HomeMy WebLinkAbout01-0149
BUILDING PERMITN~
0149
CITY OF ZEPHYRHILLS
(813) 788~6611
Permit
Date
b}- tl1-o /
-----
~-... ELE~~..._.... PlU~'-- MECH~'SewerConn
P<O~rtvowC~/ *- ~ :lJ;;~~--1k- :::::::t:~.
JObAddres~~~__~# _ __ _ T.I.F. s.
Parcel I. D. #
Zoning:
DescriDtion of Work
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
C.O.'
DATE
Inspector
~
Company
Address
CelePhon~?'1)) .'5A/- bO 4'7
Valuation or ~ / -
Contract Price ..,,:) I (p 1JD
.
City license Registration # ;:2 /~
State Certified license#
'/7ldL4. &m ~ \... dAr~
BUILDING
PlUM~'"
~
.M H'W APJI e: A L
SlB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
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 Twenty Five and 00/100 Dollars ($25,00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from fawlty 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.
.~
.... ~ ~
'roposal
A 2-VIO,
I~I MIIBar Construction, Inc.
Roofing . Concrete. Commen:ial . Residential
15911 US Hwy.301 North. Dade City, Florlcla 33523 Oc
352/567-6047 8001582-2383. FAX: 352/567-4454
813/782-7288
Page No.
1
of
2
Pages
U.s. Intec Certified
Platinum Inslaller
#5204
State Certified
Builder #CBC023221
State Certified
Rooter#CCC051562
State Registered
Roofer #RCOO55215
RCI Registered
Roof Consultant #0149
Member of the Florlda
Roofing and Sheet Metal
AssocIation
PROPOSAL SUBMITTED TO
HELEN NEWCOMBE..
PHONE
813/783-6154 WK.
DATE
11/10 lOb
STREET
P. O. BOX 845
JOB NAME
HAIRSTYLING BY BOBBIE
CITY, STATE and ZIP CODE
ZEPHYRHILLS, FL 33539
JOB LOCATION
38334 5TH AVENUE
ZEPHYRHILLS, FL
JOB PHONE
ARCHITECT
DATE OF f>LANS
We hereby submit specifications and estimates for:
ROOF ~!.~~~~.!.....~~ !~~..~~!~!.!.~G FL~T "OD~~~.~~....~!.!~~~~....~QQ~!~...~.!~~~.......
The existing . roofing insu1.~.1:..~~.~.....~~.c:i....~.<>..~.~.~:'.l:9..l\l~l\l.I?:J::~~.~....~J;.~....!:9.....~~l\l.~.~.~....~~.....pJ~.c:::.~.....~~c:f.....I:l.~........... ............................
overI'a'i-a...v'ith.....the.....o.ew....ii.s.. Intec Permaglas APP 4.5 M modified bitumen roofing membrane in
........."l.~l?,ClE~Il.~~~.....!~.~~...~.t:'.~.....!'J.P~C?.~~.~.c:::."l.~.~~.l.l:.E.I.....J:l.~!.~!..~............... . . .............. .............. .. ................... ................................. ........................
1...........T..~~...!:ll:.i..!'J.~.i.l.l:9.....E.l.l\l!?~.~t:'..~~.~...l\l~.c:i..i..~.i..~c1..t.>.~.1:.~l\l~l.l:.....:r.:c:l~.;.~.~g.....El.y.El!:~l\l.....!..~.u.....I:l..~...c.:.~.~~.~~I:f......~J.l.I:f...P.:r.:.i.l\l.~I:f..............h......
with an asphalt primer.
.. ....2~...... . Provide and' install a n.ew....lj'~..S~......Intec Permagia.s...APp....4..5....i1...white....~iran.uie.:.sur'ia.ce............................
. ... ......:r.:().().~.i.~.g....l\l.~1!'~:r.:"l.l.l:~....lIf~.i.C?t:'.....i.:El.....~......~.~:r.:C?.~:::.~pp~.i.:.~I:f......#.\1~.!.y:..~l:f.h~J;~.c1.....l\l.c:l.l:f.i..f.J.~c1.....J:li..!:.\1.l\l.~~....:r.:9..c:l.:(...Ely.~.~.~.l\l.............
that is heat welded at the seams to form one sheet; and offers U.S. Intec's 12-year
1 i mi tetf".~:r::r:~l.l:~y.....~J:l~~i.:Ell.l:~~.... P:r:~.::::r.:~~~c:i.,...li.l.l:c:lp.~El...~.El.I:IJg~.t:l.~!~~
3. :rh..~ newm~.~p~.ppp~.~~.~C?...~~:r:l\l~9!~~.~PP ...1.~.? .".r..()c:l~.i.!,g l\l~l\l.b..:r.:.l:l.!'.~.m'.';1.,.~m);).~...J\.1..~),y.:l:l.l:f.h~r..~I:f...PP....
directly to the .primed. existing roof surface by heat-welding using large propane
torches.
4. Pr o.....i..c:i.~.. ~!'.c:l......~!'.I:3.~"l.~.:l.....!'.!!.....~~.....g.~.:l.'g~.....g."l.~.y..l:l.!'.~.~~I:f......l\l.~!:.li.l.. ..~l:l....~c:l:r.:.~P.....l:l.:r.:.c:l.~~c1......~.h~.p~.:r.:.i..l\l.~!:.~:r.:......c:l~..........
the roof over the top of the existing drip edge.
................... m.".... .. .......................... .-...'.... ........................
5. The air conditioning units ~ill be raised and completely roofed underneath and reset
... ... ~~.P.~~ElS:l.':r.:~...~:r.:.~l:l.!:~c:l1.~.x . .1~p wood.fil.l.~~p~:r.:I:I~........ ...m. .... ................... m...........
6. ...Pr..c:l.y.~d.~ ancli~Elt~.U.c:ll.l:~:'.'~y..lIlClAfiI.!:\1:r.:~::r.:~!i~:( ....~Il1:,fiI..l:1.1:,.. CI ..r..l:1..~~Clf....QIl~:v.~Il1:, .P...:r.. .J"~.~.
s.f. of roof area.
tit 'ropoSt hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
SEE PAGE TWO
dollars ($
).
Payment to be made as follows:
Invoiced amounts not paid In accordance with the payment terms s~all be considered delln.
quent and bear interest at the rate of one and one-halt percent per tOnth. Owner agrees to
pay all costs incurred, such as allomey fees. collector fees. court sts, etc., lor collection
01 delinquent invoices including Interest. Owner to carry fire, toma and other necessary
insurance. Our workers are fully covered by Workman's Compen$atlon Insurance
!
Authorized
Signature
Note: This proposal may be
withdrawn by us if not accepted within
30
Acceptance of 'roposal - The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as speCified. Payment ill be m e as outlined above.
Date 01 Acceptance:
Signature
)
Member of the Florida
Roofing and Sheet Metal
Assoclallon
U.S. Intee Certified
Platinum Installer
#5204
,
'ropassl
~ MIIBar Construction, Inc.
Rooflng . Concrete. Commercial . R88idenlial
15911 US Hwy. 301 North. Dade City, Florlda 33523 Oc
352/567-6047 8001582-2383 FAX: 352/561-4454
813/782-7288
PHONE 813/782-1680
813/783-6154 WK.
Page No.
2 of 2
State CertIfied
Builder #CBC023221
State Certified
Roofer #CCC051562
State Registered
Roofer #RCOO55215
RCI Registered
Roof Consultant #0149
Pages
~
PROPOSAL SUBMITTED TO
HELEN NEWCOMBE
STREET
DATE
11/'10 00
JOB NAME
P. O. BOX 845
CITY, STATE and ZIP CODE
ZEPHYRHILLS, FL 33539
ARCHITECT
HAIRSTYLING BY BOBBIE
JOB LOCATION
38334 5TH AVENUE
DATE OF PLANS
JOB PHONE
ZEPHYRHILLS FL
We hereby submit specifications and estimates for:
7.
The exist.~~.~..JJ.'::t~~!E.....~f.l.~.....~.~!.~.I:lP.CJ..~.~.....I:lr..I:l~.~~.I:l..~~.~.....~.CJ.....E!.~~.~.f.l.....~.~.....P..!.~.C?~.~.....................
8. Any existing wet insulation, deteriorated metal deck, or rotten wood nailers will be
.h..hm.r.eplaced.h..J'n.....s....c.ost.;;;.pIl.i's..m.baslshmsb.ovem.a'iidh..b.ey.ond.mtheh.hcontiacf..hiiifce:h..........h..h..mh..m..hhh..h.hm..h.....mh.............h.h.hh
m..h9~.Ovriei..htohji'r.ovld.e...sccess.h'forh.d.en:veiy...t.iuck.s....forh.ToadfngluriIoacffiig..forh.he'iiffi.e....roof.mm...........h
area.
.............._......... m............_................................................................................................................................................................ .......................................................................................................................................................................................................
,.
10. This set of specifications'takes precedence over any other specifications, blue-
..prlrits~..u.or....co'jitriict"md(icumeritli:....u.....KiIB.8r...t.olisfru.ctIori.~....Ilic:....is..n.of...re'iiJJion.slbIe...................uu.....u.........m.U.
f oJ:.....~.~.~~~.~.....~.~. ..~~.~ . .rCl~.~...c::.~'::t~.~.~......~r......~.~~.~~.I:l.~.... ........................... ... .............................................m............m.........'m. ............................. ...........................
11. KilBar Construction, Inc. to provide General Liability ($2,000,000 limit) and
.. ..........Woi..ker:.'.ii....Co.TRjieJis.s.t.lciil.....Ilisur..n.ce.....a.nd......r.o.cif.:[lig.....per1Di.t.~....................... .................................................
lie propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
THREE THOUSAND SIX HUNDRED THIRTY AND 00/100---------------------- dollars ($ 3,630.00 ).
Payment to be made as follows:
DUE UPON COMPLETION.
Invoiced amounts not paid in accordance with the payment terms s~all be considered delln- Authorized
quent and bear Interest at the rate 01 one and one-hall percent perjrnonth. Owner agrees to Signature
pay all costs incurred. such as attorney lees, collector lees, court Fosts, etc., lor collection
01 delinquent invoices including interest. Owner to carry lire, tom~o and other necessary Note: This proposal may' be
insurance. Our workers are lully covered by Workman's Compenratlon Insurance withdrawn by us If not accepted within
30
Acceptance of 'roposal- The above1prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as speCified. Paymen ill be de as outlined above.
,
C..:1)~
Date 01 Acceptance: Signature
uu_______)
-. FRSA-SIF I Above the Rest'
. .
CERTIFICATE OF INSURANCE
ISSUED TO:
COPY PROVIDED TO:
Zephyrhills. City of
Building Dept.
5335 8th Street
Zephyrhills FL 33540
MilBar Construction, Inc.
15911 U.S. Hwy. 301
Dade City FL 33523
ATTN:To whom it may concern
Date: 02/12/2001
This is to certify that
MilBar Construction. Inc.
15911 U.S. Hwy. 301
Dade City FL 33523
being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of
compensation by Insuring their r1sk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING
CONTRACTORS ASSOCIATION SELF INSURERS FUNO.
EXPIRATION DATE:
870-032597
01/0112001
01/01/2002
LIMID
Workers' Compensation Statutory. state of Florida
COVERAGE NUMBER:
EFFECTIVE DATE:
Employers' Liability
$100,000 . Each Accident
$100,000 . Disease, Each Employee
$500,000 . Disease, Policy Limit
REMARKS: Non<ancelable without 30 days prior written notice.
This certificate Is not a policy and of Itself does nat afford any Insurance. Nothing contained In this certificate shall be
constructed as extending coverage not afforded by the pollcy(les) shown above or as affording Insurance to any
insured not named above. This provides coverage for Florida policyholders and Florida domicile employees only.
&p'~~
Tom Dralle, Administrator
FRSA-8lF
B~~~
Debbie Kemmerer. S1F Accounts Ihpre".ntative
FRSA.S1F
. .
NOTICE OF COMMENCEMENT
MCI # 2687
Permit No.
Parcel I.D/FOLIO # 11 26 21 0010 16600 0190
State of Florida
County of PASm
111111111111 1111I111111111111111111111111111111111111111 I11I
2001017830
Rcpt: 474168 Rec: 6.00
DS: 0.00 IT: 0.00
02/12/01 ______ Dpty Clerk
~S91~~~IMA~4 : r~S~O fOUNT:f C1,ERK
OR BK 4535 PG 1443
THE UNDERSIGNED hereby giwe notice that the improvement will
be made to certain real property in acco~dance with Chapter 713, Florida
Statues, the following information is prorvided in this notice of
commencement.
l.Description of property (legal description ofproperty and address if available)
Section 11 . Township 26 Ranqe /1
2.General description of improvements FLAT ROOF OVERLAY
38334' 5th Avenue
Zephyrhills, FL
3.0wner information ,- .'
a)Name and address Hlf.F.N L. JOHNSON NEWCDffiE
b )Interest in property ~
c)Name and address of fee simpl~ titleholder (if other then owner)
1':.~' -... '
..~)
~"contractor (name and address)
5.Surety
a)Name and address
b )Amount of bond
6.Lender (name and address)
DaVi~ R. Abla/MilR:Jr Construction, Tnc
15911. u.S. 301, Dade City, FL 33523
.
N/A
N/A
7.Person within the State of Florida desipated by owner upon who noticesor other documents may be served as
provided by Section 713.13(1)(a)(7), FloHda Statues.
Name and address
8.In addition to him or herself, owner designates
of to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statues.
9.Expiration date of notice of commencement (the expiration date is one year
:::: ;:::~:::mg unless a diff~ ::~: ::: ' / / // ~ --d _
COUNTY OF PASCO PRINTED Nl\ME & = ~ "t/::J.:::i:;~~",Z
The followin instrwntm~.. as acknowleqged before me this..aLday of j<LYI\1. "'I' L.\.Ah, by \~~ II.' In ~~uh.l'WIl-,c
who IS personally known lo...me or who produced as identification.
------- I
After recording, return to:
Name f~'LO.'D C'; :--:;TRUCTION, NC.
v I t ~. .
Address 1eQ11 II S 301
City . n::lrl~ CltV. FL 33523
i
Name(print)
Title or rank
Serial number, if any"'~
:&
11194
~
~ MilBar Construction, Inc.
l .
15911 U.S. 301 · Dade City, Florida 33523 C>
352/ ~7-6047. 800 /562-2393. Fax: 352/567-4454
Date:
02/12/01
'lb:
City of Zephyrhills Building Dept.
Re: . License # CCC 051562
'lb Whan It May Concern:
Please accept this letter as authorization for Scotty Absher
to act on behalf of myself, David R. Abla ; and MilBar Construction, Inc.
in the procurement of all legal pennits and/or licenses as required by the
state of Florida and/or the various city and/or county governments located
therein; authorization is. also granted to sign in my stead as required in
the acquisition of the aforementioned pennits and/or licenses.
~:d
DAVID R. ABLA
VICE PRESIDENT
;.
state of Florida
County of Pasco
The foregoing instrument Was acknowledged before me this 12 day of FEb, 2001
~ David R. Abla who is personally known to me and did not take an
oath.
~L
Notary Public: ~~. r--.. Conmission:
lvia A. . vett '-" __________
l"lOLlVIA A. LOVeTT
i~ \ Notary Public. State Of Florida
jOj My Commission Expires July 28 2004
Commission No. CC954594 .
Slate CeltlfI8d
Bulkier IICBC023221
Slate Certified
Roofer IICCC051562
Slate Registered
Roofer IIRC0055215
RCI Registered
Roof Consullanll10149
APPLIcATrON FOR PERMIT
CITY OF ZEPHYRRILLS
BUILDING DEPARTMENT
zc.t.,
DATE RECEIVED
PLANS REVIEW' FEE
JOB ADDRESS
3?l~o.Dc
JD'hV\SuY\ N.t~ ~ hL
6'~ J\I( n\A.."-- , "2-\-\\ \\ ~
PHONE ~18 % . \ lDiC
OWNER'S NAME ----1tQ. \f..V\ L.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID # n--z..<<... 2.\. \)Oh.~... \'0....\)0.. O\~
WORK PROPSED: (JNEWCONSTRUCTION
(J ADDITION
(OBTAIN FROM PROPERTY TAX NOTICEl
~t~U'l~
(JALTERATION fl REPAIR ~ INSTALL
o DEMOLI SH
o SIGN
(J MOVE
PROPOSED USE: DSGL FAMILY DWELLING
)licOMMERCIAL
(JMULTI-FAMILY
(J INDUSTRIAL
(J# OF UNITS
(J SWIMMING POOL
(J MOBILE HOME
(JOTHER
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
~\~ ~~ O"lK\~"f
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
(J BUILDING
$ 3.10'30,,00
VALUATION OF TOTAL CONSTRUCTION
(J ELECTRICAL
(J PLUMBING
(J MECHANICAL $
(J GAS ~OFING (J SPECIALTY
AMP SERVICE
(J FLORIDA POWER
(J W.R.E.C.
VALUATION OF MECHANCIAL INSTALLATION
(] OTHER
TYPE OF CONSTRUCTION: (J BLOCK
(] FRAME
(J STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
BUILDER
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
******************************************************************
ELECTRICIAN
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
***********.*******************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
SIGNATURE
~ ~.~ - COMPANY Mi\&w- CO'll.~"".\Kr_
STATE CERT OR REGIST # Cf:.L. OS\'5\t'L
A..... CITY PROCESSING # J ~ . .
************ *********1************************** ******~+* ***** .
OTHER
CONDITIONS OF PE~Ml~ AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit n~y be subject to ~deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. 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 regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a 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
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the ~Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs 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 may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of ~Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the ~owner", I cerify 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.
E. 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, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I Inust take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sellsitive
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
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone ~A" or ~A,etc.", it is
understood that a drainage plan addressing a ~compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
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 code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be 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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VJ\LUE D OT NEED TO RECORD AND POST A '~EM~
SIGNATURE: CONTRACTOR
STATE OF FLORJDA
COUNTY OF ~1\'(~
The foregoing instrument was acknowledged
Before ~ this ~ day of ~ , 1~'
by ~~,i\ Q.' I\b \.!..
__ jDame of person acknowledged)
~o is personally known to me, or
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before Ill;. this ~ay of ~ ~ , ~\
by ...0 ~.,,'1.. _ \ fl...
~(name of person acknowledged)
~o is personally known to me, or
~t6t~
o who has produced
(type of identificati~m)
and WhODll.- 19'<'Id not take an oath.
Signature ~~ acknowledgement
QUVIA A.LOVETT
Name tYf ~~R\~.
Commission No. CC954594
Dwho has produced
(type of identification)
and who did... [3::tld not take an oath
Signature of p rson taking acknowledgment
OLIVIA A. LOVETT
. tate Of FIorkIa
Name M9 tiwbi8d:l~pi8t:
Commission No. CC954594