HomeMy WebLinkAbout16-18028 �
I CITY OF ZEPHYRHILLS
r _ ,� 5335-8TH STREEf
($13)780-00z0 1802$ �
BUILDING PERMIT
,
PERMIT INFORMATION � � LOCATION INFORMATION ` I
Perrnit R�umber: 18028 Address: 54Q2 3RD ST '
Permit Type: RE-ROOF ZEPHYRHIL.LS, FL. �
Class caf Wark: ROOF REPLACEMENT Township: Range: Book:
Propas�d Use: NOT APPLICABLE Lot(s}: Block: Section:
Squa�re Feet: ' Subdivision: CITY OF ZEPHYRHILLS
Est.Value: Parcel Number. 11-26-21-0010-09300-0150
Improv. Cast: 9,620.00 OWNER INFORMATION
Da#e Issued: 32l27I20�6 Name: SWICK MARY l. REVOCABLE TRUST SV1l
Total F�es: 85.00 Address: 5402 3RD ST
Amou�nt Paid: 85.OQ ZEPHYRNILLS FL 33542-3936
Date Paid: 12/27/2016 Phane: 614-266-6656
Wor,k Desc: RERQOF SHINCLE
I CONTRACTUR S APPLICATIt)N FEES
RYMAN ROOFING INC REROOF RESIDENTIAL 85.00
.
�
� Inspections Fie uired
DR IN R OF I S�-� -
TAPE J{71NT8 RQQF INSP 'j'� �
F�NAL I� � l
REINSPECTION FEES: (c)With respect ta Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local�overnment shall impase a fee of four times#he amounfi of the fee imposed for the initial inspec#ion or
first reinspection,whichever is greater,for each such subsequent reinspect+on.
NOTiCE: In addition to the requirements of this permit, there maybe additianal restrictions applicable to this property that
may be faund in the pubEic recards of this county, and there may be additional permits required from other governmenfial
� entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of cammencement may result in yaur paying twice for
impr�vements to your property. If you intend to obtain financing,consult with your lender or an attorney
( before recording your notice of commencement."
Comptiete Ptans,Specifications Must Accompany Application.At( wark shall be perfarmed in accordance with
Ci Codes and Ordinances. NO OCCUPANGY BEEORE C.O.
� NO OCCUPANCY BEFORE C.O.
,
' C� {v ('/� ..
� ONTRACT SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN fi MClNTH5 WITHQUT APPRt�VED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PRCITECT CARD FROM WEATHER
s�s-�aaaa2o City of Zephyrhi�ls Permit Application Fax-813-780-0021
I � Building Department
Date Received � �a a 7 i c� Phone Contact for Permitting I� /C1� — (I�V ! I
Owner's tdame �� c U.�� C 1� Owner Phone Number W17 'a�W"�(o��
Owner's Address ��1 Q r �� ��'�-�� �h 1 i� `a Owner Phone Number �— �
Fee Simpte Titl�hoider(dame �� �1 Owner Phone Number � �
Fee Simple Titi'eholder Address
JOB ADDRES � ��O t,� �C �- t� f�l I� S� �! ��+J y� Li�T# �___r�,_�
SUBDMSION � � PARCEL ID# �1 -a�-a i -r�a1� '� �q J�t� "V��v
i (08TAINED FROM PROPERTY 7AX NOTICE)
WORK PRQP SED e , NEW CONSTR 8 AE3DtA�T � StGN � � Q DEMOLtSH
{ 1NSTALL REPAIR
PRQPOSED USE Q SFR Q GOMiVI � OTHER �"
TYPE`OF CON�TRt1CT10N [� BLOGK • Q FRAME 0 STEEL Q
DESCRIPTIOFI OF WORK �QI� tJM" ���f� ��S {�QI�PS ri t`t� 1)' � SC��iE (� t��`lt� �� ����OIc�� I
BUILDlNG SIZ� � SQ FOOTAGE•L��•Y�} HEIGHT � �
u� ���� $ , j„�a ,b� VA�UATION'OF TOTAI CONSTRUCTION
�P'
�.�ELE TRtCAL � � AMP SERVlCE Q PRQGt2ESS EiVERGY Q W.R.E.C.
QPLU 81NG $ �� �
� ,
QME HANICAL � � VA�UATION QF MEGNANIGAL INSTALLATIQN
OGA Q ROOFING Q SPEGIAlTY � OTHER
FINISHED FLOOR ELEVATIONS � � FLOOD ZONE AREA �YES NO
BUII,DEl2 � COMPANY
SIGNATURE i REG�STERED Y/ N FEE CURRE� Y/N
.....,
Address! License# � �
ELECTRI.CI COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �— p �
PLUMBER „ COMPANY
SIGNA"fURE REGISTERBD Y-/ N FEE CURRE� Y/N
Adc3ress` License# i �
` MECHiRNIGA4. � COMPANY
SIGNATUi2E REGISTERED Y/ N FEE CURRE� Y/N
��«Ss'� License.# �— �
� ��,� ,, .
OTHER� ' .: �,� � � t�L� COMPANY lCOD*'� �L
SIGNATURE': REGISTEREp Y N FEE RE� /N
Address;. ���, � /�i��S � ' 3���� �icense# ���!J ���.S �
; RESlDENTlAI!',. Attach.{2),Plot'Pians;(2j=se#s of Building PEans;(4)seYof Energy Foirris;R-O-W Permlt,for new.construation,
- ,,.; Minimum;.ten�.(:16}working days aftersubmittal�dafe. Required onsite,Con'struction Pians,Stormwater Plans w/Silt Fence installed,
� Sanitary;Facili6es.&�1,,dumpster,Sife:W,ark Permit for�sutidivisionsAarge proJects
°- COiVtNlERC! Rttach�(2)complete"set§�of Suiiiiing Plans ptus a Life Safety Page;(1}sef af Energy Forms.F2-O-W Permit for new consfruction.
� i Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Starmwater Plans w/Silt Fence installed,
� Sanitary Facilities&1 dumpster.Site Work Permit foc a!I new projects.All commercial requirements must meet campliance
:-StGN RERMt i AttacFi'(2}sets af;Engineeretl Pians. • - _
**"PRQPERT`f SURVEY required fot aII.NEW construction.
Directions: - '
i Fill out appiication completely.
� Owner&,Contraotor sign back of appllcation,notarized�• � '
if.aver$2500,a Notice of Commenaement is requlred. (AIC npgrades over$7500)
'" Agent(fo�r tfi'e=cont�actor)or Pawer"of'Attomey(for tFie owner)would be someone with notarized letter from awner authorizing same
�OVEE2'7'HE C,OUNTER PERNi1TIlNG (capy of contract required}
Rei�rmafs if shi gles Sewers ,,�.,,�,ervi�Upgrades�'A'IC Fences(Plot/Survey/Fo tag ) •��^��°°���"`"r'�'�'�;:"�����'Y s���
_ � ' ,;,�.;^'l.;;V';�; t'.:v^„ •',ti,�. - , O e ,:; '�'i�;:�"( �,:11tti'{ a7�P.11�ns"' � Y�`:� �a''�
Drivewa. -Not over Counfe�;if,on pubtic�roadways'.:needs ROW� , `""""'''`;'�' }`�"" ` ����� , •p.'r'�,t _�
� ,� a" a .'�-, ., �` , , _ � ti��;rC,7' � i'•�gZ ^u;:. r,':
`' %� �� .er� ' ' t,a � . ���,
t� . �:.( i,;1�. �i; ' ' '� '' '';:F;�—Y � ._: .. �{;', a.j+:Llit: ;':!i;i?, •� � ;'".�=�:.',v:
��r� i
� ` - .i,';ii.y ,�. ;I.3Ftf�:�_'.'-=.i{;.t?,.`��r f,��ss� y{
`A .. :.,`,i�,icf.�'i.�l"� � ,vl�'�"�'.Sx""'A' _ � '� ;' ,1.� ::it;f�ll il`� �r i, �.d+�r'+_C¢7"^'C,-."+�,
. . urt...k:y�°" "e"�ri�i�ty�4J'�+�""�"�.'°�'� ''�Ts'p'r.� T,._
�K,cpp"�3°.a.'^"'��vi.�::y?;^v" i,;
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NOTICE QF DEED RESTRICTIONS: The undersigned understands that this permit may be subject ta"deed° restrictions"�'
which_may be mare.restrictive.than County regulations. The�undeesigned assumes°respcinsibitity':for compliance'with':any ���
applicable deed restrictions. _ , . �
UNI.IGENSED. CQNTRACTORS AND CQNTRACT�R RESPpNSfB1�ITIES: If the--ovirner has hired a� contractor or �
contractors to undertake wark, fhey may be required to be:licensed in accordance with state and local regulations:�.If=the�f
contractor is:not_licensed-as required by law, beth the owner�and:contractor may�be cited-for-.a r�iisdemeanor violation -
under state law. (f the ovuner or intended contractar are uncertain as #o what ticensing requirements:may..,appty for;tiie� �
intended work,.they.are�advised ta contact�the Pasco Courity Building Inspectibn Division=Licen'sing Section.af 727-847-
8009. Fu�thermore; if the owner has hired��a `coritrac#ar or coniractors, he is advised #o `have the cantractac{s},sign d; ,
portions af the "contractor Block° of this application far wrhich they will be responsible. If you, as'='the awner`'sign�as'the ;
contrac#or,.that may be an irtdication that he is not praperiy licensed and is nof erititfed to permitting priviteges in Pas.co
Caunty. . _ �,. '. �
TRANSPORTATION IMPACT/UTILITIES•IMPACT AND RESOURCE RECOVERY FEES:�The undersigned understands
that Transpartatian lmpact Fees and Recourse Recovery Fees may..appty to the construction af new.builiiings, change=of" ��
use in existing buildings, or expansion of;existing buildings, as specified in Fasco County Ordinance number 89-07 and
90-07, as amended. 7he undersigned alsa understands, that such.fees, as-may=.be due, will �ie identified at�ttie�titiae af �y'
permitting. It is further understood that-Transpartatian Impact Fees and Resource.Recovery Fees must be paid prior ta
receiving a "certificate of occupancy" or�nal power release. !f the project does not involve a certificate of occupancy=or �
final power release, the fees�mus# be paid prior to permifi issuance. Furthermore, if Pasca County Water/Sewer Impact, �
fees are due, they_must be paid priar to permit issuance in accordance with applicable Pasco County ordinances.�
CONSTRUCTItJN LtEN LAV1f{Chapter 793, E[afida Statutes,as amencEed}: If valuatian af wark is$2,5Q0.00 or mare,.1,; :;
cerkify that I, the applicant, have been provided with a copy..af the "Florida Construction Lien Law=Homeowner's
Protec#ion Guide" prepared by the Florida Department of Agricul#ure and Gonsurner.Affairs. !f the applicant�is someane,:
other than the"owner", I certify that i have obtained a copy of the above described document-and promise-in good faitti to
deliver it to the."awner" prior.to.commencement: � ' �
CONTRACTOR'SlOWNER'S AFFIDAVIT: I.certify.that a11 the information in this appl�cation is accurate and that all wark
will be dane in compliance with all applicable�laws r'egulating construction, zoning and-land-development. Application is
heceby made fo obtain a permit ta do.,wark and installa#ion as indicated. 1 cer#ify that nci tnrork or installaticin �tas
commenced prior-to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land devetopment regulations in the jurisdiction. 1 also
certify that I understand tha#the regulations of other 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 but are not limited to:
- Qepartment of Enviranmental:Rrotectian-Cypress Bayheads,'We#land Areas and Environmentally Sensitive
Lands,Water/Wastewa�ter Treatment.
- Southwest Florida Water Management Dis#rict Wel}s, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks; Navigable Watennrays. _ _ _ _
_ _ - Depa�tment-af Health-&-R�habilitativ� S�rvices/Environmentat .Nealth Unit Wells, Wastewater Treatment,
Septic Tanks. '
- US Environmental Pratection Agency-Asbestas abatement.
- Federal Aviation Autharity-Runways.
! understand thatathe following restrictions apply to the use af fill:
- Use of fll is nat allowed in Flood Zone"V"unless expressfy permitted.
- If the fill material is ta be used in Fload Zone "A", it is understood that a drainage plan addressing a
"cornpensating volurrte" will be submittec# at time of permitting which is prepared by a professional engineer �
licensed by the State of Florida.
- If the ftll ma#erial is ta be used irt Flaod Zane "A" in connection with a permitted building using stem wal!
construction, I certify that fiil witi be used anly to fill the area within the stem wali.
- If fill material is to be used in any area, I certify that use of such��ll will not adversely affect adjacent
properEies. tf use of fill is found to adversely aff,ect.adjacent properties, the awner may be cited for vialating
the conditions af the building permit issued under the attached permit.application, for lots less than ane (1)
acre which are eievated by fill,an engineered drainage plan is required.
If I am the AGENT FCIR THE OWIdER, I promise in good faith to inform.the owner of the permitting conditions set farth in ,
this affidavit prior. to commencing constrtaction. ! understand that a separate permit may be required for electrical work,
plumbing, signs, wells, poots, air conditianing, gas, or other installations not specificalty inciuded in the applicatian. A �
permit issued shall�be construed to be a license to proceed with the work and not as autharity to violate, cancel, alter, or
set aside any provisions flf the technical codes, nor shatl issuance of a permit prevent the Suilding Otfcial from thereafter
requiring a correction of errors in plans, construction ar violations af any codes. Every permit issued shall become invalid
un{ess the work authorized by such permit is cammenced within six months af permit issuance, ar if work authorized by
the permit is suspended or abandaned far a period of six(6)months after the time the work is'commenced. An extension ,
may be requested, in writing, from the Building Official for a period�not to exceed ninety (90) days and will demonstrate
justifiable cause tor the extensian. If work ceases for ninety{90}cansecutive days,the job is considered abandoned.
WARNtNG TO�QWNER: YOUR FAfLURE TO RECORD A NOTIGE t3F C{.�MMENGEMENT MAY RESU�T IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU�INTEND TO OBTAIN�FINANCING, CONSULT
WlTH YOUR LENDER OR AN AT7'ORNEY BEFORE RECORDING YOUR NOTlCE OF`CCIMMENCEMENT.�__. �
,__— . -FI-GJRiD}i�ft��T{F:S:ii?:p3) _ _ __ — --- -- - -
OWNEROFtAGENT G� 1 '� �� �Ov� CON7RACTOR C� �Q- l 'C�-�! C��
8ub c' e�a�d swo to or nn }befo---(�rd.�ne�his t, a01tn Subscribed a�d swom �a rm )be e me th' ' �.'.L..
__S�M�by �. CL G O �i (J��A by ��l'- D
Who islare personally kn to me or h s/have produced ` Who islare personally kno to me or ha /have produced
as identifica6an. as identifica6an.
.-`�"
G' " id'"( '_��� Notary Public • �"'— / Notary Public
Cammission h1o. �� Commis 'o No.
„�����,, qIVNq MA
��\III/II/ ,��PRY P�4R
Name o ' s P�g¢i�+�4.�P��B af Flprida
� -���� ��5���� orida `'• *• �ommisslon�
z': :•_ Commisslon M FF 958064. ' FF 958064
'%' �� My Carnm.Expires Apr 4.2020 '��Ii OF fL�O,, MY Gemm.Expires Apr 4.2020
. .�
'r `` +r""��t� Bonded thiough.Matianal Natary�Assn.
'�°����'�� 8onded throuqh_National Notary Assn. '
. _._
,�A'�Y , v�,; ,
AMERICAN �/���
y ,�. .3•= D�RES " �-� tI
j-� Rym�n Roo�ing, Inc.
- � �3 � -� A Division of Ryman Construction,Inc 5%fee for credit cazd processing.
��`}�`"` "�'�u� � 36413 SR 54 Ze 4 P
�y��, `�:^yGi}g�' �
` phyrhills, Florida 335 1 Pro osal#
�� '""`� ` j�` Phone (813)782-6094 • Fax(813) 788-6773 NO.
`� � 0037
�m����'��� 1-855-Go-Ryman (1-855-467-9626) • Lic.#CCC 1325505 Estimate# '
�✓Q www.RymanRoofing.com ���c.�
i� �e�de�� ��� �� �����-�➢ �9��a�a Job#
OwnedPurc aser.Mary SWICk Date: 12-14-2016
Claim#: � InsuranceCompany:
Policy#
�ob address: 5402 3rd. Street �;�y: Zephyrhills Z;p: 33542
Mail to Addr'ess: / f!J E-Mail Address:
Home #� Cell #: '��-266-6656 Business #:
0J Comi lete tear off of existing ASpllalt SI11t1gIeS Additional Notes/SpecialConcerns:
✓Q SecUre all loose roof decking as needed according Install new GAF Royal Sovereign 3-tab fiberglass
to Florida Building Codes •
Q✓ Rooidr�edinwitn Synthetic underlayment 25 yr. shingles
Q✓ Install new valley metal with galvanized metal ..�r PfICe iI1CIUdG'S up to t1No SheG'fs of pl�/WoOd
✓� Installl new 6 "drip edge color: �,,��1�'Z ���GS ��eplacement if needed
�✓ Inst �II new lead boots
✓Q Inst�ll all new general roof vents
[�✓ Install new ✓❑Shingle �Metal �Tile Remove satellite.dish and reinstall , alignment by other:
�Modified Butimen ❑TPO
Q Man facturer (sn�nyie, metal or tlle)GAF
Marjufacturer �o or Mod. eimmen)
�Color.(Shingle,MetalorTile) �'-,�►(�c.� ��a,y- �S
� Colo�r.(TPOorMOD.Bitumen)
�✓ All roof related debris removed from job site, pick-up loose
nails using commercial grade magnet G
✓Q All �aterials, labor and permits furnished Base Price�$ ��v�o.o0
� Pro�idea 5 vear laborwarranty
Additional tems: �
� '
�
I ��1 � ��.
� � - - ��.
. .� t�
Payment I ethod: �;,, Check# ����✓t �Cash � �Financing �Insurance Claim
❑ CreditlCard# �
Exp. Date CC ID#
Down Payment:$ 3,367.00 Amount Financed:$ Approx. Monthly Payment:$
PaymentTerms: �n full upon completion
Extras: ,I '
*Base Pnce does NOT include any unforeseen costs as described�below unless indicated in"Additional Items"abOVe. customer�nitia�
�Defici�ent 1/2"plywood replaced at a cost of$ 65.00 per sheet in the roof field,which includes labor&materials.All other wood work/ad-
i ional la�or,such as, but not limited to,valley rebuilding, rafter replacement, 1x decking,etc.will be a rate of$5.00 per lineal foot plus the
cost of materials. .
THIS BECOMES A BINDING CONTRACT UPON ACCEPTANCE OF PROPOSAL.PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTRACT.
I ACCEPT THIS PROPOSAL AN�ER�BY CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE PROVISIONS OF THIS CONTRACT.
�l `����a �lo
Purchase :„� Jn�ij�r��Ti ,<,�rL•�-;� Date:
Purchase • �� Estimator•Rob Noojin
� � • � llllll�ll141111l1lIIlllllllllll(IIII!lllllllllllllllllll1111� � � �
2016201472 '
Pertnit No. Parcei ID No i� � �U/_�� ~ i.1C1 t V � l{ i .���✓ ��� �i•.J ►.+v� ,
� NC3710E OP COM'NIEAICEMENT � N�c�+ ,
State of I � V `f t..�.� Caunty oi ���� ~��''
N 19 00
TNE UNDER3tGNED hereby gives noitce that imptuvemetyf x�ill be made W cettatn rea!Pmperty.and in accordanes with Ghapter 773,Fipdda Stalvtes. ���
the faitwuing infamaBan(s prov(ded in lhts Notica ot Cammencement:i/,"1 1__a 1�- lJV� � -�O q3 DO -� b i 5b
1. Des�criptlon ot Prope Parcel Identilic2tlan o. �� �a«� 7C N
�tA��: {�yoa ��� - z�h�n���� �� �sKa
, ,r�N
2. Ge leral DeserlpUon ot Improvement � (`�' 3��
1 C�I (J{"fi- �e--(�U ! c.q..
��
3. Owner Info n or Lessee Infartnation if the Lessee co tracted iqr.the fmpravernent: �t9 m
I ��� Sw}�-IC- � ,� �
� . e r cSF- 74,� �("hi11,5 �� 335``(a �
na�dress � cay�� '� srate . "
�
Interesi in Property: �
X
N�me ot Fee Stmple Titieholder.
{{(difter�n#fiom dwner flsted a6ove}
Addre'ss m Q n � �n C-" Cfty State
� �Cbntractor. �j s�/} / cij
Nam �1 (� � 1 t�3G/ Y f t 1 � i ��V i �
� ���Aiidress (.�{ Q!'"� Cily��! Siate
G�ntractnts Tetephorse No.: ,i l r���U v���� • t j a
6. ��rety:
�Na
Name �N u'
O
/�ddtess • Gtty State 6�z
Amaunt ot Band � Tetephone No.: r���'
�LY��
6. Lender.
I Nama „� / ��?
�y ��o
�ddress City Siate �W�
ender's Telephone No.: � p
����Qp��, �
7. �ersons within the State af Florid �gnated by the awner upon whom noUces or ather dacumenis may Ge servad as provided by.�°° ,,,��
Sectian 713.13{1j{$}(7},Ftarttla S t ��.�� � � ° , � �
+ fJ: Q x
Name v� a+ �,, �}
:9�,.,.
Address ��Y tiqti t v
Telephone Number of Designated Person:
G`� � /
1{`�.'*'�. �:
8. tn edditEon ta himself,the avmer dest n o� t� �r� �
to rece(ve a copy otthe Lienor's Notice as provided(n Sectta�713.13(1)(b),Fiorida Sta �� �1'��`''�,� ��
ITelephone Ptumber af Petson or Ent y Designated by 4amer. e .r, ,-�.� . : � ��
9. Expiration date qf No4ce of Commencement(the expiration date may not be 6efore the campl on a�,�fon I�6on�ryand ftnai uyment to the � y�, �°����
contractor,6ut wlll 4e one year fram the date aF recording unless a different dffie(s speGfle�: �1 � CY�� n _
WARNlNG TO OWNER: APSY PRYMENFS MADE 8Y TNE OWNER AFi6R THE F.XPiRATtO OF THE t4Q'iIGE OF GQMMEt+tGEM�N'f
ARE CONSIDEREO IMPR(7PER PAYiIAENTB•UNDER CHAPTER 713, PART i, SEC'ftON 713.i3, Ft,ORiDA STATUI'ES, AND CAN Y
REGOR4ED AND POS E'0 ON T}iE J08 S!'If`ME SEFaRE T�k1E FlRST lNSPE0TI0(V R F!YOU I�N'pTEND 70 OBTAIN FNNANCING,ONSULT' Q Z U �
WlTH Y011R LENDEI2 OR Ai3 AiTORiaEY BEPORE CqMMENGtNG W�RIC OR RECORDII+tG YOUR NOTlCE OF COtutMENCEMENT. � W ii. � � ..W�
� U` � U- S.,,• � C?
h e read the faregoing�otice oi cammencement and th�t the fads stated thereln are true to the best C.J L � O �„,�^� J y-
y � — U (,� J�./ Q- �
,�.s`+'n"v'p�.,o m now 44D
s�c�y Pubiic-State of Fiortda � a"' o � t�— � � � w
� -PA�nmiasian�FF 912551 �"' � � z � a �
;,,a �i� ��m. Slgnature af O or Le e ,or Lessee's Auihorized � � � — � �
Y �es Auq 24.2019 ofltceriOlrecta Peru,ernr,:anager y. � t— a Q O
e tr�
�� `` tt- tZ' U U
�r) lkNMbdUlqt�Ip111W011Ali�lEf�yASdiL �"" ttt
� = aoLL. �
� � �,,� Sign�jary's 11Ue/Qffice /j�//�(� ��S�rr tr C� !— d- l�t! p �Y
e foregoing' trument was acknawiedged taefore me this��day of !./C�.. ,2��,by ► ` '�^"�7 v"" L�`� C,� = Q � p � J✓
Wrl.tLT tJj�...Q„_ ttt
as •(f y pe ot authoM y,e.g„officer,trustee,attome y in fact)for I— z J
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