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Home My WebLink About11-12028 CITY OF ZEPHYRHILLS „/ ' S335 - 8TH STREET (si3)�so-oozo 12028 BUILDING PERMIT Permit Number: 12028 Address: 6420 BRENTWOOD DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: BRENTWOOD FIRST ADDITION Est. Value: Parcel Number: 04-26-21-0030-OOD00-0011 Improv. Cost: 6,200.00 Date Issued: 6/21/2011 Name: TESMER WINIFRED & DANIEL Total Fees: 70.00 Address: 6420 BRENTWOOD DR Amount Paid: 70.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/21/2011 Phone: (813)782-5151 Work Desc: REROOF SHINGLE 25 SQ A 7. r � � N TAPE JOINTS ROOF INSP FINAL �-(-[/ 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 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 k�cording your notice of commencement." + ;; ``��- � f � CON CTOR SI RE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Pasco County Parcel: 04-26-21-0030-OOD00-0011 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, June 18, 2011 Parcel ID 04-26-21-0030-OOD00-0011 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value TESMER WINIFRED B& Ag Land $p TESMER DANIEL R Land $21,326 6420 BRENTWOOD DR Building $66,719 ZEPHYRHILLS FL 33542-0621 Physical Address Extra Features $605 Physical Address N/A Market Value �88,650 Assessed (Save Our Homes) $88,650 L@Qal DeSC�iptlOn (First 4 Lines) Homestead 196.031 -$25,000 BRENTWOOD PB 29 PGS 86-89 LOT Non-School Additional Homestead Exemption -$25,000 1 TRACT D LESS COM AT SE COR Non-School Taxable Value �38,150 LOT 1 FOR POB TH S89DG 52' School District Taxable Value �63,150 22"W 7.80 Ff TO SW COR LOT TH Warning: A significant taxable value increase may occur when sold. Click here for details and info. regarding the posting of exemptions. Land Detail (Card: 001 of 001) Line Use Description 2oning Units Type Price Condition Value 1 0100 SFR OPUD 6,000.00 SF $3.55 1.00 $21,300 2 0100 SFR OPUD 43.43 SF $0.61 1.00 $26 Additional Land Information Show Mineral Riahts - 5 Acres 0.14 Tax Area 30ZH FEMA Code � Residential Code SIVLGP2 Buildina Information - Use 07 - Single Family Villas (Card: 001 of 001) Year Built 1992 Stories 1.0 Exterior Wall 1 Concrete Block Stucco 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 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2.0 Line � Description Sq. Feet Repl. Cost New 1 � BAS 1,216 $67,123 � Z � FEP 120 $4,637 3 � 336 �— $7,397 4 FOP 66 $938 Extra Features (Card: 001 of 001) Line Description Y ear Units Value � 1 � DWSWC �� 1992 �r 343 � $528 2 r CON PTO 1992 50 $77 � Sales History Previous Owner N/A Year Month Book/Page Type Amount 1992 � � 3027 / 0912 WD $20,000 � 1992 05 3027 / 0911 WD � $10,000 � http://appraiser.pascogov.com/search/parcel.aspx?sec=04&twn=26&rng=21 &sbb=0030&b... 6/21 /2011 �� City of Zephyrhiils Permit Application Fax-813-780-0021 Buiiding Department Y� � � 1 `� - (� C� �'� -C .� ( ( @�te Received Phone Contact for Permittin9 � ��0� _ Owner'sName �� Vt �� --� (.(t ��. t`Q��1� OwnerPhaneNumber �� / Ol�'�( 5 Owner's Address �(� ��✓7�'C,IJC�C;� �Y - Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS � lr ,'1 GIX� � - � !� t ( � S ��c� LOT # �� SUBDIVISION r'��1 , PARCEL ID# O`C �O� �"— � � � QQ t (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR e ADD/ALT � SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE O SFR � COMM � OTHER S .(Z TYPE OF CONSTRUCTION [� BLOCK Q FRAME 0 STEEL Q DESCRIPTION OF WORK IT lrC�'� Q� O�S S t✓1 I� S BUILDING SIZE � SQ FOOTAGE �� HEIGHT �BUILDING $ /' �� U, VALUATION OF TOTAL CONSTRUCTION IQ DELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. �PLUMBING $ 2 � Z� QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION ',' � � QGAS � ROOFING Q SPECIALTY 0 OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER COMPANY SIGNATURE � REGISTERED Y/ N FEE CURRE� Y/ N Address C ' License # ELECTRICIAN � COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address � License # PLUMBER � COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # f`' ` ' OTHER F COMPANY OQ�t � � SIGNATUR +�' REGISTERED Y/ N FEE CURRE� Y/ N Address �jC; � J J� � S �7 �( License # �C �� S�S RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy FoRns; 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 Wor1c Permit for subdivisions/large projects COMMERCIAL Attach (3) comptete 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 8 Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over 57500) ** Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter fram owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A!C Fences (PIoUSurvey/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. Fu�thermore, 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 IMPACTIUTILITtES 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 Transportativn 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 finai power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees a�e 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 regutations of other government agencies may apply to the intended work, and that it is my responsibi�ity 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 8 Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos abatement. - Federal Aviation Authoriry-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 1 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 F0,�2 IMPROVEMENTS TO YOUR PROPERTY. IF YOU TEND TO OBTAIN FINANCING, CONSULT WITH YOUR LEND R OR AN ATT Y BEFORE RECOR G OU NOTICE OF COM N MENT. FLORIDA J RAT (FS,,.S. 7.03) � , � OWNER OR A �'� ^ � CONTRAC '��! Subscribed and sworn to (or affirm before me • Subscribed and swom to (or afflrrme efore"ine this� "-"' by _ by _ Who islare personally known to me or has/have produced Who is/are personally knovm to me or has/have produced as idenUficaBon. as identification. Notary Public Notary Public Commission No. Commission No Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped � �� tJ�se— �, ��5�� =;;; � � a.�::�rJ � �.-� `p �� R;� �5;�� iG 1�� i. �r' A Divisiun of Ry�i�an Construction, Inc. ��. �� ti� b� o/� Proposal # �� V� iNC. 36413 SR 54 • Zephyrhills, Florida 33541 y� ��"� Estimate #(�� Phone: 813-782-6094 • Fax: 813-788-6773 ��_ �� a� License # CCC 1325505 Job #� �� 9 W;�;��'j�-�'yi�� Also, Serving tF�e Central and East Coast of Florida �7r�t�3� Customer: (�t� 1/1 �7 Te.GX �� M� Date: ��lD� �� aa��5�: �0�-1�,-t� � r�•'r l,�orx� D r, c�t ZZ.�h�r �. ,' �� S z�p: s 3 � s�a Honie #• O�3 1 �8a' � �S1 Cell #• Business #• L-mail Acicli•ess: — l�(;omplete te�u� off of existing s t� � �� Additional Items: , k �O ��'� �Secure all 1o��5e roof decking as needed according �o.C..�C. \Uw►'nuw� � ; to Florida Building Codes �j � o j�'�" � r �� of dried in with QP�e..� 3S��GK SLILR f .�S". !10'�r i n \ ` �lI�stall new valley nletal with galvanized nletal -}-�:S SC�, o� L�bI^��1V'O ^�at�To,n� ,e,� ❑ Install all new " dtlp edge coloi�: T�x�.er� r+�r.�,�� .� �. e.l t� �•, C t.�� _ �iistall all new lead boots _ 01 S�_�S ��istall all new j�_T yeaa� fiingus-resistant shingles �;��Z\�r' �,�t��c�wJ (�t/c� l�hiiiglebt•an��/color•:C-�A�/��'. T�M�je��(1�� O yrC� l�bO.r Wa.rrantyPackage. �All roof i•elated debizs t•emoved from job site Total bid price $ d oZOO_ �� All niaterials, laboi• and peimits fiu•nished � Ext_ra l�"t�ad plywood re�>laced at a cost of �� per sq. ft. ni the roof field. All other wood work/additional labor, such as, but not liuiuted to, valle5 rebitilding, rafter replacement, etc. will be a rate of $SS' .�v per man hour plus the cost of materials. TiiIS BECOMES A BINDING CONTRACT UPON ACCEPTANCE OF PROPOSAL. PURCHASER ACKNOWLEDGES RECEIPT OF A COPY OF THIS CONTItACT. 1. All n�aterial is guaruiteed to be as specified zu�d completed'ui a substanti:il workntatilike manner. 2. All ugreements contuigent upon strikes, accidents or delays beyond our control. Owner to cany fire, hurricane and other necessary insurance upon above work. 3. Labor w�ura��ty does not cov��r da�uage to roofs caused by light�u�ig, hiuricane, tonudo, hailstonn, impact of foreign objects or other violent storm or casualty daniage to roofs due to settdeillent, clistoltion failu�•e �n• cracla��g of roof deck, walls or f'ou�ldation of a builcW�g. 4. Workm:ui's compei�sutiun a�ul �ublic� liability u�sur;uice on above work to be taken out by Rl'NIAN ROOFING, INC., a Division of Ryman Coi�struction, Inc, or it's subcontractois. 6. RYMAN HOUFING, INC., a Divi�ion of Rynuui Coiut�-uctioii, lnc is not respoiulUle to provide uiy materials or to perfonn any work other than what is described above. Replacement of deteriorated decldng or fascia bozuds, i� not included and wili be cli�uged as an eactra �uiless otheiwise stated herein. ti. This contract is subje�t to tin.�l approval by RY11-IAN RUOFING, INC., a Division of Ryman Const�uction, Ine. and is the entire a��eement of the parties a�1d no otlier written or other forn� will recog�tized. 7 A charge of 1.5"ro will be madt un �ill uiipaid balzuice� after 3U days, plus �liarges uicml�ed for non-payment procedures, plus attoiliey's fees. S. A 4% prucessulg fee will be aclded to all creciit ��ard ordeis. Ity►nau Roo6ng, Inc., a Divisiuit of Ryman Construction, Inc. will iiot be responsible for axiy dan�age to septic taziks, sod, stu•ubbery, paint, satellite signal loss, sprinklers, concrele diives or tuiy underground pipi�ig. Yaymetit Scliedule Payment Method: r Acceptance of Proposal STATUTORY NOTICE REGARDING CONSTRUCTION L.IENS: ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB-SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOU12 CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR NIAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SEKVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PRO�ECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS 1VIADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A"NOTICE TO OWNER". FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED 1'HAT YOU CONSULT AN ATTORNEY. I ACCEPT THIS P AL AN EREBY CE ' FY THA1' I HAVE READ AND F[JI.LY UNDERSTANll THE PROVISIONS OF THIS CONTRACT. Purchaser: , Date: Purchaser: Estimator: iii�iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii� - � � 2031094767 •- ' NOTICE OF COMN�NCEML+'i��t STATE OF Ft.ORIDA COUNTY OF Pasco THE UNDERSIaNED hereby gives notice tt�at improvemant will ba mede to catain real proporty, and in accordance with Chapter 713, Florida Statues, tha following information is provided in this Notice of Commancement 1. Descriptioa ofPropcuty: P �No. o�l-a6 al " �(7.3(7 — (°�0�00 — bOl � (�L/�c'� i3 r.�r� ��rr� fJr . Z.er�h.r�- i tl S Fc. "53SCF� (�ren��c�.r.c'.�- P6 o2q P6-S '� 6- Lo t l Tvuc�`- � C.e ss CC�w1 /4-T s� Co/Z ,� l.o�f- l-�oK �E3 �rN SBq Qo- sa-' aa'�w-�.$o Fr 7o sw co2�- 2. Gene 1 Descripti of Improvement: �� Y� 3. Ownor Infocmation: Name: 2�- •�— � IJL. 1< <'✓1�Q� Addross: ' City Z Stats �=C� Zip codo 33 S�f `c� ' Interest in ro ,� el �►'►.��5 Name of.Fea Simple Tittlaholder: If other than owna: Addrass: City Stste Zip Coda 4. �ontractor: ��1�_ �-oc��'i��v� � �i3-?�a j ddress: 3C+41 .� R. 54. Zeohvrhills. 3�54Y _ __ __ �. 3ure Name j�[A � p �� R�Pti:1374048 R�e: 30.00 tY� D5: 0.00 IT: 0.00 � Addresa 06/21/11 C Cook, Dpty Cl�r � City State Zip Code ' Amount of Bond: S �. I..snder: Name 1�ILA Phone # � _ Address . ---- PRULR 5 0'NEIL,Ph DSPRSCi CLEORf� cOhPTROLIER _ City State 06/21/11 ��I"j P � 1 - � OR BK b�� '�. Persons within the State of Florida desi�ated by own� upon whom nouces or othor documonts may be served as provided by Section']13.13 (1) (a) ('n, Florida Statutes: � � Nama 1�1LA Phone #' ' Address � City State ' Zip Code $. In'addition to himsel� Owner dosi�atea: 14LA � of Phone # to recaive a copy of tho Liertor's Notice as , provided in saction 713.13(1) (b), Florida Statutss. ' ¢ Y 9. Expiration date of Notice of Commencement (tho expirati.on date is ona (1) year from the date of rocording unlass a O � w�� W w : different date is apocifiod.) � t °� z�� >- � _ i � U cn � O �-- WARNINC3 TO OWNER: ANY PA�TS MADE BY THE OWNER AFTER Tf� EXPIRATION OF THE �� o� �a `" � w 1�10TICE OF COMMENCEMENT ARE CONSIDERED• IMPROPER PAYMENTS UNDER CHAPTER'713, �- '� w � o- � �ART I, SECT'ION 713•13' FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYINd TWICE FOR � o� o Q 0� �MPROVEMENTS TO YOUR PROPERT'Y. A NOTiC$ OF COM1vIENCEMENT MUST BE RECORDED AND �,,� LL� c� v �OSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION: IF YOU llVTII�iD TO OBTAIN �� o o� � �INANCIN(�, CONSULT WITH YOUR LENDER OR AN A`ITORNEY BEFORE CO1vIlvIENCING WORK OR O� n- w � �� iECORDING YOURNOTIC OF COMMENCEMENT. `�. i� c� z w r ' i7�ec.t'� �~~-j ..J Signature of Owner. Printod Name /171 /�'/L°I� � ti u � �'1 .M ,�� : � F— tY a. d� W '- � � LL STATE OF FLORIDA `,,{, ��',:�,,. � v O p n? courrrx �F P�� ,� �,.. _.�;: � r� � o ; ,�t ,. :� � eO � ?�'ha foregoing instrumont was ac1Q►owledgad bafore me this _� day of �_� '° ; 20 «aoiiaU kno�vn � w�n Q� w c�,,, .,; t to ma or who produced idmtification, and who did/did not taka aat6 (ploasa circlo which) :'�.-;t�t ar � S dnaa ' ; a � � Q > r a''' t- _ � Z �- � ;P� AA6Uar. kort�nr f/� I— F— �� (3. m '� �yCornr�'r.uu�� JD7S3810 Notary Public• My Commissioa Expires: �► � �wref �rrn:� ' -. -* � Undar penalties of p�jury, I doclare that I have read the foregoing Notico of Commoncomeut�and lhat the facts :st�tGd in it are frue t ba Cof my knowladge and balief. " �•••�• L �� / �.SIE[l8hli6 QWt1Cf .Sl�,lllil$ AbOVO� a,: �� ,� Y , 7