HomeMy WebLinkAbout06-5876
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5876
Permit Number: 5876
Permit Type: MECHANICAL
Class of Work: AlC CHANGEOUT
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 3,862.00
Date Issued: 6/16/2006
Total Fees: 50.00
Amount Paid: 50.00
Date Paid: 6/16/2006
Work Desc: AlC CHANGEOUT
Address: 39219 5TH AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 12-26-21-0030-00100-0180
Name: MORTELLARO, JASON
Address: 39219 5TH AVE
ZEPHYRHILLS, FL. 33542
Phone: 813715-4067
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REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
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."
NO OCCUPANCY BEFORE C.O.
~~ ~.
/ CONTRACT NATU E PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-710.0020
City of Zephyrtlllls Pennlt Application
Building Department
Fu.a13-710.oo21
:'--=O'~~~~~~"~~:~Ob? I
.......- ~A f5 rfl AlE.. 2a'Ii'feJltu.<:. I 0-__1 I
Fee Simple TIlteIIoIder Name I I 0wMr Phone NumIIer I I
Fee Simple T1tIeholcIer A..,.. I I
l39aJ9611fAv~ 2ePllyel/,l{S I J:{. 3.3!J'~a.. I LOTI I I
I I PARCEL IDlJ 11:1. - c;;? b~ a J - Do 3D-- (X)/ DO - b/&DI
(OBTAINED FROM PIlllPER1Y TAlC NOTICEI
D NEWCONSTR E3 ADOIAlT 0 SIGN D MOVE 0
IlZl INSTALL REPAIR
PROPOSED USE 0 SFR 0 COMM 0 OTHER I
TYPE OF CONSTRUC11ON 0 BLOCK 0 FRAME 0 STEEL D OTHER I
DESCfUPT10N OF WORK IfI-/~ (!~ OW-
I so FOOTAGE I
I
I
Is I
IS3p~IOO I
o GAS 0 ROOFING 0 SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA
JOB ADDRESS
SUBDMSlON
WORK PROPOSED
DEMOliSH
HEIGHT I
BUILDING SIZE
o
o
o
~
BUILDING
IS
IS
VAlUATION OF TOTAl CONSTRUCTION
ELECTRICAL
AMP SERVICE
o
PROGRESS ENERGY
D
WR.E.C
PLUMBING
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
DYES
DNO
BUILDER
SIGNATURE
COMPANY
REGISTERED
Add_
ELECTRICIAN I
SIGNATURE ,
Address I
~
Y IN
FEE CURRENT
Liceme II
COMPANY
REGISTERED
~
Y/N
FEE CURRENT
License II
~
Y/N
FEE CURRENT
Y/N
FEE CURRENT
Address
License II
RESlDENllAL
AIIach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Fonns
Minimum ten (10) wormg days after submittal dais. Required onsit8. Construction Plans, Sanitary Fadlilies & 1 dump..r
AIIach (3) sets of Building Plans; (1) set of Energy Forms,
Minimum ten (10) woOOng days _ submittal dais. Required onsite, Construction Plans, Sanitary Fadlilies & 1 dumps...r
All commercial requirements must ~ oomplilWlCe.
AIIach (2) selS of Engi.-ed Plans.
"*'"PROPERTY SURVEY required for aU NEW construction.
COMMERCIAL
SIGN PERMIT
ow.:tIons:
Fill out application completely.
Owl.- & Conlraclor SlgI1 beck of application, notarized
" - S2IOO. . NotIce of Co__1I1s rwqulrecL (Ale............... $IOOO}
- Agent (for the contTador) or Power of Al1cmey (for the owner) would be someone with notarized IeIblr from owner lUhorizing same
OVER T1tE COUNTER ~ (Front of Application Only)
Reroofs s-s Service tw- A1C DriYeways Fences (PtotISUfV8ylFootage)
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake wOl1l., 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 wor1<, they are advised to contact the Pasco County Building Inspection Division-licensing Section at 727-347-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County .
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of wor1< is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify 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.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all wor1<
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 wor1< and installation as indicated. I certify that no wor1< or installation has
commenced prior to issuance of a permit and that all wor1< will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regUlations of other govemment agencies may apply to the intended wor1<, and that it is
my responsibUity to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterlWastewater 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.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use offill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a profeSSional engineer
licensed by the State of Florida.
If the fill material is 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 material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
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 permit application, for lots less than one (1)
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 of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate pannit may be required for electrical wor1<,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the wor1< 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
requirinll & correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the wor1< authorized by such permit is commenced within six months of permit issuance, or if wor1< authorized by
the permit is suspended or abandoned for a periOd of six (6) months after the time the wor1< is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. Ifwor1< ceases for ninety (90) consecutive days, the job is 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.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification,
, ethis L
~lorCJ
Notary Publi
Commission No.
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NameofN , '
~"~ SUZANNEMWATKlNS
'.\ W.6 MY COMMISSION 11 DDSJ9J56
~",,,"1fI' EXPIRES: Apr. 11.2010
(407) 311-01113 Florida NolIIry SeMce.COllI
Name of Notary typed, printed or stamped
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5878
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:
5878
MECHANICAL
NC CHANGEOUT
NOT APPLICABLE
Address: 5714 18TH T
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-07900-0120
6,727.00
6/19/2006
65.00
65.00
6/19/2006
NC CHANGE OUT
PARLAT RE,BARBARA
571418TH ST
ZEPHYRHILLS, FL. 33542
Phone: 813862-3019
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~/J~
REINSPECTlON FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
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."
NO OCCUPANCY BEFORE C.O.
~I{J& 1s t~/07Ci t'~ ~
ONTRACTOR IGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8" St, Zephyrhills, FL 33542 ,
813-780-0020 FAX: 813-780-0021 ( / _ I ell (<1-
DATE RECE IVED ~ I L / '-t'
PHONE CONTACT FOR PERMITTING
OWNER'S NAME.::B..R( blJ..i <l. PCU La. toi e..
JOB ADDRESS ~ ~ r; /<.( /t:/ f-h 8.
PHONE rt{PJ)-30/9
LEGAL DESCRIPTION: LOT(S) BLOCK
PARCEL ID # 1(-/lw-'dJ-lJdO- 07QOD-()/aD
SUBDIVISION
(ORTAIN FROM PROPF.RTY TAX NOTICE)
WORK PROPSED: []NEW CONSTRUCTION
D SIGN
D ADDITION
DALTERATION
D DEMOLISH
D REPAIR
ltINSTALL
D MOVE
PROPOSED USE: DSGL FAMILY DWELLING
D COMMERCIAL
DMULTI-FAMILY
D INDUSTRIAL
D# OF UNITS
D SWIMMING POOL
D MOBILE HOME
D OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK C/o 41 t=I-"f-('Jmd 4/0[..3 -1r) Va:!- /~ton 13S~~ 51<.u.::J
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
D BUILDING
D ELECTRICAL
$
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
D FLORIDA POWER
D W.R.E.C.
D PLUMBING
D MECHANICAL
$
(11)1- ro
VALUATION OF MECHANCIAL INSTALLATION
D GAS
D ROOFING
D SPECIALTY
D OTHER
TYPE OF CONSTRUCTION: D BLOCK
D FRAME
D STEEL
D OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES D NO
CO~C:;!t'()~SECTIQN'
BUILDER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
ELECTRICIAN
COMPANY
SIGNATURE
STATE CERT OR REGIST #
******************************************************************
PLUMBER
COMPANY
SIGNATURE
STATE CERT OR REGIST #
SIGNATURE
*********************}1***'i.l***********~~ ~.,
COMPANY H - oL aL... r-rc.:-, C!!.:~
STATE CERT OR REGIST # {!aci)SI L/ob2...
************************************************************
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
Cit~ 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
Qe 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 abandoned fora
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 DUd not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
l''l/a,me:
;:)~AK.S HUME IMPROVEMENT PRODUCTS, We.
P.O. BOX 522290
LONGWOOD, FL 32752-2290
1.-407-551-5376
2.
NOTICEOFCO~NCEMENT
FLo{Z,' D LA
'f?&D Rcpl: 1007120 Rec: 10.00
OS, 0 00 IT: 0.00 k
. . Dpty Cier
' 06/19/06 _..._._.n_
The UNDERSIGNED hereby gives notice that iniprovement will JEO PITTMAN I PASCO COUNTY CLERK
be made to certain real property, and in accordance with 06/19/06 08: 53am IpG if 1.. 171I
Chapter 713, Florida Statutes, the following information is 7171I41 2~~
provided in this notice of Commencement, OR BK ~
'1. DesCrlption'ofproperty: Oe~aldeSCription of 11- 'd(j;- ~'I_ 0010 - O?9oo - a/ aD
property, and street address if available) . .
. 51J'-1.... I'6Tir S-l. zq;heiL..h~ Us +/.. 32:D'fR ..
C,-t1d (){Lt"~~liru'~~l. PGSLf ~~4-.:;O{ l~ 1;2,lql<'/--I- IS-
J, <'J I A.f; A t \?>\6a.1~ dv"&1~1 pg
General description of improvements: -.:b..'t'p ~ ~ ~~ t\ .\ ~(Q (
State:
1111111111111111I1111111111111111111I11I11111I11111111111111
2006123752
County:
3.
Owner information
a Name and address:
b. ' Interest in property:
~ony----ptl.f la.*D(~ ~ 61/<1 /<tin :5t,
()l (1 )n€r Le~ (~L\s ?;;3~-V Z-
c. Name and address of fee simple titleholder (if other than owner):
R4
Contractor: (name and addtess)
. , '11~
~-f~Ozf/t1!(iUO;t;OVl
5. Surety
a Name and address: NA .
..
b.
Amount of bond
$
7:
<CW>- u.. ~
lQ~:t 0 ffi
C!lzcn >- .....I
zocn<c (.;)
_ W~Q I- >-
g~t: a: I-
WW~' ::::> ~
~~ . 8 W
.....<..>~~I- 0
~ou:: en :5
11-0",. - <..>
u.. <:>:c a:
~;:!:!?l-NC3
--0:1: :1:.....1
~ 0 I- C5 I- 4( 25"
Q >- ZW
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0:.-....00.....1 a:
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.....z ....ZI1. <C
q:=> ~~~
~O() ~a:4(
VI ....0 ~
a:
c
w>-
""":I cc
6.
Lender: (name & address) NA
Persons within the State of Florida designated by Owner Upon whom notices or other documents may be
Served as provided by Section 713-13(1)(a)7, Florida Statutues: (name and address) .
8.
In addition to himself, Owner designates the fOllowing person(s) to receive a copy of the Lienor's Notice as
provided in Section 713. 13(1)(b), Florida Statutes: (name and address)
ABOVE NAMED CONTRACTOR
Ex~iration date .0fNo~ce of commeJ1.cem~nt~.~~e is ~ear from the date ofre~~rding unless
a differen te IS specified) 7.t/ !L..~ ~ ~ .
. ", ~~/ '
. 9.
. (Signa ofownerk~3_0Do_n_ L/.~'.-6 :r.~Lh!:.... $-IS-03,
Drivers License #: Pt,45 - tJt I-tiS. 7~';'O '1.,Y? I ~ "'-0 <i(
awn"',Nmne ~'1?~~ 1>ARJAk~
Own"',Add=" .S7/'-I j~.s.. 2;:~k~e.l..u~
.fSsv~ c;: I ~-b~
ti"j> . 7 -0<7- 2,"(' ')
All information must be typed or printed legibly to comply with recording requirements.
1'"' }
r- ~~S4":l-
~
STATE OF FLORIDA ---:--:>
. COUNTY OF r.1lSCo ,
The forego~strument was acknowledged before me this 1.#J,..iIc.. .#b~
/ '. ~.r ,~ .
Who is P~SO~Ykn .' to or has produced t71)ffJ:vtf L,) /L as identification and who did (did not) take an oath.
/.' . . , .
"
(Signature of per son taking acknowledgement)
(Name of officer taking acknowledgement - typed, printed or stamped)
(Title or rank)
9 Expires: DEC. 15, 2008,
M9 ~')t~~.TBsjh3t:1.tuL1.. 8undlng 1..0., Inc.
(Serial number, if any)
\..' .
-'.' .
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