. % r_f- -•--�--•—•-- phq�e Contact for Permitting � ��
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Owner's Name Owner Phone Number
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Owner's dras � � /' l� Owner Phone Number
Fee Sim e itleh,der Name Owner Phone Number
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Fee Simple 'tlehdl�er Ac`dress
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JOB ADDRESS LOT# cZ��
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SUBDIVISION; PARCEL ID#
i� (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED e .. NEW CONSTR 8 ADD/AlT 0 SIGN Q Q DEMOLISH
� INSTALL REPAIR
PROP,OSED U�SE Q SFR Q COMM 0 OTHER
TYPE�:OF CONSTRUCTION Q BLOCK •• Q FRAME 0 STEEL
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DESCRIPTIO�� OF WORK V G
BUILDING SIZE SQ FOOTAGE a'� ()D � • HEIGHT •
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BUILDING $ �" CI� ��� ���—
�. � DO O. VALUATION'OF TOTAL CONSTRUCTION P�N E�EpHYRHrLLS�
QELECTRICAL $ AMP S�y�Rk.SHqL Q PROGRESS ENERGY M�R�:E.C.
LC
F�ORIDq gU LO dES Mp�Y wrTh
OPL�MBING $ NATIONq ING C - - - _.
CITyOFZEP ECTRIC�DE.
QME��HANICAL $ VALUATION OF MECHAfYI�;4�6l�� ION
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Q.GAp � ROOFING Q SPECIALTY 0 OTHER � -`
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
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BUILDER � COMPANY
SIGNATURE I� REGISTERED Y/ N FEE CURRE� Y%N
Address License#
ELEC,TRICIAPI COMPANY
SIGNATURE� REGISTERED Y/ N FEE CURRE� Y/N
Address? License# �
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P.LUMBER;, I COMPANY
SIGNATURE� REGISTERED Y/ N FEE CURRE� Y/N
Address' License#
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fNECHANICAL' � COMPANY
SIGNATURE'�' ' REGISTERED , Y/ N FEE CURRE� Y/N
Address'�~ � ' License#
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07HER�, �-h � � � 4 COMPANY �
�-SIGNATURE�4=;'s . REGISTERED Y/N FEE CURREK Y/N
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Address:•. �, . l` � l ' License#
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;'RESIDENTIAL=*;n .Attac6?;(2)-:Plof P.lans;�i(2)�'sefs�of�Building�Plan§;(1�)°set ofEnergyForms;R=,O=W Permit,for new.construction,
�. �":,;z f,.�'i•;_:'.'Minimum,,ten�(,90);workingiiiays'afte�sutimittal;date. "Required`onsite;Con`struction Plans,Stormwater Plans w/Sllt Fence installed,
. Sanita,ry,;Facilities;&;1;dumpster;°Site;Wor.kPermitfor..subdivis'ionsflargeprojects "
;�.COMMERCI�L Athach`�(2)cornplete sets of'Buildirig Plans plus a Life Safety Page;(1)sefiof Energy Forms.R-O-W Permit for new construction.
; � - I Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
��'•' Sanitary Facilitfes&1 dumpster..Site Work Permit"fo�all new p�ojects.All commercial requirements must meet compliance
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�::SIGN:PERMIT AttacFi"(2f sets qf;Engineered•Plans:•
�:^•: �i ��RRPROPERTY SURVEY.required for,.aII.NEW construction. � �
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��:Directions: " , _ - - _ -
` ` Fill-:out application completely.
�Owne�&'Contra�torsign back of application,notarized
If over$2500,a Notice.of Commencement is required. (A!C upgrades over$7500)
'"- Agent(ftir'th`e�corifrabtor)or'Power°ofAttomey(fortFie ovmer)would tie someone with notarized letter from owner authorizing same
{'�OVER'�i'HE COUNTER';PE.RMITT.ING. (copy.of contract•.required) -` '" '
Re�oofs if sFiingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
..j �.......... .. ..._ .. ._ .. .o.. .-.;'.t�fJ2I::)N.:.�:•z.=t"1r�a.i�Y.ei...-e-
Driveways-Not over Counter if on public roadwa s.ne��13 RQ ; ,-�� ; � '
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NOTICE OF.DEED RESTRICTIONS: The undersigned�understand�.that,.�his permi#may be stabjeat:to".cleed?'_restrictioiis"'�;�' '�+
which:may.,,be more;.restr�ctive;�fFian'County regulafions: �Tiie�under.s�gned:assamest�espons`rbili`ty�fdr.compliance=�`nnfh.any �'��
•applii:able-deed�restrictions. �.;;s,�;,;,���i��,�v,�,:� y
UNLICENSED. CQNTRACTQRS AND� Ct:1NTRACTCIR RE3PONSIBILITIES:� If•ttie=:bvvi�ter�has�I�ired»°a�=con#ractor or , ,{
con#ractors to undertake work; they may,,_�be;:requ,ired`to be:licensed in accordance wi#h sta#e.and:locai�:regulatians::`If��thie=���?x:�
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contractor is:not licensed,as�required'by.'taw, both the owner'=and�conftacEor;map��6e>ci#e��fof��:a misdemeanor viofafr'o�• =
under state law. If fhe owner or intended;cantractar are>uncertain as ta what:ticensing�requicements;�rnay�apply.�_fo„r=�tii;e.��'!��;�i;`
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intended�work,.they-ar�•advised to coritact thie Pasco County Buiidi�rg':Inspection`D'ivision=Licensing$ection at727�847= _:�
80Q9. Fur#herrrtore, if the owner has`-tiired a`ccir�tractar or cant�actors, he�is advised to !have the contractor{s).,sign_�.,�;�,,:
portions of the "contractor Block° of this application_for which they wiil be resp.ansible.��Ifi:you, as''fhe'yoininer`sign�asf,ttie� �'�;�;};
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contractoc, that may be an indication that he is no# properly licensed ariii is not erititled to perrr�it#ing privileges inzPasco:,,.a;�„
Caunty. � ' - ' ._ r; ==.�Y t;�
TRANSPORTATION-IMPACTIUTILITIES IMPACT AND RESQURCE REGOVERY FEES:-The u�dersigned understands �.,_:;,
��,:.w::�...�,,,.,e.
that Transportation lrt�pact Fees and Recourse Recovery Fe.es�may.;appty ta the constructian of new.buif,ciings,:charige=ofs�µ-;;`�'�
use in existing buildings,:or�expansian of;:existing�buildings, as specified in Pasco County Ordinance number 89-Q,7.�an'.d` ���
9Q-07, as amended. The-undersigned a{so urtderstands, that such:�'ees,<as-may..b.e.due, wi11-be;ictentifled=at�ttieY:tiriie°of��'�}`����
permitting. ��It is further understood that Transportation Impact Fees�and Resource�Recovery Fees must be paid.prior'to ;;��
receiving a "'certificate of-occupancy," or final power release. If the praject does not inuofve a cerkificate of occupar;icyAor:�;�r��:.��
final powet rele.ase, the fees=must be�,paid prior ta permit issuance. Furtliermare,.if Pasco�County Wa#erLSew�rrlmpaet;r,�' �
fees are due, tliey�must be paid prior to permit issuance in accardance with'applicable..Pasca County ordinances. ' .
GONSTRUCTION��IEN�i:A1N{Ghapter 713,�Ftor�da Statutes,as amended}: If valuation af watk is$2,5{}d.00.vr_ma�e;�t:,�;. `
certify,tha# 'I, the applicant, have been provided with a capy..of the °Florida� Constructian Lien Law:Homeowner's ' � -
Protection Guide" prepared by the Florida Depar�ment of Agriculture and Cansttmer Affairs. !f the app{icant�is someqne_, .
other#han the"owner", i eertify that i.have obtained a copy of the above described'document�and promis'e�in goo.d`.fai#ti'to`Y,�,�:,
deliver it;to the".Qwne�'..prior�fo'commencement. � + •
CONTRACTOR'S/01NNER'S'AFFlDAVIT': ;l�.ce�tify that al(the infor:mation in this application is accurate and'that at(-work
will b� done`in�_compliance�with'all applicable'laws regulating construction, zoning�and land�development. Application..is _
hereby made�`to"otifa�n„a permit_ta .do work and,�,nstallatiaci=as,,indicated. 1 certify that no�wark or.insfallat�any has
commenced prior.to issuance of a permit�=and�`th;at;all°;�wo'�k'�wilL:_be performed to meet standards of all laws regulating ,
constru�#ion, County and City codes,' zoning ,regulaticiris:,'and=�land�development regulations in the jurisdict'tott. �I�also 1
certify that i understand that the regulations;af other gdverrimenf'agencies may apply#o the intended work, and that it is � ��
my responsibility to identify what actions�I�`must:take;to;be'in compliance. 5uch agencies include.but are not limited.to: i:
- ..Department af Environmental�`Protectian-Cypress Bayheads; Wetland Areas and Environmentally Sensi#ive
Lands,Water/Wastewater Treatment. �
- Sauthwest Florida Water Management District Wells, Cypress Bayheads, Wetland Areas, Altering �
Watercourses. '
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Departmen# of Health & Rehabilita#ive ServiceslEnvironmentat .Health Unit Wells, W:astewater Treafinent, ,
Septic Tanks. ' � �
- US Environmen#al Protection Agency-Asbestas abaternent. ,
- Federal Aviation.Au#hority=Runways. � ,
I understand that�the follawing restrictions apply to�the use of�II:
- Use of fiit is not allawed in Flopd Zone"V"untess expressly permitted.
- If the fill material: is to be used in Flood Zone "A°, it is understood that a drainage plan addressing a
"compensating valume� will be submitked at time af permitting which is prepared by a prafessional engineer "
licensed by the Sta#e of Flarida.
- if the fill materiat �s to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fii�will be used only to fill#he area wfthin the stem wall.
- If fill material is ta be used in any area, I certify that use of such�fill wi14 not adversely a�Fect adjacent
properties. If use of fi(( is found to adversely affect�adjacent properties, the owner may be cited for vio(ating
the conditions of•the�building.permit issued under the attached permit.application, for-lats less than one (1) '
ac�e whichare elevated by fi11,an eng�neered dra�nage plan is required.
If I am the AGENT FOR 7HE QWNER, I promise in good faith to inform the owner of.the permitting conditions set forth in •
#his affidavit:prior to commenc�ng cdnstructlon. ! understand that a separate permit may be required for electrical wock,� '
ptumbing, signs, weits, poots, air conditioning, gas, or other insfa(tations not specifically included in the application. A. ; �.,:;
permit issued shall�.be construed to be a license ta,proceed with the work and not as�authocity.to violate, cancel, alter, or
se#aside any provisions af the'technical codes, nor shall issuance af a permit prevent the Building Clfficiat from theceafter �
requiring a aorrection of e�rors in plans,=constructian or violations of any cades. Every p�rmif issued_slialf become invalid
unless the work autharized by such permit Is commenced withln six months of permit fssuattce, or if work authorized by
the permit is suspended.ar abandoned for a period..of six(6)manths after the.time the work is commenced. An extensian
may be requested, in writing, from the Buildin� ��cial for a period not#o exceed ninety(90) days and will demonstrate �
justifable cause for the e�c#ension. If work ceases far ninety{90)consecutive days,the job is considered abandoned.
WARNlNG TO OWNER: YOUR FA1I.URE.TQ RECQRD A NOTtCE QF COMMENGEMENT MAY RESULT IN YC1UR
PAYING TWICE FQR tMRROVEMENTS,;TO YOUR_.PROPERTY.> IF.�YOU�INTEND~TO�OBTAIN'FINANCING, CONSULT '
_. _`_W1TH.YOUR:LENDER 4R Ald.ATTORNEY BEFORE-lZECORDlIdG-Yd}UR lVOT�C-E=OF{CE?!1lIMEN�EMEN`i. - � --—
F�ORIDA JURAT{F.S. 7A3) .
OWNER OR AGEMT GL��i�—e-�"- C�NTRACTOR �, . ?�s-"'� -
Subs b and swa�/, t t�,r� `,�e�}beforem,e thts Su scri ed and s ark fa;�r a��jiRn,,��before Sne this �
bY f�') .�-IL% Yf.�'�,�Anl;� �Y �...Z�bY...����1�1 C!r r f���7
ho is/a�r_e�persona�lly known to me or haslhave produced Whe' /are pe onally known ta me or has�have.produced
I1Qlv�K� !.1 C�J�IS� as�dentlftcation. _D�t�R� Lt C,��t11.� as identificatlon.
hTt�'� t- Q�, _ Notary' Public Notary Public
Commission No. �} � Comrnission 1�0. � �
.1���'A £l�A1N� RUFFEI—�L— Qc–,gR/� �clall�� -�UF��-
Nam� ' Name of Notary ed,printed ar sfamped
, �„�y�„ti
. ,�Q�,....;q�,,,,�DEBRAELAINE RUFFELL � .��;:^��1 pE9
;� •;Commission#GG Q45343' s�w�• �.=. ���AtNE RUFFELL
' 'r=Exptros Ncvember 7,2020 , :r; ;.=Commission#GG 045343
• �';;;°•'' Ba�dedthiuTroyFainlnsurancey00-365�1Utd r; s,,�+P;:ExpiresNovember7,2020
, • • ws .•°„�;°•° BotxtedTlwTroyFaintneurartce800�365�70i9
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City of Zephyrhills
BUILDIN�PLAN REVIEW CO1��ENTS
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Contractor%Hameowner: _ �k��/v T� �/-��$6��S
Date Received: � �r`J � /�
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site: q �O/,G 5 /�"��► c�T�'�E T
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Permit Typ�e: f7')�T/-�'L �C��
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Approved w/no comments: Appxoved w/the below comments; O Denied wlthe below comments: O
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This comm�t sheet sha11 be kept with the pe.�mit and/or plans.
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Kalvin ' �lans Examiner I7ate Cantractor andlor Homeowner
II (Required when comments are present)
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j, DTSGLpSIIRE STAT�' FOR OiVNER �
'; CITY OF ZEPH7t'RHII,�LS BIIILDING DBPARTf�3ENR' I
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` T: i! � �� have read aad fu13y uade=staa8 aad
agxe�e to t e provsgiaas o£ this instrumea�.
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The lunderaigaed sta�tea sad a£firms that he ar she is deairous of cotistructiag,
reaovat3.ng, adding to or reraofiug his or her own domicile, that he or ehe
�e�ua2ly oeaupies, or will aceupy by eaid domicile, aad Bame is aot far �
xent,; lease or sale. That he or she shall aomgiy with �he fallowiag aoaditiaas:
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1. T�a� the owaer �ad he or she alone Bhall act as the builder for all phases of
coastructioa.
2. That th� owaer will comply with all p�ovisioas of the City of Zephyrhills
ozdzaaaces and cades pertiaeat ta the buildiag.
3. Tha� ia the event various phases of caastruetion ate stabcoatrae�ed, he wi21
eug�ge oaly propexly liceased subcontractors aad will persoaally sugervise
such work.
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4. Tlxat ia the �vent the Suildiag Iaspectar shall require carrec�ious ta be made,
th� owaer will aseume fu1Z regpoasibility to xasure they �re made, and upoa
ccmpletiaa wi21 caZl for a reinspection befare proc�edinc� with the buildiag.
5. That the otvaex ah�.11 assum� full respoasa.bili�y fox the coa�tructioa aad wi12
nat expect aupervision oE h3s wvork from the City o� Zephyxhills 8u31diag
Departmeat.
b. That pziot to fia�l iaspecti.oa �ny additioaal feee, iacluc�iag reiaspectioa
fees, mnst be paid ia �u3.1. A svx�ittea request frcm this affice sh�ll
cionsti�ute aa o�fiaial aotice to pay additional fees,
� 7. That the owaer shall camply with all City, State aad Feciexal laws ia re�ard �o
soaial securi�i, workman's compensation, lien laws, etc. , whete applicable.
8. That the owner shall comply with aIl the safetg► codes iaeueol by �he Florida
Iadu�tria2 Ca�aission.
9. S+�tate law requires eanstrtictioa �a be done b� lieeased aontraetors. Ycru ha�se
a�plied for a pexzc�3t aader asi exemption to th�t law. The e�cempti.oa aZlaws
you, as the oivner of your proper�y, to act as your own coatractos with certaia
I r�estrictioas even thongh you da aot h�ve a lic�ease. You must provide diarect
oiaei�e supervisiaa of the coaatructioa yourself. You may 'buildl or improve a
o�ne-fa:ui3y or two-family resici�nce or a fa.rn► outbuildiag. You may alsc bn3.Zd
or improve a commexcial buildiag, provided youz aosts c3o aot �atceed $75,000.
I The buildiag or residence must be for yous owa use or occupar�cy. =t may aot
i b�e built or substasi,tially impraved for eale or lesee. If you se1Z ar lease a
b�ui3diag gou have built or svbstant�.ally improved yourself withia 1 year after
the cosistructioa is comp3ete, �he law wi12 presvme �hat you built or
substa.atially smproved if for sale or lease, which 3s a vioZatica a� this
i exemptioa. You may aat hire aa wnliceased person to �ct as your co�ntractor ox ,
to supexvi�e people workiag aa your builtliag. It is your responai.bility to
� mlake sure that people employed by yau have Iiceuses required by state law and
by eat�a�y or muaieip�l iicea�iag ort3iaances. You may aot delegate the
respoas3bility far sup�rvisia+g vdork to a 13ceas�d caatractor who is aot
liceaeed to perform the woxk lieiag done. Any persoa workiag oa yaur buildiug
wlio ia aot lic�ased muet wark und�r your direct sup�rvis3.oa and must be
emplayed by you, which meaas th�t you muat deduat F.�.C.A.. aad withholdiag ta�c
arid pxovide workers� tsompeasation for that QmpZayec, ail as pre�erib�d by law. '
Youx coa�struatioa must eomp3y �rith all �pplieable laws, ordiaances, bu3ldiag
codes, aud zaaa.ag re atiaas ,
O�R'S SltfifiAT DATE � , f
�Dl2ESS --���_l� -
P,�IONS '
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�; 02/20/2017 K. D. K. , Dpf.y Clerk
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PfiULR S 0'NEIL,Ph D PRSCO CLERK 8 COMPTROLLER
NOTIC.E OF.COMMENCF,'NIENT 02/20/201 /0�3•08 m 1 of 1 q
I OR BK �'TC�� P� _220 i.
i' Pemiit No.
� �' Propuryldendfieatioallo.II-Z�i-2(—p010—Z�`�00—a0�0
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l; 1'HE LiNDERSIGNED hueby give inSorms you thet the improvement will ba mede W cmtain real Ptoperty,eud ioa eecordeace with
II Section 713,13 ofthe Flmide SmWtes,the following informetlon is proylded}II thi,y NOTTCE OF COl►�NCENlENC.
�I 1.DescriptionofPropert)'(I�Sa(descr lonJ1l���s� �n o,5'r ��' �j �'cJilS�1t� Z�bSIIk-�(+.t IC t ���t
�i a)StraetAdd[as: r
I' 2.deneial description o�imp»yemeuts.
� R/ 'l�/J,
� 3.oamer Infocrost�on
� aj Nsme�d eddr�:I�(��(S 1� (Z �R'25f1�r�S0�{�I 8�� S�l ZFPf+YRI FI e�S FLA: 33S�f a—
b)Nsme ahd addtess of tee stmple Mleholdcr('�f ot3�er thaa owaer)
� e)Inie�rs!im PraP�Y
4.COnuc$ctbrinformatibn `P,��"�/ '
a)Name�d (G IVGwG(i(i, ..j��jl� /.�'1� �7'��E ZF (L�S,,�G' ���y.., �
b)T�lephone No.. ��=z/ � ?./'! Fax No.(Opt) ��� `TT�s�����Uv y
S.S�uery Infarmetlon .
e)Tlazne end eddtess;
b)Amoupt ofBond;
c)Te]eghane No: ' F.ax No.(Opt)
6.Leadcr
s)Aieme�d eddress•
, Phone No.
7.Identlty of pecson withia the Staze of Florida dealgna�ed by owner opop whom notices oF otha donmients may be served:
e)Name ead addcess:
b)Telephone No.: F�c No.(Opt)
I B.In addition to himself�owneT dcsignaces tlip fnilowirig person to receiw a copy bfihe x,fennr's NoUiee es'provided'm Sectian..
713.13(1)(b�Florida Smt�rtn: .
e)Name ead addres.r.
b)TelephoneNo.: �� �� .FaxNo.(Opt.)
9_Expicat[on data of Notice of Commencemprit(ttre e:pication date is one y�ar frbm the data o(recordfng ess a dif3'e're¢t daW�s
speci5ed):
WARN7NG TO OWNIt12: ANY PAYMENTS 14�ADE BY T$S Q'GyNER AFPE[t T$E�7CpJRA'TION UF TBIE N01TCE OF
CUMi►�NCEM�NT ARE CONSID�RED�NJPROPER PAXMEfV1'S i7NDBR CSl�R 713,PART I,S$CITON 713.13,
FI:ORIDA STATUTES;AND CAN RESULT IlV YOUIt PAYIIVG TWICE FOR 1144i�ROVSMENI'S TO YOUY2�ROPERTY.
A NOTICE QF COh'DYIENCBMENT MUST BE RECUEtDRD�,1VD POSl&b ON THE JOB SITE BEFORB THE FIRST
i INSPECTION. IF.1'O(T INTEND TO OBTAiN RIIVAIV'CING,CONSULT YOU�t Y.ENDER OR AN ATTORNEY BEFORE
COMMENCIIVG WORK OR RECORDTNG YOIIR NOTICE OF COMhlENCEMENT.
/ '
STAiE OF FLOItIDA � �_ ,
C011MY OP PASCO (
, ��ofOwavorOwna��� ar ce�odPtnaa
I S'��. �• �' ,`7
I• 't7�e'��m tvment was aelmowledged 6efacz me thf��d y of 20�,
.—�Y_C��L��T � f mtlhority.e•&o ca, , ettomsy
�n fect)fnI �� (namo ofpecey oa beh f o eat
� Pecsonsl2y Knnwn_OR Produced Identificetioa Nomry Si
Type of Ideatification Produced �- Name(prmt) v�
Verificattoa pursuent to Section 92.SZ5,Florida Stawa.s.Undu pcnetacs of perjury,I decle:e that J have read the foregoing and tbai
the facte stated in it aze Gue W the best of my lmowledge end befieE
�i Sherra Long
� � F �,,� Notary Public s,&,.�o��.� s.�„��..
��.a;,.�
, State of Floritla ���e�, � . � �,
� STATE OF FL�RIDA, COUNTIf OF PAS�O
My Cammission fxpires 1012912018 �,°�.�� �' THIS IS TO CERTIFY THAT THE FORcG01NG IS A
Commission No.FF 172725 � � . �� >.<���` ' TRUE AND CORRECT COPY OF THE DOCUMENT
,� .;;`� �� � I I E
I'� ��-��,�i' • a N FILE OR OF PUBLIC RECORD IN TH S OFF C
yv
'� � m�fa�"c x .� � � 17NESS MY HAND�D OFFICIAL SEAL THIS
``;� (��°, ^� !��DAY OF -'L�b' ) .:J'.+ , 2��
�4.
, � � � - P A U L A S.O'N E I L, C L E R K&C O M P R O L L E R
� � 3�8� 1 A , �
�, �,q�� ��� BY V��� DEPUTY CLERK
�! -