HomeMy WebLinkAbout05-3826
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
3826
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
3826
RE-ROOF
ROOF REPLACEMENT
SINGLE FAMILY RESIDENTIAL
Address: 575014 ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
5,606.00
2/08/2005
60.00
60.00
2/08/2005
RE-ROOF
Name: KELLY ZIMMER
Address: 5750 14TH ST
ZEPHYRHILLS, FL. 33542
Phone:
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.
cI -2/dW ~ ~
C~TOR SIGNATURE PERM~
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
APPLICATION FOR PERMIT
CIn OJ' ZEPHYRHILLS
BUILDINGDEPAR'l'MENT
Mcr 3500)
DATE RECEIVED
PLANS REVIEW FEE
I'; '.
PHONE 812~/1 R9-5~O\
Z-c- - Lt 38S4d
LEGAL DESCRIPTION: LOT(S) \ \~ \ 3 BLOCK I . tf1SUBDIVISION~-l-t1-DP 2-hUls
PARCEL ID # \ \- 2.Lt> - Z-l -C;o \() - 0"1 30D - all 0 COBTAIN FROM PROPERTY TAX NOTICEl
OWNER'S NAME
JOB ADDRESS
WORK PROPSED: ONEW. CONSTRUCTION o ADDITION OALTERATION o REPAIR o INSTALL
Os I GN o MOVE 0 . ciOOFI~ '.
DEMOLISH
PROPOSED USE: OSGL FAMILY DWELLING OMULTI-FAMILY 0# OF UNITS o MOBILE HOME
.'
o COMMERCIAL o INDUSTRIAL ' 0 SWIMMING POOL o OTHER
DESCRIPTION OF WORK
o RESTAURANT & HEALTH DEPARTMENT APPROVAL
~}(\\ ng l p
ann) F1M Re- Roo+'
s\^. \ (\~ \e.:= ciIF
SQUARE FOOTAGE. =P\O--\; ~
HEIGHT
BUILDING SIZE
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
o BUILDING
$ 5, ~O ft;, (ft)
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
o PLUMBING
o MECHANICAL
o GAS '-ROOFING
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
$
VALUATION OF MECHANCIAL INSTALLATION
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
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BUILDER
SIGNATURE
COMPANX
STATE CER'l' OR REGIST #./ ,!,
CITY PROCESSING U
,\ . t'oi
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· COMPANY
STATE CERT OR REGIST ff
CITY PROCESSING #
ELECTRICIAN
SIGNATURE
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PLUMBER
SIGNATURE
COMPANY
STATE CERT OR REGIS'f 11
CITY PROCESSING 1#
**********~****************i********************************~*****
COMPANY
STATE CERT OR,REGIST 1J
CITY PROCESSING #
MECHANICAL
SIGNATURE
.
...................................*..***************************
SIGNATURE
ROOFING
~~~
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COMPANY MILBAR ~STRUcrIOO, INC.
STATE CERT OR REGIST # acc 051562
CITY PROCESSING U 218...., '" '
OTHER
***********************~*****************************************
qJNIH'l'lONS O~' PC:HM1'l' AH'llJAVl'l'
A. NOTICE OF DEED RESTRICTIONS ,"
The undersigned understands that this p~rmit DUlY be subject to "deed restrictions" which
may be m~re 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 requir~~
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 JlIisdel~eano,r
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 oftpe "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 ~e an indication that he is not properly ~icensed and is
not entitled to permitting privileges in the City of Zephyrhills.,
C. TRANSPORTA~ION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCT~ION LIEN LAW (CHAPTER '713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant" have been provid~d 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 pronuse 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. II
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 regu;Lations 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 fiJ.l material is to be used in Flood Zone "A" or "A, etc.", it is
understood that a drainage plan ~ddressing a "compensating volume" will be submitte~,which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance. ..
A permit issued shall be construe~ 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 Buildi~g Of7icial fForn thereafter requiring a
correction of errors in plans, constru~tion, or v~olat~ons of~nyLcode. Every per~t
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 .!tbandoned for .a:'
period of six months after the "time the work is commenced. One 90 5lay extension of time
may be allowed for the permit with fee charge of $15.00. The exteJsi~n 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 PROPER'DY. IF YOU INTEND TO OBTAIN FINANCING, ,.CONSULT.:
WITH YOUR LENDER OR AN ATTORNEY,BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 I~E ~OT NEED TO RECORD AN. .P POST A "NOTICE OF CO EMENT".
~~.
SIGNl\TURE: OWNER OR AGENT DAVID R. ABLA
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STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this_ day of 1!L-
by DAVID R. ABLA
(name of person acknowledged)
~who is personally known to me, or
"
STATE OF FLORIDA
COUNTY OF PASCO
The ~oregoing instrument was acknowledged
Before me this day of , 1,9 ~
by DAVID R~
(name of person acknowledged)
~ho is personally known to me, or
PASCO
.
Signa
of ideritificati?n)
take ~n oath.
o who has produced
(type of identification)
~id not take an oath
and whoD did
wledgement
Signa
owledgment
Name t
Name
L./U\' ;;:Ul.I4 Mo,"
"~3_~:~
State C 'rtltled \~)
Iluilder #C JC023.!21 /
State C ,rt/fled
,looter /loC :COS15062 I '
State Ae Ilstered
'oater *A :0055215 I !
Rei RIl( Sf.red II
R)gf Cons'- tant #0148 I
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york area daUy. If
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2. Provide and install DIilY 15 lb. sat.urated :felt paper. !I
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3. Provide and inet.all n.w TABKa -lIeit.aglP ~ Aft- 30-ye;r lam:l.nated d Lmenliionlill II
..._ ..,. ,... ",. _..a.lg ~,,::: ~,eliimant. ..fi.~tgJ.~l!\aJ" .!iib:L.,~lgsJ_ ..o'lmi'.r......tp.. .f\t~ l,~f;<t.,..~t bgJ.~. .c;l) lQI:". ..;(1 Pl..,1.I~ltKQ...'.fJ.....,.J!
standaT~,~~~~~S...~~~~.~~~5 boav.. · 3~~~.~~~..,~.:~~.=~~~~.~~~~~....~~tJil TAHKO, 11
Replace all de.aged flashings (valley, vent., or any weU flasl,1ng). I
l~;lb
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I ,.ROrOSAl Sl./IiMITUD TO
I ZUKER, KELLY
, STREET
i 5750 14TH STREET
Jroposal -.. -,
Member of the Florid.
Rogfing II'1d ~ Metal
Anooilrtion
u.s. Intec Certified
Platinum Installer
'5204
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M II~!~ .~<<!~!oI!~cS!!~~7~lnc.
15911 US Hwy,301 North. Dade City, Florida 33523 Cc
352/567-6047 · 800/562-2393 · FAX: 3521567-4454
PHONe
81JI788-5301
JOB NAIIIE
ZIMMER RESIDENCE
CITY, 5U.TE .no Z/,. CODE
I ZEPHYRHILLS, FL 33S42
JOB LOC"TION
57~ 14TH STREET
I CATE 01' PLANS
ZEPHYRltILLS. FL
IIIIOHITI(lT
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RE-RQOF
6BIaGLE ROOFING.",
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S. Provide and install new l...ad boots for tbl! plutllblng v.llte.
G. Provide and inst.ail new pre-finiahed aluminum eavedrip (whitp or breln).
7. R~ove the e~isting brick chimney at the b.ck af ,!~e houee.
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.c_ ~~~~r hereby to furnis~~aterial and labor-=comple;; in accord~~ce with above spe';bi~n I, for t~;~~;'~~ I
SEE P#.GE THREE. . 0018"' ($ ). ill
F'1IY1T1lIl1I1O be rroall as fol~ I
A'''''orlzed ~~=-~:
Invoiced ltnoun15 nol paid in aceorcanee with the paymenltellTlli shall be conSiCllll'<<l ClCIin- MUU I /-~-----; I
q~lIMI and bear in.rlsl aJ th8 rail 01 ono and ooo-hal peroenl per mD~lh. OWnllr a(11l1$ 1:0 Sign121ure ) ""'--- ---E:- ---I I
pay all coma incurr~, euch as alto,,,.y f.u. eo'~or rees, courtCOllB, eto., lor collection NOIO~ TtU p..........."" m;y bo 'I'
01 delinquent Involc8& il1c1uclno intsrut, OWner 10 cany I:re, tomBdo and olll'r nec:essar,. ~lhdl'4lWll by us II not ~'Z:;.jed \l1IttIn 3/2 __ days, I,
Insurance. 011 workers are lu!y COIlllr&d by WOrkman's CompenS(lllon lnauranoe. ...........' .',)
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fli.1Sar.Conatruct:1on, Inc. to provide 5-ypar wsrranty 011 yorkmunl5bipi px-
._.... ..clUSi.ODS,:. ,.storm. ..damagl!, ..".ark"QI',dBmil;e, ,cione,.by..".other.8,. ...t.r:ee,dUlage, ..and/or.
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:';'/ r-i\utuhtntt J)f ':Mtop.osa! - The above prices, $p~catic".
; ~i\d conJillons are satlsaktory and hereby acceptQd. You are authorized
: ~ to do the work allllpClcllied. paVrye:r:t li11~8 made .$ outlln~d abow.
:~;~, Date 01 ,ll()ceplmoe: / 2. / 10 V
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Signature
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J I PH Je No. 2 Of::l Pa{l$$
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r 8tllte C lt1ifil:f,1 ,:,
lJullder #Ie ~C023;~1 11
Slllle C !rlltlOdl 'r ,
;~OOfer #c :COSH;S2 I
State Re ,I.torad i i
~oo'.r 8ft :0055215 'I
riel Res IIlCNd I
R,)or Con$Y llInt #014& : I
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Member of tt.. Florida
Reoting and Sheet Metal
A$~ooilltion
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i PAOPO:OAL SUP-MITTED TO
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U.S. Inrec CertifIed
Platinum In.t......
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Mil Bar Constructlon~ Inc.
Rootrlg . concnlts . ComrrwClal. R~id,",l;.J
1591 j US Hwy. 301 North · Dade City, Florida 33523 el(
3521567.6047 · 800/562.2393 . FAX: 352/567-4454
ZItltlER, KELLY
I SlFlE.."T
!
, 5750 14TH STREET
i CITY. STAT~ .no !,P CODE
I ZEPHYRHILLS, FL 33542
I~RC~~~CT .___.. J:OFPLANS
! j----vY"o hsnlby submit spect1kallcm!: and C~ijmatgs fur.
'iB. FLAT ROOFING
I,
8131188-5301
~
~.f23/0~
JOB NAME
ZII'Il'IER RESIDt:HCE
JOB LOCATION
5750 14TH STREET
.. --;JOB', 10NE
1.
Test' off and dispose of the old onliii'-laYQr roo:I1Qg sYilIt..m.
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Provide ADd mechaniaally faatli'n a Firl!t!ltoDlil' ItS f1be-rgJ ass beel!! shlillil". OVl:'r t.he
Jllyyo/;n::rU~ekptTD:ttothio> "lhSt8Ila{:ron'ci!"thi"Tlreiton,~'roii!i:r1g-'iiie;iib 'ani"" .....,.
"'3~' -,.. . Pi ov ide. and' 'Inst.aU'an'niy'"]:rlre.5'tclne'APP';;'T80-wbne;" gr.nu'li",;i!luf"fa( .-ii:ionng
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. :~\:;i:i"l~~~(}~~,"oO;~~:;U[r~::::n;.~;JO::D':J:'=~rl;~.iin ~ 9Jl~~.t..~ .~~'pr .me! p..r.!-~,~,
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'"Prciv:i.deand'i'na'lall n6>1;"26 gauge gelVan1zed "Iiji;{iJl'eave(!rfp'uaro lincf'"t.hl '
...~r.l.~!~fO'.:.~.~ thtt roof as n!!~~~._........."",,, ""'" ,,,,.,............
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GElERAl.. COIIDITIDIS
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the existing roof deck will be compl.led on a cost-pllU basisibovll' I nd lttyo.f.\d
the contract price.
. .... .-.... '."'. ....., . ....... .". ".".'."".. r'.....~.. ,..",'....... ""O"""".""'fi'_"'''''''''', '.'. ...., '''''''''''R'~''_'.'''d..."..,,,_ .,'.... ........ ~'"____".R.. _,_...._.... .. ,'''', ''" _....._..... ._....
2. ,,, ,.....~~i~{h:~~~~i~.d:o:l~-:=a~':tE..~~~~.!~~l,'~.~~~~!,..~.o. .~,g';l.!" ,~,~9~__.!~~.~hnVl.':',nJ o.,~,d_~ ~.g.. "
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{/ J\cceJ.1i'ant.e of lilrupusaL - The abo~lt PfK:es, spllclf1~tiQn.,
, I and conclkons are satl.~ory and hereby Qcc;tlp:ed, Yo\.' are authorizBd
I! IQ ~Q !he work as specified. :a~~n~19 je made 8S outlined abovll.
! Oate uf Acceptance: /2.j 'S/t) 1
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~~-li1rOJ11.1~e hereby~ furniSh' matel1al a-nd'l~bor - complete in '~cco;dance wltha!lo~e speclncati~n~ for~e s~m Ol:~!
SEE PAIU:' 'tJ.tRJ;';i;,. d liar ($ ) i
Payment to bomlldQas f (>~Jf' 0 :I _ ___, ,
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Not.. Thi5 proposal m8'f oe . J
wil~drawn by us If no! ;tOQItlplrtld witllin ~ 30 _._ -jays. : i
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1I\\IOioed iIInOU"ll. nol Pll'a in ~r.OI':h1nCIl wilh !he r.aymenl 1erms snail DC eot\Sidllllld del,o-
quenl anu bear internt at t~lC ralll or one and Ofllrhelf perCetll Der montn, 0II1'1er agreeam
p-,y iU CQ'UI inamwd. !Uctl If. atlorney "'8&, collBCtOr lees. COLl'1 cellS. efC" 101 colklction
of delinquentlnvoie"tl including intt!resl. Owner to carry fino, tornado and :>1her ne<:6S$a~y
in6Ul1lnOtl. Our worl<e~ ere fully eove~~ by Wor~Jr.lln'5 Cwnpenaalion lnauram;e.
Stgna:ure
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! I P'ROPOSAL SVaMITT!o TO
I ~i:l'~ If"ER, KELLY
i '-_ 5750 14TH STREET
, i CITY. ~le ~I'd ZIP COOE
i~ ZEPHYRHILLS. FL 335.2
i l A"ICHiTECT
II .., We h~reby !IU~"cat'~ IIml.'ma:es ~~r:
if ... ... .. 3.. ~~;::~.~~::r~~;~:;.';"';1.i_;~~;'!.~ii~;~~.D~~i~.l~:.j'r"lk.~E~~
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MlJmb~ro;ttl.F'~rida --- ~. . .. --= -jprnp.osa .~-- -." StliltCCS~lfieg =---~'\(
noofing and Sheet Metal 3uilder #( 1IC023Z21 ;:
A~socilJtlon ~ MilBar Construction Inc. ~:::~ ;:!i62 ,,1'1
u.s. mlllc Certified "ooang . ConcrB18 . Commercial . R88Il1t>nZ~1 $bite R, JI&t.rod I
Pta1lnum Installer RGa"~ ::0055215 :
.5204 lb911 US HWlJ. 301 North. Dade City, Flo~idi.l3JS23 Cc Ael Ref is....d -Jil
3521567~047 · 8001562-2393 ., FAX: 352/567.4454 Rl)Qf ConSI ltant tfl)149 I
PHON; I DATE --- II
8131188-5301 L1.lI23/e, ___,;
JOIl N.w;; I i,
ZI/'U(ER RESIDENCE -----i:
JOB~OC~no~ i
57~ 14TH STREiT I,
~P~YRHILLS. FL '~IJOBI~-==-.,...;;
I:" 01' "'-AHS
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~c Jrnp.ofit hereby to fUrnish material and labor - complete in accordance wit11 above speci'icatJons for th e SUTI of: :;
F[V[ "~'lAN~ sn HllNDRiD ~TX AlE> ~e/l0Q1,----- h____ - dollars($_ ~ 60E..QL. _).::
PByment to IN u low.: I _ ! '
h -'---1;
~.~=- ~ ,,-~?/l --J!
"
DUE UPON COftPLETION.
InvoICed Qmoum. nat paid in aGCOrdallCll wth lhe pc;rm!5n112m18 shall be eOl'lSidered delln.
quent llIl'ld llclilr inter.et. trllllll.tw of CI1II .<Xi gne.hflll pBr.:enl per mcmlh. OWn~r aQl1l8I Ie
pay .. coeb iriOUrrlld, .lAC" €IS 8lIorney fees, cg"OCll)r feel. court COIlS, ele.. tor ccll5lcton
of d8lin'lu,"f.lnI'Okl_ inofur,111191I11CrMt. Owner to Cl4l1'f ffre, laTlado and olhar IlOC8&Hry
a,sura"IC.. Our wcrken; ,"P, fully cO\ier~d by Workm;lI1', Oo.~ation Insurance,
Note:Thla pro~ '!JaY Je
wi1hdtawn I;ly U6 if no: accopted wltf,in ------.B.. __ (,;;:;)'5,
,.
'~', . .. "'. - .
,j-' -- . . ',. ,., , -.. ..
;.: l\.c.ceufnnrt Df Jl'opo.$aI - The above prir;:ell, specjfjcadOI'l$
and conJlt/ons are 8atlafaotory" em hereby accepted. You .ITEI il,llf':orlzed
10 do lhe work as specified. Pa 8 w'lf be made as OUtlined abOl/fI.
2- 5. 'd'
":~-
Data of ~ep1anc9: _
'~7~ ~----" _.- --:==:...::\"
,F,,, :i
I,
-'-- I'
, :1
.-. ~ 'I
:Jff..~~ ~:<-'~i:~~
Signature
NOTICE Ol? COMMENCEMENT
MeI 1I]fjJJJ
Jcrinit No.
'arcet l.O/roLIO II
/ / -;;< (;, ~-a 1- CO I D - 07.~QD -c)//D
1111111111111111111111 111/111111 1111/1111111111 111/111111111
2005007866
:tate of Plorida
:owlty of P4 5 c ()
THE UNDERSIGNED Ilcrcbx, give, noticc that the':'iinprovement will
c made to ccrtain rcal propcrty "ill a~~ord~hce with ampter 713, Florida
:tatues. the following illformation rs provided in this notice of
JlJUlIcncemcnl. ",
Rept: 846418 Ree: 10.00
DS: 0.00 IT, 0 00
01/13/05 "
-------- Dpty Clerk
JED PITTMAN~ PASCO COUNTY CLERK
01/13/05 11O:08am 1 of 1
OR BK 6190 PG 168
./
I
.Description of property (kgal tkscriptio1l 0/ property and address if available) .
Il ' wn h' 2.(0 {an
.Gcncral description of improvcmcnts' Jy"{; {/V P <<uC' ,
,Surcty
a)Namc and address
b)Amounl of bond
Lcnder (name and addrcss)
. I .~, .
~ . \ j,,",
"1' <;.
~
Person within thC,State of Florida designated by owner..upon who notices or other documents may be served as
'ovidcd by Section 713. I 3( 1 )(a)(7), Florida Statucs. . .
Name and address .
In addition to him or herself, oWJl~r dcsignates
to rcccivc a copy of the Licnor's Notice as provided in .section
13.l3(l )(b), Florida Statues.
Expiration date of notice of COllunenccmcllt (lhe expiration date is one year
>Ill the datc of rcc.ordillg ullless a different dale is specified). . ~4= .1 .
fATE OF FLORIDA, CMN.rn'S SIGNA'l'UHE ~_ _4~
OUNTY or po...SC..D PlUNTED NAME & 'l'I'l'LE ./ /-iroj G Z/Mh1~Y- (n.:>.~
. '
'1C f~lIowillg instrumcnt was ack.n~wledgcd before 11lC .this....)...2lay of ~, 2~ by
ho is personaUy known to lIle or,who,produccd 0t.OZt../r"1 ,?t /~ as idcntification.
fter recording, re(um~. .'. ':: .. , '" ~Olatj' Si&llalurC ~---l.P~ ~ .
amc MllBAR C CtI'~STRUCTION, INC. f\~':~' ~.atne(print)' ~ . ~ '. c; {;; ~ 6~ ' L/::""?:-
ddrcss 15911 U.S; 301 . ill lltle or rank . . ~ '+;~.n ..;~,N>..u-'O"
ity '___ ___._._ p~de City, FL 33523 _.....:-__ Serial number, if any \;"lIf Expires June 27 'no7