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Home My WebLink About04-3434 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 3434 Permit Number: 3434 Permit Type: SIGN Class of Work: FREE STANDING SIGN Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: 10/06/2004 Total Fees: 87.50 Amount Paid: Date Paid: Work Desc: MONUMENT SIGN Address: 38122 12TH AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: Name: PRILLMAN MIKE Address: 38122 12TH AVE ZEPHYRHILLS, FL. 33542 Phone: FIRST CLASS ELECTRIC REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Thirty-Five Dollars ($35.00) 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 "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 and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. ~a~ ~~ CONTRAC OR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER r:-- I I I I I I 4:: ~ C: .... CI:) a c:) ot: CI:) I I I I I I I I I I == ~ a If 1 or I .,... · .... I-t ~~ u ~ I ~. --- .S ~ - --- ----- ----;:; .-- -- - -------- ot: c:::> - .s C) _u~ ___ _ ___ _ _______ ...: ~-ll. - v\'^ -; ~~~ ~ ~ (\ ~ -a ...,. t' () ~ -~~~ ~m" ~f~ <t. N r- .~ ~ "^ . " ~ .\~ V-' - \ 'fl' .:... - -4 :8 1 ,,-'" ~~~() ~ () ,\ \' _.,c ~ \) \J\ -n -~ '-\ \u ~~. -<.. r l r l r l \ r ~ .S \ C) _.1.____ g H__ - -,- 145 4:: - .~ - V') ~ ~ ~ ~ u- -sa ..., - , 'X V, f-es- .:;&'-'> o ~ -="0 '4) ~w ,J) '0- ~ ~ ~" ~ .....t ~ -' ..... >/, t ~ .r:.s 1 ~ ~ >~ ~ ~ Q Z ::J o = C-' "1 -... ......... C;) -.. ..;~ \..? . ~c\i ---- ?lJ.. LjLp ~ )..;;y ~ '-g.s ..,.it t\\c::>~ l'.\D '-' ~ .~ 2f m ~ "1 ~. GI 'S ~.; i · ~ 1.0 GI GI = .C - :::.SeGlo VJ ,J rJ) fih.~ ~ :1i . vi ~ r:l it! IV' O'i ~ I .... >< I.tI 0 ~_ \;.~O:::l""efl':l ~ ~ E~.~ a~e ~~ ~ W rJ) U ~ ~ SILCOX ENGINEERING, INC. -p.: o. 'eox '1!!17'S4 . TAMPA. FLORIDA 33614 Phone (813)cn.o 9192- IJ~Y2.:(~ -('At..{PA.. SIc::....5 JOB M lie-I! 1l!2-Il..UAA~ t< ~ALTII SHEET NO. I -z.~Pf.J /?'I'+l1 t.-(,S OF CALCULATED BY e s s DATE 9 ~ 2..1 -0;' CHECKED BY DATE I/.;.e; four, k'6;r . . z'-::p .. <f... SCALE . . - . . . . . - . l}JllJV .2g 1pSF. .hi::1l.6..~J. 5~~:~tFElt~~ii~~j" .!;l ...... .. A' Kit: /~+:"~. . : . . . . . . . . . . - . . . . ....~."~~.~;.:t....~...~....... .. $_j2.(.IS:I~) . ..-'..60e';t?~~. - _. 2'~?k .~ ..... .... ...... ., ' " /I ~/ I :l..e ... ..~... .... 4.2J2tJ;F'tpe ..... .$. ...~,s?> .....--n...... ..........................,.....~........... ........ · ........J.~...I ~. ~ ...h~ hh I . -...:. ..... I' ';:J '.. t,'PIk 1] QI:-:-' . .. ... hH1 e ~.' . ~rl:\ ..~ . '. H.?G~ZS .. PC'- . ?'! D -+2,6'4~"",,) . B.. -::... . . · .-.~-i::..;......_- $+'0 5 ~"..-1 ~-.-r' -?- V I'=~.... \ l' ... ...,. ......_ , ..0.._... ..-:;.. ..... s. sac.. r.&_61 ... --';-11 ;.a..... cml~ -P.O. ~O)' &674. T~ FL .l3674 (813)"20 91~z.. Wlt-;D / OrzSI~A;5~7--::ge) V ,. I3~,.JHVH .... v - I~. ~. '....''< ..~rL. ''f., :1-' ' ~'2.. f' :z: CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8~H st, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED It) -/.1- 01 -' PHONE CONTACT FOR PERMITTING OWNER'S NAME/1'1J c...HA~L. ~Jl.'-JMAN PHONE ~/3-788-~at.J'J /.23AJ/~. 2!=PNyx:.HILLS. J=2. 335#2- SUBDIVISION C!J,y' ~j: ~PhljR)J)1J.S / (OBTAIN FROM PROPERTY TAX NOTICE) JOB ADDRESS . 38122 LEGAL DESCRIPTION: LOT (S) ~ I - ~ 1- BLOCK~ PARCEL ID # //-2&'-P') -ooJO-OS80{)-O~IO WORK PROPSED: ONEW CONSTRUCTION ~IGN PROPOSED USE: OSGL FAMILY DWELLING I:OMMERCIAY,..e'C5. o RESTAURANT o ADDITION o ALTERATION o REPAIR o INSTALL o MOVE o DEMOLISH OMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER DESCRIPTION OF WORK hJs;-4J../- /,2l!3tJ BUILDING SIZE & HEALTH DEPART~NT~PPROVAL RT :t>~cE-r I/rFleE S)6NS: /-#/t'JJJulYlcNT IP,- SQUARE FOOTAGE <J Pt! ,11foU$f:. I;; / ~ "Jr:''1 ;' HEIGHT I RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS ~COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY ~ IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. & (1) SET ENERGY FORMS. FORM~":L <)"0 f?~ G . t> , < '~~."C l~~. PERMITS REQUESTED o BUILDING $ VALUATION OF TOTAL CONSTRUCTION o ELECTRICAL AMP SERVICE o Progress Energy 0 W.R.E.C. o PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER INSTALLATION g/J ~,5''' I &~? I "/ AREAO YES 0 .~. ( ZO~ o GAS o ROOFING o SPECIALTY o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD "_0", -~- ---- ,.- g:-'t?1J1~"';W~;;:~71f<iQ'T"":"~7'";:;:c~rry~~:mj<>=""7'""'--'\-------~~- --- -------~~- ---~~p:~;1?rfiJ'-.~;;~~~r~~ , ." , ~ 0\iJ~I,"'I~l;il't9li1f"11j;1!'I' J ,;';j,mL,f; 1;.; ',,' Ie ...,}t\J.il.n~' .54 " I . ' ., !!'Y;h,,10'1Cfu,'J~''Wl~-\;f:~~t,il.,.c~iliC&iJflfiij!i!t~k~~i'I!::1'~ F' ~~~~~~~~~~~~~Jl:r::~~~':LjL':_':"~_~____ __~._~~ _ ____~__~~~cl;1~~~~~~~~.J~ BUILDER COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** SIGNATURE 5~ p~ COMPANY ELECTRICIAN c?- STATE CERT OR REGIST # ****************************************************************** PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** MECHANICAL COMPANY SIGNATURE STATE CERT OR REGIST # ***************************************************************** ;;:THER l l J( ", COMPANY NO f'. t-~ \G.t- ~Dl ,)11 ~ tP . uJJ.- ... j1J# ~ "..... 'f..'. J.. A. NOTIC.E OF DEED RESTRICTIONS The undersigned understands that this permit may 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, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign po~tions 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. Appli~ation 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 must take to be in compliance. Such agencies include but are not limited to: *Department of Environmental Regulation-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 *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 proc~e~ with the work a~d not as authority to violate, cancel, alter, or set aside any prov1s1ons of the techn1cal.c~des, nor shall issuance of a permit prevent the Building Official from thereafter requ1r~ng a correction of errors in plans, construction, or violations of any code. Every perm1t 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 a~andoned.for ~a period of six months after the time the work is commenced. One 90 d~y extens10n of t1me may be allowed for the permit with fee charge of $15.00. The extens10n shall b~ requeste~ in writing to'the Building Official. An approved inspection must be logged dur1ng each S1X 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 VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". ffZ;'J~jtQ-/2#~~ ~;~;: OWNER OR AGENT SIGNATURE: CONTRACTOR STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _____day of by STATE OF FLORIDA 1-)", /0 /i' ..... COUNTY OF t:::ZL ..)- L: {.l. The foregoing instr ent wasOacknowledg~~J Before me this a,y of ( blljJl ,2~ by (name of person acknowledged) )OLWhO is personally known to me, or Owho has produced (type of identification) ~did~take an oath. taking nowledgement acknowledged , 20_ (name of person acknowledged) C1ho is personally known to me, or o who has produced (type of identification) and who 0 did Oiid not take an oath Signature of person taking acknowledgment Name typed, printed or stamped Name CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED PHONE CONTACT FOR PERMITTING JOB ADDRESS !U{ ~ fL e ?u ( 1:( ('1tIIL~.--vt- :> t3 (Z 2- I/! ~ue PHONE - ?y~ ?JT&f OWNER'S NAME LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION /1. -2,n -...., ( PARCEL ID # _ ~" (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: ONEW CONSTRUCTION o ADDITION o ALTERATION o REPAIR o INSTALL OSIGN o MOVE o DEMOLISH PROPOSED USE: OSGL FAMILY DWELLING o COMMERCIAL OMULTI-FAMILY o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER DESCRIPTION OF WORK c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL rt/uD~ LiP -... .5 (S ""lA 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. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERMITS REQUESTED o BUILDING erEi:ECTRICAL $ VALUATION OF TOTAL CONSTRUCTION AMP SERVICE o Progress Energy 0 W.R.E.C. o PLUMBING o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION o GAS o ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREAO YES 0 NO ~i'7;':"'~!'~7r0FFl :i~""'''''''''~'''''';:~~~~'''''F''''~'-;-~-'r----~~--~--_.- - - --- ~--~ -- ----~:7J11r~lbf;l~0;1~r~r~~ -!;' It 1m~~~~'1;~~~,~,,'~~~;;rt~~~~~~::i~_.~~~___._ _~_ __ ._ _.___.___Js:~~~bJ~~12~~P BUILDER COMPANY SIGNATURE STATE CERT OR REGIST # SIGNATURE ****************************************************************** COMPANY h;fjr C~7~ Bee r I STATE CERT OR REGIST # ftC-OcJ02-~ ?d ELECTRIC * ************************************************* PLUMBER COMPANY SIGNATURE STATE CERT OR REGIST # ****************************************************************** MECHANICAL COMPANY SIGNATURE STATE CERT OR REGIST # ***************************************************************** OTHER COMPANY SIGNATURE STATE CERT OR REGIST # A. NOTIC.E OF DEED RESTRICTIONS The undersigned understands that this permit may 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, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign pOftions 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 indica~ion 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. Appli~ation 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 must take to be in compliance. Such agencies include but are not limited to: *Department of Environmental Regulation-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 *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 a~andoned.for ~a period of six months after the time the work is commenced. One 90 d~y extens~on of t~me may be allowed for the permit with fee charge of $15.00. The extens~on shall b~ requeste~ in writing to.the Building Official. An approved inspection must be logged dur~ng each s~x 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 $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR acknowledged , 2Cl- STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _____day of by STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _____ day of by acknowledged ,20_ (name of person acknowledged) Owho is personally known to me, or (name of person acknowledged) C1ho is personally known to me, or Owho has produced (type of identification) and wlioO did Odid not take an oath. Owho has produced (type of identification) and who Odid Odid not take an oath Signature of person taking acknowledgment Signature of person taking acknowledgement Name typed, printed or stamped Name typed, printed or stamped SEP-30-F004 08:00 FROM:NORTH TRMPR SIGN 813 986 2693 TO: 7827372 P.l NonCE OF COMMENCEMENT PERMlT NUMBER STATE OF ~OA PARCB.I.D. NUMBER 11-2' '"ZI-()()}D -6$'& 01/0 The UNDERSIGNED hereby gjva noUce lhaz kr!pftMlmerlt will be made to certain r" praperty and In accordance wfth Chapter 713, FLORIDA Sf.lIlJ'UTES. the tIlIowCnlllntmlaf6.n Ie pl'O\/Ided Inthle NotIce of Corm1enc8ment LEGAL DESCRlPnON (Muat~~erlat. block.~ ~,.... lUge) 1.]: 1ii J~ 2~ s~~f~ 5"~;;~~ t)~__._ ~ ~./zH Ili.S Return origilal copy to 1he: ~1J,L:tlJtI 9!~tlll..Qe"ter J..A... .1. --d~...,<J, a.<J ~eF'j 1L .- n. J7L Wilm? ~~~~~~~~!WI 1/11I1111I1111111111 11111111I1 1111111I Rcpl:820551 OS: 0. 00 10/04/04 Rec: 10.00 IT: 0. 00 Dpty Cler-k . JED PITTMAN, PASCO COUNTY CLERK 10/04/04 03: 20pm 1 if 1.. OR BK 6051 PG. 705 OWNER IHFORMA1ION NAME/JIUt:.J.lAE.L J::k}LL IMA,J INTEREST IN PROPERTY ~6 5i/Hf/hl: ADDRESS o kJ.N!rli{ ~ ::S812Z. NAME" AOORESS OF FEE SIMPlETmEHOLOER (If other.... owner) AI~t.U . (" Slr- GENERAL DESCRIPTION OF IMPROVEMENT NAME j)~IA.t7J Id JJ1 a.SS ,~~ . CON'I'IW:mR A...t ~ ~~" ~~ ADDRESS /b 70/ r;&."f 811 /f-1'/'t;rU/LJ,. ~'- 53 s-? . BONO AMOUNTS NAME I. ADDReSS OF SURElY LENDING ORGANIZMION IV I fr- ame and AddrU3 ) Penronll within 111. State 01 Florida. cfeslgnated by 0Wr1III' upon who notJcea or other documents may be sened as provided by SECTlON 713.13 (1) (8) (7), FlORIDA STRUTEs. / ~ NAME ~/Ar ADDRESS In addIIfon to h1mB8lf, OWIler deelgnates (Name) at to receive a copy of Uanar's as PIOVided In SECTION 713.13 (1) (b) R.ORIDA SW1JTES. EXPIRATION OO'E NanCE OF COMMENCEMENT I /:) (One }'88r from dafe of 1eCOrdk1g. unleaa spedIIed) ,. Slgnatureoto.vner ~;'~ADlla~.J~~ I. Printed NIJma/)f/ e.NA~J. A. ?1e 1 LL IIUA ~ / I~ ~ ' ./ 'd CERlIFfCATlON STATEOF , ,';/-6 Co (/) It I . a.. ~ The fcregolng r~strument was acknowfedged befof8 me this &... ~ of (AddreIIs) 'i7ic5 {i u .2fJJ2.!i by 11l/(;M.I1,}/ A 11-~"dI'h1/JYJ as lcIen1lllcallan and who (did) (did not) tBIIe an oath. 313