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HomeMy WebLinkAbout95-4743 BUILDING PERMIT Permit Nt! CITY OF ZEPHYRHILLS (813) 788-6611 _ 474311 <..3--3- ?...s-- Date ~ Pmperty Ow,", - r;f! 1I;47.r Job Address: ~ ~ - Parcell.D, # / / - /)." -d-/- 00/ 0... o~--.zL 00'" ELECTRICAL PLUMBING MECHANICAL Sewer Conn Water Conn: Water Me.ter: T.I.F.'s: 0/10 Zoning: ~Jnergy Code: ..,/J Radon Gas: ;' Description of Work ~.eLL:.n. ~ ......~.11 Q ~ Complete Plans, Specifications and Fee Must Accompany Application, C.O. All work shall be performed in accordance with City Codes and Ordinances, / \3/7 > I D ./ FINAL DATE NO OCCUPANCY BEFORE C.O. DATE Inspector 730 ~\ Permit Fee - CJ-v Signafure RJ<, Company Address Telephone# Valuation or Contract Price 9/o-trV City License Registration # State Certified License# ~~~ fl ~J;~Y\A BUILDING ELECTRICAL PLUMBING MECHANICAL Breakers Ducts Insl. Compressor Final SLB Tub Set Water Sewer Final Tp. Servo Rough In Meter Can Const. Pole Pool Pre-Meter Final Ftr. Pre SLB Lintel FRM. Insul. CL WL Driveway REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Fifteen and 00/100 Dollars ($15.001 shall be made for each trip for each trade: a. Wrong Address b. Condemned work resulting from faulty construction. c. Repairs or corrections not made when inspection called. d. Work not ready for inspection when called. e. Permit not posted on job site. f. Plans not at job site. g. Work not accessible. The payment of inspection fees shall be made before any further permits will be issued to the person owning same. - - - - - - - ..!~..l - ) -<;l:f!u ::J' r.J ' "r """'llt. ~J I :JdQ'8J.!10nd ExterloreJ 'no, Q.jl/: I5/JA :fJfJ<.tL? ~ , "'...,.'MId.nd ....'8"-' b~ DWnond ~ V / T~ "~ICrIOt.. "'e , ~ &EA~S AUIhar'rtd CoIlI,1IC1or 120 II. C'Iho,," &tN.t ~;~4~:t=-- Dale: - ~/d1t.. 3 Z~1 -caw ,. Dlanlo'ld el(l'tio,. 1110, . s..", "11'''0';&8<1 COnltQCIlIt, othwll to lurrl/lh 810. P C~ link "./'lee 0 Vb;ld" ~lhIdUIo. wKII Chllt,ll;,.,k ~abrlo 0 A enc: CJ At",.,U111 Wllh VInyl COllled CIl,In Llnil F.brlc O,:1tlft<<1od ... ~.114Jt'e r"'led ~ "'ene. mawoocr ....." RlIpeIlAnl F'lllllll\lnt rr..led bow ~ FMet S"ISCIAlINSTAlJCTlONS FENCING [(...;. IOU li_lIrJN, X _ . O'AORAM ,ne rr__ 0 -.-,.-.-....'J. .... DOt.ae GAle J . , YPF , ! rH,[ (g:J,afA?}f~ .".'IIP... .......... I....,... ,......... .....,... ......... ......... ......... .......,.. ........t ......... .......... .,....... ......... ........,. "'..11I... ........., ......... J ......... ,........ ......... ......... ."...... ...,..... ......... ......... ..,...... .......,. ,......., .,..".... ......... ......... ......... ......... ......... ......... ....,.... ,.,...... ...".... .....,... ......... ..".".. ...,..,.. ......... ......... ......... ......... ,........ ""."'. ......... ......... .,........ .........t ......... ......... .......... ......... .......... ......... ,........ f........ .......,. ......... ......... ......... .......... ...,..,.. ......... ,..,..... ......,.. ,...,.... .......,. ....,.... ........, .......,. ......... ......... . ...,... .....,... ......... ......... .....,... .......... .......,. ...,..... ..,...... ........, ......... ......... ......... ,......... ......... .,...,... ......... ......... ,........ ~ ......... ....,.... """'" ......... . . . . . . . . . t . . . . . . . . . . . . . . . . r.HCt tQ J'OU(;W Sl~ ('~ l;lIlOU/olD rE"Ie1 10 ~Cl~OW 0 1;01.1"":"" 01' '~'<\NNU Fr"IjE T" lit LIlli!' 0 WI '" ",(),,,~, (1".[.(, mfr~..r.u~~,I..f~~ 0 Ffl,t:.E 10 I'U ~(\'!l 0 ^I\IC) ~I'\.II "II; ,.n,(O( LINH ":L~.1l UF 0 OI~fll[l(:f~,""S .,,!.~ STlMED 0 \VIIH CII"tJUEn SPECI"\. WOfll< TO BE AIrORMED BY CUSTOl,tiR ..,...... ......,.. ........, ......... . .. , , .. ....a ..,... . ....... ......... ......... ......." ......... .,....... ..... ......,. ........ ......., ........ ........ ........ ......., ........ ..... ., ......... ......... ......... .....".. ......... ......... ......... ,........ . ......,.. ......... ......... 't.t",.. ........, ......... ......... ......... ..,... . ".... t........ .,....." ......... ......... ........" ......... ......... ~!lffo~l~r~sl'01J ar,n~.re;lt~~f OUT R.'uon~~ 01 ~L '09'" 10 loclnlll ~'Id Id.n!lf~ 'he I1'QDe"~ dnll. ellIs.mo'II' arid lIW 'ldllraround cable, elld pipe.. f 110<" Ih,,, , ..... et>looly "'IX" 'II . ':II' I . I:lI'iQn 0' I". r...r.1I t14lsCtll)JJd In I"", O"",o,al. I w'lI a1lo defend !~_ i1MOlalnQnd Elltlllflors. Inc .nd ,.imbl.,y I"'m fgr ~II (:/)'013 'n c(>"'O!!c:holl Will. eny el"I,", mllde by lIn:tOf1ll IIbOVI II'll Ior-QUIIII Qllhe fence Ill,.., nr..,ons'bICIlQr ally ~eocI,I' WOlle de.c;,~ in Ihl, PfOJ",..1 [fr'uSll4lf GQlI~f~'* t!Wll!'~ ~~. 11Ign:I" ,~, 1I,,,,l'1Ono:l ed~,IOtf,. 'ne hRe IhCI tiCl'llo mlllle 8dQll1Ol18l ch."",'1f Unveuel ground cOndiUone ,,~ tl~ 1M' ltori-suc unus.W1 lI'OIlnu cundillon.. ...:t~ bQ mcl( fQ,,,.,,,ti<Jf15. hid(Mn l(lIJndalions, Ir" 11:I<1I1. II1d olh., tl/l1ilijor obtItoclfl' AMy o:t,<"II~~ '_cu.,y I" "IlIIIlI:l(:IQ<"Y 0:0"'I'l.'" I~ ~.~I;l"3t'(In wUll>e 1l8&p.d on eoltlfll ado1itlonallebot. ~ .1Id MlI,tllllf co.la, hlPlO""'.III Al>PlVwimale , """""'.... !lilt It _ on ........f 6<H. _ I ....... C(IIll_ Sl~tI'lIQ 0,,18 I I C(lInolelioo 0... / ..... 10 ...Ie _ ... ~ ... _............... CuaIOmat CIIn buv II ~Ot frIfOrlnlltbl ~)'llIJt ..1Intete 01' IflllallOllon CIlII.IOO-224..'J4lt' Ihll klt ,,",H Melhod 01 ~nt (The credit terms end COrtdlf~ ,rt OfOtfided Wl , ~ (lr.)CumenL) IJ r:ash; fl<lyment. III fOIlQwlI' $ CIoWI'. blle~e due Ol'l eompletloo, I] (.m.Jit l11elhod financing; ~~4. (10 S down, bel."ce du. on complellon ~;;, .......9<<4 ~ ~~No =0.' I/Wr, lhtr _11""" Ole:;~ tMsc,lb-.!d 'b~ {herlilln,'I" lefllfted 10 .. 'CUItotIltt'fl)"} Ilffer to gontrllCt with 0Iem0nd E"I.rlors, k.c. " ~il'. AvlhQtl..d ConI'lIetor. 10 furnish, .Iivef end arr.1IQlt fOl In""'~ (fA .. ""'1"'" _8"'1" 10 ~ 1"- ",...... ...o:...,ejI.'9 to .". (I~bow lIP_IOIfIo(lI'O".Oo4~ T.""''' .."., CONOltlONS 01' T.... .too~I~HT "". CONTAND ON IIOTM _. M ''''' FOfI.... ,t,CCl;PtED BY ""'_111_- :~: -"fIQ,..I,,", _ _~ YOU, 'TliE BUVl!M. MAY CANCEL ~18 TAAN8AC:1lON AT ANY TIM. PAIOFt TO MID~IQHT 0' TN&: TMIAO BUSINESS DAY AFTER THE DATe OF tHI TRANSACT10N. S.. THE ATTACHEb NOTICE OF CANCl!LLATION !"ORM FOR AN EXPLANATION Of THIS fUGHT. Copy,1gN Il~ Oo.mc>nd 11.'~Io... lite.. lI'oItI(ld.rook.1I. tlOOII8 CON'mACT COpy .0..... . e" '0' "'4 .' ,~ !i . " 8~/~7!i9~~ 16:20 --.1, "-. v-.- _ [)~AMOHC TAMPA T rr () ~d-M- PAGE 01 8132897787 ~~tf I 813~81371e? PAG! i:l2 ~ ---~ ( fri P<- S 0 f'J) p. .J r. rJ."J y"" '~----:~t~ .. 1- 1111 l . n[- _-1 .0 1Wtw. ) '1 ~ i)l J wdJ _~ \~ ~ ;t~ &d $, '.;~ fJh1~. ri~ t1t. t1JiI #lit< till iZt ~~ .LIsI4i .."",.-----~----- CRt)) f'" L.,.I Otic, or ".t ( ,1cul.t._ .'t, ,., II "",,,,r,,, r ',A, 'oun4 'rOfl Rod r, 1,'. '~vnd 'ran 't~, r U1, rOVII~ C~Gr.t. "OfI"""t C.~.r, (h,ln ~Sn' ,~,t w,r. Wlr. 'ftlt. ' ~.,. Wood fin" " p, . t.,.".r '01, D.II.I, Ovtrhud ~'"t ~.O,8. rQI"l ,r ..,'"~Ino [,p, (dV' ,f "~~tn' P,lJ,l. rofnl M Un. ~.lft, St~ Iron 4lod t,pptf "I '107 t.O,I, r~ of lank r.O,s, ,'" g1 UOl). ~1~t1' ", tll\ Qr \i_I ~~ c. " ., // -2(p.Z/ ~Oj)/tf~ tJ6c?dcJ,-tJ//L) ~""~"_~' L ___ f ..... ~ All r r IJh. ~ ~ TIllllf "1 J fl - 8Y Diamond E:=~~~ ) SQld, Fvrnl$l1ed .nd In.'."~ bV 8iamond ElClcrlQrs. 11'1C" a SliAFtS AuthorIzed Contr.ctor / '20 E. C.lhoun Street / WoOd!~c:.~ ~'-_!~'~/ ,.~ PAGE el7 Date: _ "fZ/d1'Z~ (} ~+,y p C~ I.ink r:'l'\Ce ' G(rmadilloO with Cha n link Fabric CJ Armadillo with Vinyl oated Chain Link r:atlrlc - - I YPE FENCE SPECI llNSTRUcnONS t<<J,~au1Y~{i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /I~~' r.);r' ^ 5' JI 0- )~) ,. ~::::------ ,. < --,--..,. ,~~ ~. ,'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '" . . . . of , . . . . , . . . . . . . . ~ . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . ~ - . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SPECU\L WORK TO BE RFOR"IEO BV CUSTOMER ~ . . . . . , , . ~ . . . . . . . . FENCE 'TO FOLLOW SLOI'E 01" GROUND FENC~ T'O ~OLWW 0 COUN'P"Jll~ OF GHOUNU F~NC~ TO BE LEIII'.' 0 Wlnl UIO~jli~T ~iIlAOC FENCE 10 !IE LEVEL 0 Wint LOWE ST G/MDE FEM;;1i TO t,IE LEII~t. 0 ^NO SPLIT HiE" GRAOe ~~nR1}ett~N'{ D ~McID'~~SSe" 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '" . . . . . CUSlomer Cln buy It thl$ lev until -.,...-:- ..'~ Method of P"yrn.nt (Thflr;rfJdif fo(mS 3rld conditions we orovi(jlJ(j on a $EI~al3te cJocuJ'nent.) l'" coor :39fo 8TM( lit' CClllt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . , . . . . . '" . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... . , . . . . . ....... . . . ., . . , , . . . . . . ill . . . . . . . . . tIlJlLDlNGS I ~I( Q"ffL.h_n.. OOUt4.t GAl~ .......c ........, ........ ......., ......., ........ ........ ......... ........ ........ ........ ........ ...,,,... ........ ........ ........ . . . . . . . . . . . . , . . . ........ ........ . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . , . . . . . . . .. Diamond Exterior.tnc" a Sear:; AuthQri&ed Controctor, oilers to lurnifh eto, o \\Wd F~. tJ Armawood™ Pr.$6U~ Treated Wood Fenc8 o ArmaWOOd~ We.,r R4Ipell8nt Pressvre Treated Soard WQod Fence FENCING ~EI4CE J( DIAGRAM ~~~ 0 cr .... ..... ..... ...... . ..... . . . .. ........ . . . . . . . . . . . . . . . .. . . " " . . . . .. ......... .......,.,.. ......... . ~ . . . . . . . . . . . .. ......... ......... ......... ........ .. . . . . . . .. ......... ......... ......... ........ fUS& WSI,ni ~TOMjJ · · · · · · · .. ......... ......... ......... ........ ~R~'~ Q4 ......... ......... ......... ......... ........ WI "Al9 w: ......... ......... ......... ......... ........ AT ,If ~~w ROU ......... ......... ......... ......... ........ R9$I:IQn,iWli!fo~ S'fc4Jr. logree to 1~>Cil'e 1'IIld identify the property line, f:JijSElment5 and all u'1d9l'ground cablell and pipes. I agree that I em solely resp(,)t1S1bli or Fie ocalion of the tence d~$t;)ril)'d in this prOP09al. I will al90 ~fend :,ears and Diamond Exteriors, lne and reimburse Ih~m lor "n costs in connection with any claims made by enYOn4!l about the location of the tence I am responsible for any sp,clal work described in thi~ pro~\o'al, Um.IJUII~ Cq()d(tiQ~ ~'i(i~1'la1 Ch8,~es. I agree that Diamol'ld Exteriors. Inc. has the right to ma~e additIOnal charges II unusual ground l;;ondltlon$ niiiOer .1'8 11'15 alia on, u~ unus,ua ,grOt1nd conditions may ~ rock. formations, hidd~n foundatiOns, tree roots, and ott1er similar ob&tocif:!~ Any <;;horgel!J !lecc~sary to satlsfactonly complete the i"~1..f1aIiCln will be based on actual additional labor, eQuipment and material costs, Aopro)(imate ApPrQllirnate I v~I'&l;l"'<l \hle Ie 0'11.,. (In "\lmQI,,d <SolI", 1)11(I1 will be eonl(lcl~l" S'IVIi!'19 Olllte I I Completion Date / orior 10 Ihi, ~ 10 .......~ lhe .elu.' i".'.ll8lioll d.l. ;~!\II ~lfn . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For Infor",.tlQn rtgamlng ~, eSllmatv or Irwtlll\1lion CIU 1-800.224-31361 APPLICATION FOR PERKIT CITY OF ZEPHYRIIILLS BUILDIRG DEPAR'l'KENT OWNER'S '00J $<1- v\. 7fJ2 <let 0 '3 ~S" to JOB ADDRESS LEGAL DESCRIPTION: LOT(S) 0 Ito B~UBDIVISION PARCEL LD.'/!- ?f::,-2l- d \110 -0 Sz~ () -01 (0 ~. 1'::) (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPOSED:~ew Coostruction --Addition ------Alteration ---.Jl,epair ~Atall _Sign --.JIove _Deaolish PROPOSED USE: ~iog1e Faaily ------"'F _' of Units --1I/H _ec-ercial _Indust. _Swia. Pool _Other --.Jestaurant Ii: Health Departaent Approval DESCRIPTIOR OF WORK: ill1skt 1/ Z2'K' uJ;:' f:, I (" ~ (,VI L,\At'~ <:-( BUILDIRG SIZE: x Square Feet, Height RESIDENTIAL: COMMERCIAL : ATTACH (2) PLOT PLARS Ii: (2) SETS OF BUILDIRG PLANS Ii: (1) SET ENERGY FORMS. ATTACH (3) SETS OF BUILDIRG PLANS Ii: (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERMITS REOUESTED -BUILDIRG $ 1(0. a u Valuation of Total Construction _ELECTRI.CAL AKP Service Florida Power Corp. W.R.E.C. --'lECllAllICAL $ Valuation of Mechanical Installation _PLUKBDiG GAS ROOFING SPECIALTY TYPE OF CORSTRUC'l'IOR: _Bloclt _Fraae _Steel Other FDI:ISIIED FLOOR ELEVATIORS: FT. IS PROJECT IN FLOOD ZONE AREA? YES NO *********************************..***.... BIIlIDER t~&It ~~"1011J E-vkn~N State Cert. or Regist. . Signature 0 City License Registration . 7 ~C *..*.***...*................***........... RI.RCTRICIAR COMPANY State Cert. or Regist. . Sianature City License Registration . *........*..*............................. PLDKBER COMPANY State Cert. or Regist. . Signature City License Registration . .*..*.*.....................*............. IfECHARICAL COMPANY State Cert. or Regist. . Signature City License Registration . *....**..*...................*.........*.. OTRRR COMPANY State Cert. or Regist. . Signature City License Registration . *.*.*..**.*..*...*.....**...**.*.......... APPLICATION APPROVED BY PERKIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS 'fbe undersigned understands that this pemit JaY be subject to 'deed restrictions' wbieb JaY be lOre restrictive than City regulations. 'fbe undersigned assUleS responsibility for CDpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner bas hired a contractor or contractors to undertake work, they laY be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor liar be cited for a lisdl!lH!allOr violation under state law. If the owner or intended contractor are uncertain as to what licensing requir8l8Jlts IlaY apply for the intended work, they are advised to contact the City of Zepbyrbills BuilcUng Departlent, (813) 788-6611. FurtheIlOre, if the owner bas bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the 'Contractor Sections' of this application for wbieb they will be responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that IlaY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the City of Zepbyrbills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, bave been provided with a copy of 'Florida's construction Lien Law - lkIIemmer's Protection Guidell prepared by the Florida Departlent of Agriculture and COnsUler Affairs. If the applicant is SOEHle other than the 'owner', I certify that I have obtained a copy of the above described dOCUlellt and prcaise in good faith to deliver it to the 'owner" prior to COII8DCl!lH!Jlt. E. CONTRACTOR'SjOWNER'S AFFIDAVIT I certify that all the inforlation in this application is accurate and that all work will be done in COIpliance with all applicable laws regulating construction, loning, and land developaent. Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or installation bas CDlenced prior to issuance of a perlit and that all IOrk will be perf OIled to I18et standards of all laws regulating construction, City codes, loning regulations, and land developl8llt regulations in the jurisdiction. I also certify that I understand that the regulations of other goveruental agencies IIilJ apply to the intended wort, and that it is If responsibility to identify wbat actions I lUSt take to be in COIpliance. Sueb agencies include but are not laited to: t Departlent of BnviIOlllelltal Regulation - Cypress Baybeads, Wetland Areas and Bnvirolll8lltally Sensitive Lands, Water/Vastewater 'freatlent t Southwest Florida Water Managelent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses t AIIY Corps of Engineers - Seawalls, Docks, lavigable Waterways t Departlent of Health & Rehabilitative Services, BnvirODl8lltal Health Unit - Wells, Wastewater treatJent, Septic tws t US BnviIOJllelltal Protection Agency - Asbestos abat8l8Jlt I also certify that, if fill laterial is to be used in Flood ZOne "A' or 'A,etc.", it is understood that a drainage plan addressing a 'COIpeD8ating VOlUie' will be sublitted wbieb is prepared by a professional engineer registered in the State of Florida prior to pemit issuance. A penlit 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 sball issuance of a petlit prevent the Building Official fIOl thereafter requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becme invalid unless the work authoriled by sueb pemit is COII8Dced within sil IOIlthS of issuance, or if work authoriled by tile perlit is suspended or abandoned for a period of sil IOIltbs after the tile the work is co.enced. One 90 day 81tension of tile, IlaY be all.owed for the perlit with fee charge of $15.00. the 81tension shall be requested in writing to the Building Official. An approved inspection lUSt be logged during eaeb sillODth period, or the project will be considered abandoned. WARRING to omR: YOUR FAILURlIO RECORD A KOlICH OF CCJIIIBICIIIm MAY RESULt II YOUR PAYING !IIICH FOR DIPROVIIIII!S 'f0 YOUR PROPIRtY. IF YOU IJlDlDtO OBIAllf FlIfAICIIG, COISULt wlm YOUR LBIIDD OR A11lnORDY BEFORE RECORDllfG YOUR If OtIC! OF COMMIICIHBIfI. JOBS UNDER '2,500 II VALUI 00 lOt IIBD to RECORD AND POSt A "IOtlCE OF C(JIIIIfCBMBIII'. SIGlAtuRI: amR OR AGm' SIGlIA'fURB: COIftIllC'fOR StAD OF FLORIDA COUNtY OF The foregoing instrument was acknowledged before me this , 19____ by S'fAD OF FLORIDA COOllY OF The foregoing instrument was acknowledged before me this , 19_____ by who is personally known to 118 or who has produced as identification and who did/did not take an oath. who is personally known to me or who has produced as identification and who did/did not take an oath. (Signature) (Name Typed, Printed or Stamped) NOTARY PUBLIC (Signature) (Name Typed, Printed or Stamped) NOTARY PUBLIC