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HomeMy WebLinkAbout09-9171 CITY OF ZEPHYRHILLS • 5335 - 8Th STREET (813)780 -0020 9171 PLUMBING PERMIT Permit Number: 9171 Address: 4749 5TH ST Permit Type: SEWERLINE REPLACEMENT ZEPHYRHILLS, FL. Class of Work: SEWERLINE REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: MOORES FIRST ADDITION Est. Value: Parcel Number: 14- 26 -21- 0010 - 03500 -0030 Improv. Cost: 2,200.00 Date Issued: 5/28/2009 Name: MATHEW, GEEVARUGHESE & ANNAMMA Total Fees: 41.00 Address: 4749 5TH ST Amount Paid: 41.00 ZEPHYRHILLS, FL. 33542 Date Paid: 5/28/2009 Phone: (646)416 -4476 Work Desc: INSTALL SEWERLINE FROM HOME TO CITY LINE 04 3z '€ €fit b.E ...... `:3 ... 4,604 4 - pi epah Clecu•� SEWERLINE 41.00 0 7< fr=z R €' a. • < 4- , aa„ tE VA. >. v°v5'e`.7 FINALI REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one 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 a 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 Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances 2i CON RACTOR PER OF I. PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO ► CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER • d 4 „ aai 9 1 J e - — , ,'",,;',,1-.,' . r te£ �;" &z Ytc MAY -27 -2009 WED 03:36 PM COMMERCIAL INS SPECIALST FAX NO. 1 813 949 5583 P. 01 DATE (MM(DDP( 1Y) ACORQ,. CERTIFICATE OF LIABILITY INSURANCE 5/27/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION COMMERCIAL INS SPECIALISTS INC HOLDER. THIS CERTIFICATE NOT AMEND, EXTEND CERTIFICATE PO8 17738 ALTER THE COVERAGE AFFORDED EY THE POLICIES BELOW. Tampa, FL 33682 NAIC� (813) 949 - 0481 INSURERS AFFORDING COVERAGE INSURED MARK WILLIAMS & INSURER A: p,�]Tp- WNERS INSURANCE CO. ABOUT TIME PLUMBING & DRAIN INSURER B SOUTHERN-OWNERS INS . CO . __ CLEANING, INC . INSURER C: — 26312 TWIN PINES CT. INSURER D. I ZEPHYRHILLS , FL. 33544 INSURER E' COVERAGES THE ANY REQUIREMENT, TERM OR CONDITION OF BEEN A ANY CONTRACT OR OTHER DOCUMENT WITH WITH RESPECT WHICH THIS CERTIFICATE MAY BE NOTWITHSTANDING ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS PO ICy EFf`EC77IVE POLI�YEXPIR II p'L POLICY NUMBER DA�E(MMIDD/YY1 DATEIMMIOD NY LTII INBRD EACH OCCURRENCE s 1,000,000 1 GENERAL LIABILITY ' DAMAGk (O RENT tU PREMISE iEa o urencc) $ 50,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any One Person) S 5,000 I CLAIMS MADE OCCUR B 062312 20715113 01 °18 -09 01 -18 -10 GENE>� AGGREGATE $ 2 , 000 , 000 PRODUCTS - COMPIOP $ 2,000,OOO GEN'L AGGREGATE LIMIT APPLIES PER J l POLICY I X jfC EI LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 X ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Perperzon) SCHEDULED AUTOS A HIRED AUTOS 46- 677-563 -00 01 -18-09 01 -18 -10 BQ0LVINJURY $ (PomoWent) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY- EAACCIDENT S GARAGE LIABILITY EA ACC $ OTHER THAN — � ANYAUTO AUTO ONLY' A GO $ ` — EACH OCCURRENCE S EXCESSrt1MBRELLA LIABILITY AGGREGATE S 7 OCCUR — CLAIMSMAPE S $ • DEDUCTIBLE s RETENTION S WGS ATU- R l F 1 IDTH- TORVIIMI1' WORKERSCOMPENSATIONANO E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY aOP vR1ETORa' E vE E.L. DISEASE - EA EMPLOYEE $ OFFIC IX� AITNER E Ilyes describe 6, L. DISEASE •POLICY LIMIT $ SPECIAL PROVVISIO ISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES I EXCLU SIONS ADDEO BY ENDORSEMENT! SPECIAL PROVISIONS MARK WILLIAMS LIC# CFC1426963 CERTIFICATE HOLDER ----. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF ZEPHYRHILLS DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAiO DAYS WRITTEN 5335 8TH STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 2EPHYRHILLS, FL. 33540 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE A il FAX 813 - 780 -002 ( ®ACORD CORPORATION 1988 ACORO2$(2001108) MAY -27 -2009 15:48 From: To:813 780 0021 P.1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE I 05/27/2009 PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N0 RIGHTS UPON THE CERTIFICATE Risk Concepts Corporation HOLDER. THIS CERTIFICATE DOES NOT AMEND,, EXTEND OR 410 43rd Street West Suite N ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bradenton FL, 34209 INSURERS AFFOROING COVERAGE NAICtf • 171 . INSURER A: Southern Eagle insurance Company Administrative Concepts Corporation INSURER U: Uoyda of London • AA- 1122000 406 43rd Street West INSURER C: Aspen Reinsurance AA. 1 120337 , Bradenton FL, 34209 INSURER D: Max Re Bermuda AA 3190829 INSURER E: Odyssey Re 235130 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT , TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE° OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADcYL POUCY!PP!CT1V! POLICY EXPIRATION LTR INSRD TYPE OP INSURANCE POLICY NUMBER DATEfee/DO/W) DATE(MMIDDIW) OMITS GENERAL UABILTY EACH OC(u RFNCE S — • COMMERCIAL GX:NG LIAlil4I IY eR uISFC, (Fn nmwrmrn) $ 1 CLAIMS MADE 1 (OCCUR MEU EXP (Any ens pence) S l HhKSONA. d, ACV INJURY 5 ..._, GENERAL AGGREGATE S GEN T. AGGREGATE LIMIT APPLIES PER' PRODUCTS COMPrOP AGG $ POLICY ELECT nLOC ` AUTOMOBILE UABIUTY COMDINCD SINGLE LIMIT ANY AUTO (Eu aCtiderd) S r ALL OWNED Au1OB BODILY INJURY W ' (PPr Pommel S SCHEDULED AU'10S MIRED AUTOS BODILY INJURY • NON - OWNED AUTOS (Per 5 Per a PROPERTY DAMAGE (Par uLVdwil) OARAOE UABIUTY AUTO ONLY-EA ACCIDENT S R ANY AUTO OTHER THAN CA ACC $ AU I0 ONLY: AGO S • EXCESS/UMBRELLA UABIUTY EACH OCURRENCE $ D OCCUR ❑ CLAIMS MADE AGGREGATE $ R 5 R S RETENTION 5 5 WO RKE YE RS C AND x C S OTM- A EMPLORS' L,AtllLm v1 WCO272682 -00 01/01/2009 12/31/2009 1 W U= TORY LIMITS 1 I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT S 1.000,000.00 OFPoCEWMI:MBER ExCWDCOV F 1 DISEASE -QA EMPLOYEE S 1.m0,000.0o If yes, describe under SPCCIAI PROVISIONS below C.L DISEASE - POLICY UMT S 1,000,000.110 OINot Please note that Southem Eagle Insurance Company has reinsured it's liabilities in excess of 5250,000 under the policies of 8 C Workers Compensation insurance listed above with the committers listed A - or better e( the time of p(a cement of such reinsurance. Such reinsurance ere subject to their own terms, conditions and times. This is far lnrermeBenaf purposes end 00(0109 semi create any right D E Excess Coverage under suCb reinsurences, DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ENedive 09/04/2006 023744 Coverego is extended to the leased employees of alternate employer (Florida Operations Only): About Time Plumbing 8 Drain Cleaning, In DISCLAIMER: This Certificate of Insurance does not constitute a contract between the Issuing Insurer(s), authorized ropresontotive or producer, and the certificate holder, nor does it affrrnilively or neoatively amend, extend or alter the coverage afforded by the policies listed thereon. CERTIFICATE HOLDER CANCELLATION :MOULD ANY OF THE ABrVE OEfr'.R1AE0 POU(Es BE CANCELLED BEFORE THE ExpIR•TInN City of Zephyrhills DATE THEREOF, THE ISSUING INSURCR WI LL ENDEAVOR TO MAIL 30 OATS WRITTEN NOTICE TO Tut CERTINCAT! HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 60 SHALL 5335 8th Street IUPOBE NO OBLIGATION OR LIAUILIrY OF ANY IUNO UPON THE INSURER, (Iii AOCNI'S OR Zephyrhills FL, 33540 AUTNORIZED REPRESENTATIVE Fax# (813) 780 -0021 j.) ° ""� ....4-J, - b.—. ACORD 25 (2001108) 446 - 20090527 © ACORD CORPORATION 1988 Pasco County Parcel: 14- 26 -21- 0010 - 03500 -0030 001 Page 1 of 2 Search Again Show Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes Other Agency Data: Tax Collector School Board Supervisor of Elections Data Current as Of: Weekly Archive - Saturday, May 23, 2009 Parcel ID I 14- 26 -21- 0010 - 03500 -0030 (Card: 001 of 001) Classification I 01 - Single Family I Mailing Address Property Value GEEVARUGHESE MATHEW & Ag Land $0 MATHEW ANNAMMA Land $44,796 4749 5TH ST Building $64,537 ZEPHYRHILLS, FL 335425734 Extra Features $1,938 Physical Address 4749 5TH ST Market Value $111,271 ZEPHYRHILLS, FL 33542 -5735 Assessed (Save Our Homes) $0 Legal Description (First 4 Lines) MOORES FIRST ADDITION MB 1 PG Taxable Value $111,271 57 LOTS 3 & 4 &NORTH 20.34 FT PF LOT 5 OR 6463 PG 698 & 700 Land Detail (Card: 001 of 001) Line II Use IlDescriptionl) Zoning II Units II Type II Price I Condition 11 Value I 1 II 0100 II SFR II 00R3 II 15,885.00 II SF 11 $2.82 II 1.00 II $44,796 1 I Additional Land Information I I Acres II 0.36 II Tax Area II 30ZH II FEMA Code II -- °Residential Code I ZHLGLP7 Building Information - Use 01 - Single Family Residential (Card: 001 of 001) I Year Built 1962 Stories 1.0 Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall 1 Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 None Fuel Electric Heat Forced Air - Ducted A/C Central Baths 1.0 Line I Description II Sq. Feet I Repl. Cost New 1 I BAS 111 960 1 $53,549 2 1 FAA II 322 1 $12,551 3 1 FEP II 573 1 $22,368 4 1 UOA 11 45 I $390 5 1 UEP 11 148 1 $4,128 6 1 E II 303 1 $4,239 7 I II 40 1 $558 I Extra Features (Card: 001 of 001) I Line Description Year I Units Value I 1 DWSWC 1977 1 300 $315 I 2 CLFENCE 1977 I 900 $317 1 3 FIRE PL 1979 1 1 $495 4 UDU -M 1989 1 1 $140 1 5 CLFENCE 2003 L 560 $671 I Sales History I http: / /appraiser.pascogov. com/ search /parcel. aspx ?sec= 14 &twn= 26 &rng=21 &sbb= 0010 &b... 5/28/2009 813- 780 -0020 City of Zephyrhills Permit Application tr 9/1/ Fax- 813 - 780 -0021 Building Department Date Received t - 1 6 4 4 Phone Contact for Permitting -- 111111111111ItILILY Owner's Name /44,1 � i # 7!, / /4, ui 4' t c Owner Phone Number 6'i4 -4 zit/ 7 4' Owner's Address / 1- 2 6 ,,,,,/ , z%/- -Sr��(,✓ � 9 - Aj / Owner Phone Number I Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address - - ii ' ' ^ / 11:0,..... JOB ADDRESS L / 7 (i cc- L S't _ 71,47 /Ar //j r l . e.rL/ Z LOT # SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD /ALT n SIGN I 1 MOVE 1 1 DEMOLISH INSTALL REPAIR PROPOSED USE SFR I I COMM I 1 OTHER 1 I TYPE OF CONSTRUCTION BLOCK /� 1 1 FRAME I I STEEL 1 1 OTHER 1 I DESCRIPTION OF WORK S'�w« 1 &'i - 4-&v , / h ‘ `c izU e !� / BUILDING SIZE SQ FOOTAGE H EIGHT I I BUILDING $ VALUATION OF TOTAL CONSTRUCTION I 1 ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY [ W.R.E.C. PLUMBING $ 2 ,2- 0 D„06/ I 1 MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION I I GAS I 1 ROOFING I 1 SPECIALTY I—I OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I YES ri NO BUILDER / , COMPANY 4 , , - �� �' ,• ,/ SIGNATURE V Prri-' REGISTERED Y/ N I FEE CURRE . I Y / N I Address ( - ' ° r • - . License # LEE / ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT 1 Y 1 N 1 Address 1 License # PLUMBER COMPANY t4 7j✓4►�' / /vY , ' 4-, /,:, C 4 1�{-� SIGNATURE _Ai__ REGISTERED Y/ N FEE CURRENT I Y/ N J Address I 1 License # C FC /' /Z 6. 94.___.? MECHANICAL COMPANY SIGNATURE REGISTERED I Y / N 1 FEE CURRENT I Y/ N 1 Address License # OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/ N I Address License # I RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. * ** *PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000) ** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades A/C Fences (Plot/Survey /Footage) Driveways -Not over Counter if on public roadways..needs ROW 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 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 Pasco County Building Inspection Division — Licensing Section at 727 -847- 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 work 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 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, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government 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 Protection - 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. - US Environmental Protection Agency- Asbestos abatement. Federal Aviation Authority- Runways. I understand that the following restrictions apply to the use of fill: Use of fill 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 permit may be required for electrical work, 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 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 codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work 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. If work 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 ��/�.�/ 2 __ CONTRACTOR Subscribed and sworn to (or ffirmed) before me thls Sitscribed and swo O (or affirmed) before me this . -2f'rO7 by (Y) 11 c4a -r-- Z — (.1 by �/ k w ) ) 4-0--1 Who is /are personally known to me or has/have produced Who Is /are p rsonaily known to me or has /have produced I CQex. as Identification. - o �_ as identification. 1 • I JACQUELIN • , ` L Notary Public �- Notary Public c • G Notary �J 1 Comm sion, .. II ID • 1833 Commiss No. U1rP i �r pCOIIELINEBQGES =_ = Commission DD 6 21833 " Expires December 1 8 0 0.3 g&7O19 E y r a DPCember 12, 201 Name of Nota" "'ned, printed or stamped Name of Notary typed ,' d ntajp 1 ° Fran ce 8 04 -3Bb N1