HomeMy WebLinkAbout19-21832 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 218
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21832 Address: 6741 BASSWOOD CIR LOT 6
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: DRIFTWOOD
Est. Value: Parcel Number: 02-26-21-0010-02800-0060
Improv. Cost: 9,205.00 OWNER INFORMATION
Date Issued: 10/03/2019 Name: FALAAS, DONALD & SANDRA
Total Fees: 90.00 Address: 6741 BASSWOOD CIRCLE
Amount Paid: 90.00 ZEPHYRHILLS, FL. 33542
Date Paid: 10/03/2019 Phone: 612-812-1948
Work Desc: A/C CHANGE OUT 2 TON
CONTRACTORS APPLICATION FEES
CORNERSTONE PROS A/C CHANGEOUT 90.00
In ections Re uired
DUCTS INSTALLED
DUCTSINSULATED
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
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
CONTRACTOR SIGNA URE PERMIT OFFICgR
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 Received Phone Contact for Permitting tf -
-�Trrr r-r - I I
Owners Name .Owner Phone Number
v , Z.0
Owner's Address 2ci L 35 Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS oo / Zc LtL �L LOT'#
SUBDIVISION zw G PARCEL ID# 49iI-RC/-W-aur,049- OOOO—
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD/ALT �- SIGN = = DEMOLISH
R INSTALL B REPAIR
PROPOSED USE = SFR = COMM � OTHER
TYPE OF CONSTRUCTION = BLOCK 0 FRAME = STEEL =
DESCRIPTION OF WORK 4LI' J
BUILDING SIZE SQ FOOTAGE f 1 HEIGHT.
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ . AMP SERVICE ' = PROGRESS ENERGY = W.R.E.C.
=PLUMBING $ vV v 3 z.
MECHANICAL 1$ ,9 VALUATION OF MECHANICAL INSTALLATION'-
C7,
=GAS ROOFING = SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
PLUMBER COMPANY
SIGNATURE REGISTERED- Y/ N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY a z-g� C S
SIGNATURE REGISTERED Y/ N FEE CURREN
Address V License#
' ='
OTHER COMPANY
SIGNATURE. REGISTERED. Y/ N FEE CURREN L11 N
Address License#
� iii �, � �.� 1► � � � � e � l► ti � it , t �.� �.� e. fio � ee � li.ili.� I; � � o � �.. � i � � � � � � e.triie � � � � � eoie
RESIDENTIAL Attach(2)Plot Plans;(2)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 onsife,-Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-0 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 dumpster.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.
_■ ■ ■ ■ e s ■ ■JJ_�_■ ■.■ ■ ■ ■ ■ ■ ■ • ■ ■ ■ ■ ■ ■ ■ • ■ • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ • ■ ■
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C 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 (copy of contract required)
Reroofs if shingles Sewers , Service Upgrades A/C' Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED_ CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local fegulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited fora misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009.. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County. _. . .
TRANSPORTATION.IMPACT/UTILITIES.IMPACT AND RESOURCE RECOVERY FEES:.The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to-the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time 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 project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2;500.00 or more, I
certify that I, 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", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
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 development regulations in the jurisdiction. I also
certify that I understand that 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:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment:
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the.following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone"W unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone."A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed.to be a license to proceed with,the work and not as authority to violate, cancel, alter, or
set aside any'provisions of the technical codes, nor shall issuance of a permit prevent the_Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every.permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in.writing, from the Building Official fora period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.-
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 OBTAI NANCING, CONSULT .
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOXICE-OF-eOMMENCEMENT.
FLORIDA JURAT(F.S.11 .03)
OWNER OR AGENT CONTRACTO
Subscribed and swot o(or affirmed b re me th• Subscribed n worn to(or affirmed)before me this
LD-o�-L by Lid¢ `�by
Who is/are personally known to me or has/have produced Who is/are personally known to me or hasihave produced
as identification. as identification.
Notary Public Notary Public
Commi ior! Commission
=°s' = EAMY&3CR
ENbAIS-M.MCCLELLANMY COMMISSION#GG 285215
Name d, Name of Nonjq 22
oc F •, Bnded Thru Notary Pu Itc Underwriters ,2023
Thru Notary Public Undenwiters
nttp:i/si.amazonaws-coni/ceproposals-production/ceproposaWpropo
Proposed by:Rob Wratz Donald Falaas
4946 Land 0 Lakes Blvd 6741 Basswood Ct
Land 0 Lakes,FL 34639 Zephyrhilis,FI 33542
D Tel.(813)949 4445 Tel:(813)949 4445
i Robw@cornerstonepros.com
dsfalaas@yahoo.com
WN94. vMk—, comersitone pros
Install Address:6741 Basswood
Ct
BETTER
Yourinvestment
$127/.MN.O*
$9,205
MODELS *with approved credit
Daikin Daikin Daikin Included Deductions:
DZ16TCO241 DV31PTCC14 CTK04AB -Rebate-16 Seer 2
-16 SEER -Variable Speed Air Handier Stage System($500.00)
-Two Stage Heat Pump Other Incentives:
0.1 -CASH DISCOUNT
($485.23)
Net Investment:
Financing $8,719
Details:
Min 1.38%minimum
payment
10-95%APR Payment
based
on 120 Mos
SPECIAL INCLUSIONS:
No Lemon Guarantee-12
Year/One Year
Craftsmanship
Guarantee/24 Hour
Service Guarantee!one
Year Satisfaction
Guarantee/I Year Silver
Maintenance Plan
Apples to Apples
Guarantee
5 KIN heater
Heat Pump Materials
12 Year Pads&Labor-
Assurecare-CLICK
THIS LINK!
INCLUDED SERVICES:
- NEW FLOAT SWITCH AND SAFETY DEVICES INSTALLED - PURGING&VACUUMING OF EXISTING REFRIGERANT
• CONNECT TO EXISTING SUPPLY AND RETURN PLENUMS LINES&CHARGE NEW SYSTEM TO MANUFACTURERSSPECIFICATIONS
&MAKE AIR TIGHT PLENUM TRANSITION
• NEW NEW DIGITAL THERMOSTAT INSTALLED a CONNECT TO EXISTING ELECTRICAL CONNECTIONS
• FULL SYSTEM DIAGNOSIS&START-UP' - REMOVE EXISTING EQUIPMENT FROM PREMISES
• REGISTER WARRANTY WITH MANUFACTURER * CLEAN WORK AREA TO CUSTOMERS SATISFACTION
AVAILABLE UPGRADES &OPTIONS
N RIP
of 3
10/2/2019, 10:45 AM
%,0111CISLU11t;rros http://s3.amazonaws.com/ceproposals-production/ceproposa)s/propo..
Yt
'Clio
UPGRADE I(APPROVED and included in the price)
$0.00
Available for BEST BETTER,GOOD,BUDGET
Horizontal Air Handier Add thermostat wire if needed.No charge
UPGRADE 2(DECLINED by the customer and not included in the price)
$0.00
Available for BEST BETTER
Fresh Aire Single Bulb Bluetooth UV light
I.To View The HVAC Opcostwebsite-CLICK THIS LINK!
2.Tb read about Cornerstone Pros-CLICK THIS LINK!
Finance Company:
Account#:
Plan#:
TERMS & CONDITIONS OF AGREEMENT
1.Purchaser hereby accepts the equipment and service described above and agrees to pay Cornerstone Pros the price shown above.
Z All equipment and material are guaranteed by Cornerstone Pros to be as specified.AM work will be completed in a workmanlike manner
according to normally accepted practices-
3.Materials and work in addition to that described herein will be furnished only on Purchaser's authorization and will be paid by Purchaser as an
extra charge-
4.Upon failure to pay any sums due hereunder,Purchaser agrees to pay Cornerstone Pros interest at the rate of one and one half percent(11/2%)
per month(annual rate of 18%)on all outstanding balances.Customer also agrees that it shall pay all expenses incurred by Seller for the
collection of any delinquent accounts including,but not limited to,actual attorney's fees,filing fees and cost.Any and ail disputes arising out of this
sale shall be interpreted under the laws of the state in which the work was performed.I agree to pay collection fees,reasonable attorney's fees and
court cost in the event of legal action.
6.Cornerstone Pros shall not be liable for any default caused by events beyond its control,including but not limited to,fire,flood,strikes,
accidents,or delays affecting this work or other operations in which it is involved,directly or indirectly.
6.Purchaser shall permit Cornerstone Pros reasonable access to the property on which equipment is to be installed-Title to all provided
equipment remains with Cornerstone Pros until all amounts due thereon are paid in full,whether such equipment is affixed to the realty or not,and
shall remain personal property and be deemed sever-able without injury to the freehold.On any payment default by Purchaser,or if in Cornerstone
Pros's judgment reasonably exercised,its equity appears to be imperiled,then,Cornerstone Pros may without further notice enter the premises
and remove or resell the equipment and Purchaser shall be liable for any deficiency or loss sustained by Cornerstone Pros in connection
therewith.
7.Once equipment is connected at Purchaser's property,Purchaser assumes all risk of loss or damage to such equipment and shall insure same
of 3 10/2/2019, 10:45 AM
nttp.iisi.amazonaws.com/ceproposals-production/ceproposals/propo...
fully to protect all interests of Cornerstone Pros,cost of insurance to be paid by Purchaser.Cornerstone Pros carries liability insurance and Paym
Worker's Compensation Insurance. Finan
8.Cornerstone Pros provides a one-year limited labor warranty-Equipment or system failure due to lack of propef maintenance service or abuse is
expressly excluded.Normal maintenance check-ups and filter replacements are the responsibility of Purchaser.All other warranties,expressed or
implied,are the responsibility of the manufacturer of the equipment,parts,or materials used in connection with the services.
9.There are no warranties,expressed or implied,for existing equipment,ductwork,drain lines,copper lines or humidity control issues or other
materials not installed by Cornerstone Pros
10.All warranty work will be performed during Cornerstone Pros's normal working hours,8:OOAM to 5:OOPM,Monday through Friday.
11.Purchaser is responsible for all costs and reasonable attorney fees incurred by Cornerstone Pros in connection with any action or proceeding
(including arbitration and appeals)arising out of this agreement including the collection of any outstanding amounts due,whether or not suit is
filed-
12.Except as provided herein Cornerstone Pros makes no other representations or warranties,either express or implied,including,but not limited
to,any implied warranties of merchantability or fitness for a particular purpose Cornerstone Pros expressly disclaims all other warranties.
Cornerstone Pros's maximum liability hereunder shall consist of refunding all moneys paid to it by Purchaser hereunder subject to removal and
return to Cornerstone Pros of all equipment provided hereunder Under no circumstances will Cornerstone Pros be liable to Purchaser or any other
person for any damages,including,without limitation,any indirect,incidental,special,or consequential damages,expenses,cost,profits,lost
savings or earnings,lost or corrupted data,or other liability arising out of or related to this agreement,or the services or equipment provided Done
hereunder octal
13.This agreement shall be governed and construed solely according to the internal laws of the State of Florida,without reference to any conflicts
of laws.
14.This agreement is the complete and exclusive statement of the agreement between Purchaser and Cornerstone Pros and it supersedes all
prior oral and written proposals and any prior or subsequent communications pertaining to the subject matter hereof.
15.1,the consumer,understand the terms and conditions of the third party finance company that I have selected to finance this project with and
understand that once the project is complete all payments for the project and payment issues will be directed to the third party finance company
that was selected by the consumer. Cornerstone assumes no responsibility with the finance contract that was signed by the consumer with the
third party finance company.
16.1,the consumer,understand the terms and conditions of the Renew Financials PACE program,including but not limited to the program
description,how the program and payment terms work and what type of work and/or services qualify for the finance program.Cornerstone Pros
uses Renew Financial as a recommendation to consumers if denied for traditional financing. If the consumer agrees to use the Renew Financial
PACE program,they waive their right to the three day rightof rescission.Cornerstone Pros is not responsible for any misunderstanding of the
program and for the program terms and has provided the consumer with all program details and contact information for Renew Financial.
By signing below you,the consumer,agree to all statements above and waive the right to seek legal action against Cornerstone Pros for any
reason regarding the Renew Financial PACE Program.
Payment to be made as follows:Balance due upon completion of installation prior to Installation crew leaving the location of project
Cornerstone Pros proposes hereby to furnish and install the equipment and materials as described above on the terms and conditions provided
herein.This proposal is good for thirty(30)days from the date hereof,but may be accepted at any later date at the sale discretion of Cornerstone
Pros
2 Ton Heat Pump(15-18 Daikin)•Date Created:10-02-2019
of 3 1 Ot2/2019,10:45 AM
ti
DUCT CERTIFICATION FOR INSTALLATION OF NEW DUCT WORK OR MODIFICATION OF THE EXISTING
DUCT SYSTEM
FLORIDA ENERGEY.CONSERVATION CODE(FBC ENERGY,SECTION 403)TO BE LEFT ONSITE AND.PICKED
UP BY INSPECTOR
Owner: z��4--y ®4
Permit#: �/\
Site Addrets:aZA/d, Atfs L,J10 1 t gC L.IIE-� LLL,:5
Contractor.: z 1?4 S
Final Inspection Date:..
I certify that I have installed new-or modified the existing duct work associated with the HVAC system.
referenced by the permit listed above.and found it complies with the requirements.FBC Energy Code,
Section 403:3.Where modified,the existing ducts-have been sealed using reinforced mastic or code-
a_pproved equivalent. Ducts are'located within conditioned space (Section 403.3)System was tested as
per FBC Energy code;section 403.3.2.1.All new ductwork is to comply with FBC Energy 403.2 and FBC
Mechanical chapter 6.
Name of License Holder(print or type) Signature of License Holder
10/04/2019 04:35 PM Rcpt:2097018 Rec: 10.00 DS:0.00 IT:0.00
Nikki Alvarez-Sowles, Esq., Pasco County Clerk&Comptroller
Permit No.�� �^- Parcel ID No e�q+gj
NOTICE OF COMMENCEMENT
Slate of 1 County of 4/9 3
THE UNDERSIGNED hereby gives notice that improvement Will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided In this Notice of Commencement:
1. Description of Property: Parcel idenfirication No. !Pg",R&
Street Address:4/2-11-1S ,.����
Z. General Description of Improvement Q�lr�fit/J i7Af 1�/w/ .Z'��,�/ /�I�F'�IZ A LG L? ti
3. Owner Information or Lessee Information if the Lessee contracted for the improvement:
Nama G//RCe •� �f�}� 1�l '� �L
Address City State
Interest in Properly: �JrSi 19c�
Name of Fee Simple Titleholder.
r� (It different from Owner listed above)
Address city Stale
4. Contractor: �d11 �j ��) �ARas
0 AAW! �3�tr� � �r� 42
Address City Stale
Contractor's Telephone No.;�!3^9rj/�► /L�4✓„�
5. Surety:
Name
Address City State
Amount of Bond: 5 Telephone No,:
8. Lender:
Name
Address City State
Lender's Telephone No.:
7. Persons within the Slate of Florida slgnated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),FhrfdaSiat s:
Name
Address City Stale
Telephone Number of Design ad Person:
8. In addition to himself,the a er designates of
to receive a copy of the honor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the dale of recording unless a different dale is specked):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under,penalty of perjury,I declare that I have read the foregoing notice of commencement and that the fads stated therein are true to the best
ATEOAWN.MCCLEUAN �� � n
.: M�' StAI8�I0N W265215 c"`-�-�✓'�
Signalure of er or Lessee,or Owners or Lessee's Authorized
Q,• EXPIRES:Jan ify22r2023 Of(1ceUDirectodPartneNManager
AFF'�''• Sanded Thm Notary Public UndeswIlters
Signatory's TilielOfllcee
The foregoing s acknowledged acknowledged before me this 3 day of " ,20%guy �� lc c S
as (type of authority,e.g.,of5cer,trustee,alto fad)for
be wh i ec ed).
Personally Known[I OR Produced Identification 2 Notary Signature
Type of Identification Produced L-- Name(Print) ��