HomeMy WebLinkAbout05-3993
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
3993
Permit Number: 3993
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: SINGLE FAMILY RESIDENTIAL
Square Feet:
Est. Value:
Improv. Cost: 2,676.00
Date Issued: 3/18/2005
Total Fees: 67.50
Amount Paid: 67.50
Date Paid: 3/18/2005
Work Desc: WINDOW REPLACEMENTS
Address: 5831 14TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
Phone:
DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB
DUCTS INSULATED LINTEL PRE-METER WATER
SHEATHING FRAME MISC SEWER
MISC INSULATION WALL MISC MISC.
MISC. INSULATION CEILING MISC. MISC.
MISC. DRIVEWAY MISC. MISC.
REINSPEcnON 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.
~-~
_ PERMIT OFFI
INSPECnON - 8 HOUR NOnCE REQUIRED .
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECEIVED
3/i{,/o5
, ,
PHONE CONTACT FOR PERMITTING
JOB ADDRESS
Me, (" "(
t; ~3\
\ N~~\~~
14 tk.S -t.
-:r
PHONE <rll ~ 9~;) ~9 ,\C;
OWNER'S NAME
SUBDIVISION L \-\ M (S
LEGAL DESCRIPTION: LOT(S)
BLOCK S I
PARCEL ID # \ \ - :1 ~ ~ d.. \_ OeJl 0- O<l00 ' OQ Tn /OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION 0 ADDITION DALTERATION ~EPAIR 0 INSTALL
o SIGN
PROPOSED USE: ~SGL FAMILY DWELLING
o COMMERCIAL
o MOVE
o DEMOLISH
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK 1t; W~t\dc~ -' \Le_~\~ M~~~ S'; l.e h;/' S~ 2 e
BUILDING SIZE SQUARE FOOTAGE HEIGHT
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.
FORMS.
~
PERMITS REQUESTED
0 BUILDING $ ~Co-::r6 VALUATION OF TOTAL CONSTRUCTION
0 ELECTRICAL AMP SERVICE 0 Progress Energy 0 W.R.E.C.
0 PLUMBING j)S2N ;...J \. ':)
4\0 T '-{k1fS-~-'1i.
o MECHANICAL $ VALUATION OF MECHANCIAL INSTALLATION rJ... f04'"t 0 L(.3
o GAS o ROOFING o SPECIALTY 0 OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES 0 NO
STATE CERT OR REGIST #
***************************************************
ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
MECHANICAL
COMPANY
SIGNATURE
STATE CERT OR REGIST #
*****************************************************************
OTHER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
A. NOTICE 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 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 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.
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 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 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 VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
acknowledged
, 2~
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)
Dwho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
Dwho has produced
(type
and whoD did 0 did not
of identification)
take an oath.
Dwho has produced
(type of identification)
and who Ddid Qjid not take an oath
Signature of person taking acknowledgment
Signature of person taking acknowledgement
Name typed, printed or stamped
Name typed, printed or stamped
PASCO COUNTY BUILDING PERMIT APPLICATION
CENTRAL PERMITTING OFFICES: SHADED AREAS FOR OFFICE USE ONLY
· Dade City: (352) 521-5144 FAX (352) 521-5149 OCCUPANCY' SEQ#'
13852 17th St.. Dade City "
· New Port Richey: (727) 847-8126 FAX (727) 847-8901 NO. OF UNITS:
7530 Utile Rd.. Rm. 210 New Port Richey FIRE DISTRICT:
· Land O'Lakes: (813) 929-1266 FAX (813) 929-1307
4111 Land O'Lakes Blvd. (US 41), Land O'Lakes TYPE CONSTRUCTION
THIS APPLICATION MUST BE TYPED OR PRINTED IN INK DATE RECEIVED:
AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS
---------------------------------------------------------------------------------------------------------.
IS THIS APPLICATION THE RESULT OF A STOP W~K ORDER OR NOTICE OF VIOU\TlON? Y _ N_
~ OWNER'S NAME: r^-c-c '4 W, <... ~ I""", dI PHONE # (~) "1 i Z - 2 q ~ <1
g JOB LOCATION: S & ~ t \ I 4 r::II .51: SUBDIVISION: ~ H f'A... ~
a:l PARCEL 10#: s...!l.. T ~ R 3:.L SUB ~ BU< e ~-100LOT ~ PROJECT # TAl _ LOT SIZE _X_
~ OWNER'S PRESENT ADDRESS: ~- ~ ~ I '''t'il'' Crl-. CnY: 2cf''^ '( c\...~ [b STATE: j: L ZIP: 'US'"f'to
~
o FEE SIMPLE TITLEHOLDER'S NAME M other than owner):
address M applicable): CnY: STATE: ZIP:
~ ~~:~-~;;;;;-6j~-:--s-::-ij~~-~t:---~~---:;~-~~~:~~=F-----------.
g # BEDROOMS _ # BATHROOMS _' _ 'TYPE CONSTRUCTION: 0 BLOCK 0 FRAME 0 OTHER:
a:l FILL Y _N_
a IF MOBILE HOME OR RV: MAKE
~
Q.
ex: WORK CODE
o
en
w
c
PERMIT#:
II III IV
BY:
v
VI
YEAR
SIZE
FEES BLOCK
PLANS ON FILE? 0 NO 0 YES
MODEL NAME
PRE.PAlD PLANS FEES: $
PLANS FEE: $
VALUATION $
~ 7(,."""
RECEIPT .:
BUILDING: $
---------------------------------------------------------------------------------
BONDING COMPANY:
~ ADDRESS:
o
o
a:l ARCHITECTIENGINEER:
a:: ADDRESS:
w
~
o MORTGAGE LENDER:
ADDRESS: CrTY: STATE: _ ZIP:
~~~;;~;-----~:-7-----~-- -:~~--------------------------------------------
SIGNATU PHONE' I g I ~) b 1. 0 - (". ( It I
~ ADDRESS: c:> "'7 ,e . ~CnY: (' c....~ l ~ STATE: a ZIP: ~ ~ be c;
g STATE UC . nf applicable) <.. 60 PASCO CO COMPUTER 10':
...I
a:l
a::
g ELECTRICAL CONTRACTOR:
~ SIGNATURE:
.- ADDRESS:
a STATE ue # (if applicable)
o POWER CO:
CI1Y:
STATE: _ ZIP:
CnY:
STATE: _ ZIP:
ELECTRICAL
FEE: $
PHONe. (_)
enY: STATE: _ ZIP:
PASCO co COMPUTER lOt:
SAWPOLE: AMPS:
MECHANICAL CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE UC # (if applicable)
o NEW 0 ALTERATION VALUATION: $
MECHANICAL
FEE: $
PHONE. l-)
CrTY: STATE: _ ZIP:
PASCO CO COMPUTER 101:
(ReQUIred)
PLUMBING CONTRACTOR:
SIGNATURE:
PLUMBING
FEE: $
PHONE' (_)
CITY:
ACORESS:
51:&::: _ ZIP:
STATE UC # nf applicable)
# RXTURES: SEPTlC PER #
~OCOCOMPUTERIDt:
SEWER: WATER: WELL:
OTHER
BLDG.
FEE:
$
OTHER CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE UC # fIf appllcablel
'TYPE CONTRACTOR:
PHONE # (_)
CI1Y: STATE: _ ZIP:
PASCO CO COMPlJTER 101:
VALUATION: $
---------------------------------------------------------------------------------
OTHER FEE TYPE:
AMOUNT: S
RECEIPT#:
RADON
FEE:
$
$
---------------------------------------------------------------------------------
JOBS UNDER $2,500 IN VALUE 00 NOT NEED TO
RECORD AND POST A "NOTICE OF COMMENCEMENr
TOTAL BUILDING PERMIT FEE:
....NonCE....
BOTH THE OWNER AND CONTRACTOR OF RECORD (Ucense Holder) MUST READ AND
SIGN THE REVERSE SIDE OF THIS APPUCATlON
lpeIIIIrt tonn 10/91)
EomoNS OF THIS FORM RELEASED BEFORE 1191 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITIING STAFF
A. NOTICE OF DEED RESTRICTIONS
The undersigned understand that this permrt may pe subject to "deed restrictions" which may be more restnctlve than County regulations. The
underSigned assumes responsibility for comPliance with any appllcaole deea restnctlons.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake wol1<, they may be reaulred Due licensed In accoroance with state and lOcal regu-
latIOns. 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 reaulrements may apply for the Intended work. they are adVised 10
contact the Pasco County Building Division - LicenSing Section at (727) 84 7 -8009.
Furthennore. If the owner has hired a contractor or contractors, ne IS adVised 10 have the contractonsl sign portions of the "contractor Blocl<;" of
thiS apPlication for which they Will be responsible. If you. as the owner sign as the contractor. you are Indicating mat vou. rather than the contrac-
tor, are responslOle for the worle If the contractor wlsnes you to sign as contractor. that may be an Indication that he IS not properly Iicensea and
IS n9t entlVed to permitting prlVllege~ In Pasco County.
"
C. TRANSPORTATION .MPACTNTIUTIES IMPACT AND RESO!JRCE REqOV~RY FE~S, .
I The underSigned :!:lnderstand that Transportation Impact Fees and Res~U(l=e Recove,yF~s may ~PP!y to th~ construction ('If new bUildings,
change of use In e)(tstlng bUlldl~gs, orie~panslon of eXisting buildings. as Speclfted In 'Pasc~ County Ordinance numbers 89-07 and 90-07, as
amended. The underSigned also understands. that such fees. as may be due. Will be Identified at the lime of perTT1Ittlng. It is further understOOd
that Transportation Impact Fees and Resource Recovery Fees must be paid pnor to receiving a "certificate of occupancy" or final power release
If the prolect does not involve a certificate of occupancy or final power release. the fees must be paid prior to oerTnIt Issuance, Furthermore. If
Pasco County Water/Sewer Impact fees are due. they must be paid pnor to permit issuance. In accordance WHh applicable Pasco Countv ordi-
nances.
D. CONSTRUCTION LIEN LAW (Chapter 713. Flonda Statutes. as amended)
If valuation of wol1< IS $2500.00 or more. I certify that I. the applicant. have been prOVided With a copy of "FlOrida Ccnstructlon wen Law -
Homeowner's Protection gUide" prepared by the FlOrida Deoartment of Agnculture and Consumer Affairs, If the aopllcant IS someone other than
the "owner." I certify that I have ootalned a copy of the aoove descrloed 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 oe done In compliance With all applicable laws regulating con-
struction. zOOlng and land development.
Application IS hereby made to obtain a permit to do work and Installation as Indicated. I certoly -hat no work or InstallatIOn has commended
pnor to Issuance of a permit and that all work Will be oenormed to meet standaros of all laws re:J'~lat'''g constnctlon. COUllty codes. zOOlng reg-
ulations. and land development regulatlo"" In the JUriSdiction. I also certify that I understand that U,e regulations of other government agencies
may apply to the Intended wol1<. and that If 13 my responsibility to Identify what actions I must take to be In compliance, Such agencies Include
but are not limited to:
· Deoartment of EnVIronmental Protection - Cypress Bayl,e<lds. We,land Areas and EnVironmentally SenSitive Lan':ls, WaterlWastewater Treatment
· Southwest FlOrida Water Manaaemelll District - Wel!c:;. :ypres!:. Bayheads. Wetland Areas. Altering Watercources
· Armv Cores of Enameers - Seawalls. DOCkS NaVIgable Waterways
· Deoartment of Health & Rehabilitative Services EnVIronmental Healttl Umt - Wells. WastewatEr Treatment. SePtic Tanks.
· US EnVironmental Protect;onAaencv - Asbestos abatement,
;" .
. Federal AViation Authorltv - Runways,
I understand that the follOWing restnctlons apply iO tN! Lise of fill:
. Use of fill IS not allowed In Flood Zone "V" unless expreSSly permitted,
. If fill material IS to be used In Flood Zone "A" IllS understood that a drainage plan addreSSing a "compensating vOlume" will be submmed at
time of permitting which is prepared by a profeSSional engineer licensed by the State of Flonda.
. If fill matenalls 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 matenalls to be used In any area. I certify that use of such fill Will not adversely affect adlacent 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 oermlt
application, for lots less Ihan one (') 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 ot the permitting conditIOns set forth In thiS affidaVit Orlor to
commencing construction.
I understand that a separate oermlt may be reqUired for electrical work, plumbing, signs. wells, poolS, air conditiOning, gas. or other Installations
not speCifically Included m the applicatIOn.
A permit Issued shall be construed to be a license to proceed With the work and not as authonty to Violate. cancel. alter. or set aSide any provI-
sions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter reoUlflng a correction of errors In plans.
construction. or Violations of any codes. Every permit ISSUed shall become Invalid unless the wol1< authonzed by such permit is commenced
within SIX months of permit Issuance. or If wol1< authonzed by the permit IS suspended or abandoned for a penod of SIX months after the time
the work IS commenced. An extension may be reQuested. In wntlng, from the Building OffiCial for a penod not to exceed ninety (90) days and
will demonstrate Justifiable cause for the extension !f worK ceases tor ninety (90) consecutive days. the lob IS conSidered abandoned.
WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR ROPERTY IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YO NO CE OF COMMENCEMENT
SIGNATURE
--ile
SIGNATURE
---- ~
CONTRACTOR
DATE
-
.3-(0-0 ':::>
DATE
d- ~?.)-{)~
MY COMMISSI
EXPIRES
Gwinnett County
State of Georgia
My Comm. Ex ires ,Jan. 21 2 06
MY COMMISSION
EXPIRES
NOTARY AS T
CONTRACTOR
NOTARY AS TO
OWNER OR AGENT
Return to:
. Na~e: TIID At-Home Services, Inc.
d/b/a The Home Depot At-Home Services
Address: 3200 Cobb Galleria Pky. Ste.
200, Atlanta, GA 30339
11111111111111I1111I1111I11111111111I111111111I111111111111I
2005048972
Rcpl:864833
OS: 0. 00
03/16/05
Rec: 10.00
IT: 0.00
Dpty Clerk
This Instrument Prepared By:
Name:
Address:
JEO PITTMAN, PASCO COU~TI CLERK
03/16/05 10:44am 1 0109
OR BK 6273 PG
Property Appraisers Parcel Identification:
NOTICE OF COMMENCEMENT
Permit No.
Folio No.
,l-~I.o -d-.\. 0'0\ () - OS \ 00- 0 o~o
STATE OF FLORIDA ()
COUNTY OF Va.....5( .D
The undersigned gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following infonmtion is provided in this NOTICE OF COMMENCEMENT.
Legal description of property (include street address, if available:
General description of improvement:
Owner Information - name and address:
~W:d<. !""6
-"5"<6 3\ ~ t\- S+
. "'7..... f \'''.r' \.;. \\ ~ "'3 3 S- \of ~
Interest in Property:
Name and address" of fee siII1?le titleh~.~der (if other tl!an P'YUer): .
Contractor - name and address: The Home De t At-Home Services
207 Kelse Lane, Suite G, Tam a, FL 33619
Phone Nwnber: 813-630-4111 Fax Number:
Surety - name and address:
813-630-4112
Lender - name and address:
Phone
Number:
Fax Number:
Amount of
Bond:
$
Person's within the State of Florida designated by Owner whom notices of other dOalments may be served as provided by Section
713.13(1)(a}7., Florida Statues:
Name and address:
Phone Nwnber:
Fax Number:
In addition to himself, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(I)(b), Florida Statures. (Fill in at Owner's option)
Phone Nwnber: Fax Number:
Expiration date of Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified).
V ~;10~' }t)~p pi S'g"'tureofO~"
/lJa yy )J1' f//6/f/tt n cL
Printed Narne"ofOwner 1 Printed Name of Owner
jYI,4ry /t1. LV. LK fl L.i r-J 1>
Sworn to and subscribed before me by ~ who is personally known to me or produced r::' /..., D l...
as identification, and who did..ALLtake an oath, this~ day of Feb ,20i...$:.
Signature of Notary
'/?Ja...v/.. <:. t,J ~ "\.
State of Florida
\\''''''/ M k S N rth
",~~~y.~~~~.. ar . 0
~:'~'::~ Co~ission #DD246843
~~. .'~'<:~ Exprres: Se;. 26, 2007
".,1 ~ ~~~~ ... Bonde =t=i'htl
"111\\\ At1atlti(" BQnrfing ('n. lne!
Printed Name of Notary:
Commission No,/Expiration:
SeQ.# I Product Approval Numbers ~Ubmittal
Cateqorv I Manufacturer I Florida Approval #
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