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Home My WebLink About11-12030 CITY OF ZEPHYRHILLS ✓ 5335 - 8TH STREET . " (si3)�so-oo20 12030 BUILDING PERMIT Permit Number: 12030 Address: 6458 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-OOD00-0070 Improv. Cost: 5,750.00 Date Issued: Name: KELSEY, VICTORIA LEIGH Total Fees: 65.00 Address: 6458 BRENTWOOD DR Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542 Date Paid: 6/21/2011 Phone: (813)783-4214 Work Desc: REROOF SHINGLE 25 SQ 5. � ��:,�_. �� J �.. , � TAPE JOINTS ROOF IJV SP FINAL 'f-/'�( 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 � 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 ording your notice f commencement." � , � � , � .- �.-�'�---i_u. �i CONTRAC SIGN U 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-OOD00-0070 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, June 18, 2011 Parcel ID 04 (Card: 001 of 001) Classification 01 - Single Family Mailing Address Property Value KELSEY VICTORIA LEIGH Ag Land �p 6458 BRENTWOOD DR ��d $13,889 ZEPHYRHILLS FL 33542-0621 Building $64,787 Physical Address Extra Features $1,678 6458 BRENTWOOD DR ZEPHYRHILLS FL 33542-0621 Market Value ;80,354 Assessed (Save Our Homes) �79 738 , Homestead 196.031 - $25,000 Le4al DeSCriDtion (First 4 Lines) Non-School Additional Homestead Exemption -$25,000 BRENTWOOD PB 29 PGS 86-89 LOT 7 TRACT D Non-School Taxable Value #Zg�7gg OR 4297 PG 693 School District Taxable Value ;54,738 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 3,912.49 SF $3.55 1.00 $13,889 Additional Land Information Show Mineral Riahts - 5 Acres 0.09 Tax Area 30ZH FEMA Code CX� Residential Code SIVLGP2 Buildina Information - Use 07 - Single Family Villas (Card: 001 of 001) Year Built 1992 Stories 1.0 Exterior Wall i 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.p Line Description Sq. Feet Repl. Cost New � 1 BAS 1,216 $67,123 � FGR 336 $7,397 3 FOP 66 $938 4 FSP 120 $2,318 Extra Features (Card: 001 of 001) Line Description Year Units Value 1 DWSWC 1992 343 $528 Z FIRE PL 1992 1 $1,073 3 ON PT 1992 50 $77 —� Sales History Previous Owner KELSEY DAVID W& Year Month Book/Page Type Amount 1999 � p9 � 4297/0693 � �p 1992 li � 3089 / 1596 WD $82,900 1992 0� 3047 / 1485 WD $10,000 http://apprais�r.pascogov.com/search/parcel.aspx?sec=04&twn=26&rng=21 &sbb=0030&b... 6/21 /2011 si3-'�°-°°z° City of Zephyrhills Permit Application Fax-813-780-0021 Building Department `��i �-- �-x � - 5 ��t Z v� Date Re�.�ived _ 7. � '-' � Phone Contact for Permittin j Owner's Name � �C. Y' 1 p� ( � � lS � Owner Phone Number 3 g 3��a � Owner's Address �J`"� 5 � r�✓l�C.l.)C?C3G'� �Y� - Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS b� �� P J �_ LOT # �� SUBDIVISION �✓'� C,iO�_ , PARCEL ID# �� G��Q�p` �'�,3 ` 1j Q -�Q �(� (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT 0 SIGa �] Q DEMOLISH INSTALL 8 REPAIR �pp'�- PROPOSED USE Q SFR � COMM � OTHER S y� � TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WORK ��C� �- y� ��G p� �j 6 Ly1 ��S BUILDING SIZE SQ FOOTAGE �O C7 HEIGHT �BUILDING $�� rJQ VALUATION OF TOTAL CONSTRUCTION �ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W,R.E.C. QPLUMBING $ QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION �GAS � ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address ' 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 # OTHE ` • '° COMPANY �Ci� QQ \✓� ""t-►' ?L- � SIGNA REGISTERED Y/ N FEE CURRE� Y/ N Address �c7�- � S� � 1� yl l( l S � 3� S�-( � License # �- SSD 5 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Bullding 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 8 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 submlttal 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 requlred for all NEW construcUon. Dlrections: Fill out application completely. Owner 8 Contractor sign back of application, notarized If over $2500, a Notice of Commencement is requlred. (A!C upgrades over s7500) ** Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from 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. 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 finai power release. If the project does not involve a. cer#ificate 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'SIOWNER'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 8� 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 T_WICE OR IMPROVEMENTS TO YOUR PROPERTY. IF YOU NTEND TO OBTAIN FINANCING, CONSULT WITH YO L ER OR AN A NEY BEFORE RECORDING YOU NOTICE OF CO NCEMENT. FLORI JURA . .117.03) � OWNER CONT Subscribed a wom to (or a d) before e t' Subscribed and swom to (or a rm d) before this by b y Who is/are personally known to me or has/have produced Who islare personally known to me or haslhave produced as idenUfication. as identification. Notary Public Notary Public Commission No. Commission No Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped � ,,,. ;��; � - '}�� • �� '. , ��. , A Division of Ry�nan Cofistruction, Inc. Px'oposal # � s�� iNC. 36413 SR 54 • Zephyrhills, Florida 33541 Phone: 813-782-6094 • Fax: 813-788-6773 Estimate # ��'� License # CCC 1325505 Job #� � a � '�'�'��-�t'�i"1►-II�+i�� Also, S�rving the Central and East Coast of Fiorida ��s�� Customer: �rG-�pr�. �'�SQ7/ Date: ��3 �/ I' Acich�ess: ,�� R ��` � L�r c�ty:�1�-Ir1r. � �LS z�p: 33sy1 F�ome #. . 1 3- 7 �3 -�a��{ Cell #: Business #: �-inail Address: _ �.�2oniplete tea.r off of e�sting �� ; r,c�S Additional Items: �� `Z["�' O� /b.L�J �Secure all loose roof declang as needed according _$;_��q��,�_�5,�� G �� to Floi•ida Building Codes ��` �� V �� Ge�Roof ciried in with '�30 ��tk �nsi a11 new ��a11ey metal with galvanized metal ��,; nq �� j• � a � r p C�'�istall all new �__" drip edge color: j�1, ��. �istall a11 new lead boots `',' R ''� ^ °`�""'^�''�'^ �_ }�stall all ne w� y�:� �Ilgus-resista.nt shingles �,y'Stiingle brancUcoloi° �-,,Q�/F ��c"T:r��er,�n� �D f 0 « Waxranty Package. �All roof relai:ed debris removed from job site �.�i�All materials, labor and peiznits furnished , Total bid price $ J � E��tr��a� �Bad plywuod replaced at a cost of $ �. 5`O per sq. ft. in the roof field. All other wood work/additional labor, such as, but not lintited to, valley rebtulding, rafter replacement, etc. will be a rate of $SS• � per man hour plus the cost of materials. T�IIS BECOMES A BINDING CON1`RACT UYON ACCEPTANCE OF PROPOSAL. PURCHASER ACKNOWLEDGES REC�IPT OF A COPY OF THIS CONTR,AC1: 1. All niaterial is gu:u�anteed to be as specified and completed in a substantial worlmtanlike manner. '�. All ap •eements contuigent upon strikes, accidents or delays beyoi�d our conti•ol. Owner to caz•cy fue, hurricane and other necessary insurance upon above work. 3. I.��oi• w;u•r�ity dues not covar d�miage to roofs cai�sed by liglit�iuig, }�m�•ica�ie, tomado, hailstonn, impact of foreign objects or other violent storm or casualty damage to roofs due to sett7en�eiit, distoi•tion f'ailw e or ci•acldiig of roof deck, walLs or fomidation of a building. �. Worlana�t's compei�sation and public liability u�sura�ice on above work to be taken out by RYNIAN ROOF'ING, INC., a Division of Rnna�i Coi�struction, Inc., or it's subcontractois. :"�. RYNIAN ROOF'ING, INI;., a Drvi�iai of Rym<ui Const�uction, Lic. is not res�onsible to provide any inaterials or to perfornl any work other than what is described above. Heplacement oY' deteriorated decking oi• Y'ascia boards, is not umluded and will be ctiaiged as an ezcta�a urtless otheirovise stated herein. 6. Tlus cuntiact is subject to tinal approval by RYMAN HOOF'ING, INC., a Division of Ryman Coi�struction, Inc. and is the entire agreement of the parties aaid uo other wiitten or other fa�n�s will recugitized. 7 A ctim�ge of 1.5% will be made on all unpaid balances after 30 days, pli�s ctiarges ulcurred for non-payment procedw•es, plus attoniey's fees. !i. A 4°io processing fee will be added tb all credit czu•d ordeis. Rymun Roofu�g, L�c., a Divisiun of Ryman Construction, Inc. will not be responsiUle for any damage to septic tanks, sod, sluubbery, paini, satellite signal loss, sprinklers, concrete drives or any undergrouud piping. Payment Scttedtile: Payment Method: � Acceptance of Proposal �TATUTORY NOTI . R �aunrN� ONSTRiT("TTnN I NS� ACCORDING TO FLORIDA�S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE 1VIATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RI�HT `['O ENFORCE THEIR CI.AIM FGR �AYMENT 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 YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIF,N IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE, 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 'CO OWNER". FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED TI3AT YOU CONSULT AN ATTORNEY. I ACCEPT THIS PROPOSAL AND HEREBY CERTIFY THAT I HAVE READ AND FCTI.LY UNDERSTAND THE PROVISIONS OF TffiS CONTRACT. Purchaser: � ` �-�� a.�..x_ Date: � — � --' � � Piu�chaser . Estimator • . �; IIIINIIIIIIIIIIIIIOillllillllilllllllillllllllllllllilllll � 2011094770 � . ' NOTICE OF COMIVV�NCEMEIITT STATE OF FLORIDA COUNTY OF Pa �C(� 'I'� UNDERSIC3NED heroby givos notico that improvement will be meda to cartain roal proporty, and in accordanca with Chapter 713, Florida Stgtuas, tha following infonmation ie providad in this Notica of Commencemon� 1. Descriptio� of porty: Parcol No. 6 I - D pp - `� O s ,- (a-- � s a �'� a �s ss-� Lo 1� o �-{aq� � Pc�- ��3 2. General Descl jpG'�on of Imp�ovement: � rtept :1374048 Rse : 10 . 00 �_ i�i raof' DS: 0.00 IT: 0.00 ',06/21/11 C. Cook, Dpty Clsrk — 3. Owner �nformadon: \c, r l� (Rt Q(S Aaar�• �K 5$ , � C'n' state �- ZiP codo _ 33 S'�L� � Intarest in Pro arty: _�+,w V1Qr Name of Fee Simple Tittlohold�. If other than owner: Addrass: ' C1 �' State Zip Coda 4. Contractor: �� vrlp� �C . _��j 7'�- 6 p� � �Addrass: 364�. �,:�]�yr1iL1= PL. 33541 5. Surety: Nama N/A p}�� # ' Addresa C '�3' State Zip Coda Amount of Bond: � - - pq�lA.p 5 0'NE1L,Ph � PRSCO CIERK L COMPTROL�ER �. Lender. Nama NLA Phone # ; 06/21/11 8: a 1 of Address — OR BK �� P� �4 - Cn 3' Stnta Zip Codo 7. Persons within tha Stato of Florida deaignated by owner upon whom noticos or other docomonts may be served as , provided by Section 713.13 (1) (a) ('n, Florida Statutes: ' Nama 1�/A Phone #• Address ' City Stata ' Zip Code 8. In addition to himsal� Ownar designatss: NLA of Phona # to recaiva •a copy of tha LianoPs Notice as ' providod in section 713.13(1) (b), Plorida Statutss. �• F.�cpirafion date of Notice of Commencement (the oxpiration dato is ona (1) year from thc dato of recording unless a diffetent dats is specifiad.) � ; . . �VARNINC� TO OWNER: ANY PA�IVIII�TTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE 1�TOTICE OF COMb�NCEMENT ARE CONSIDERED IMPROPER PAYMETiTS UNDER CHppTER'713, Q � w Y �ART I, SECTION 713• 13• FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYINC3 TWICE FOR c� w� � w �MPROVEMENTS TO YOUR PROPERTY. A NOTIC$ OF COMMENCEN�BNT MUST BE RECORDED AND ��"-� w � � OSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION: IF YOU 1NTEND TO OBTAIN v�i ? ��'� � F INANCINCi, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE CO1viMENCING WORK OR ��= a"' rr =` } � ECORDING YOUR NOTICE OF CO M M E N C E M E N T. ��w � z� a � �-( p - � � $ignatwe of Owner: Z( • ��.. ' 7� Printed Name _"' � � �.�"o r: .�. r � $� � � � � U � � �— �=00� � STATE OF FLORmA ' :; ;' „ , i' � �-- y. U � �OUNTY OF �tc.c� = ' . .: � p f- a � O �c ty '` �r. - i..;�:� � = O � � � '�'t►o foregoing iastrument was acknowlodged befora ma this da� of N1 O�, ,�:^�' . F:,` . '" �.`,,,,, � � � l� �� , 2A,�, p��llv �ci►o.+m� �� t � � z o � t�r who pmducod identi5cation, and who did/did not teka oeth (pleaso circle which) � V(c�c�v�Y \4p.�� ...: ., �'., •', . " . p r- � � = Q - � " � � W i Y f�,'. Y � No�A�Y.PUbllc St� of Fbr�1P • � LLi Q �} � Z Notary Publia: y Commission Expires: :� �: Chihfle�� Yry DD7618!¢ �,, Q� ac � O O an��"..�Expxen . .: Q � h Z W U�j (n Under penalties of perjury, I doclare that I hava road the forogoing Notico of Co � tha �cts ata`ted in it are ��_� w=`�^! true w �he bast of my knowlodgc and belief. � '��h : <� ; - Q � � � z � � ..,,.. t) 1-�- � O 5 I d 0 e �• ( ignature of Owner Signing Abova) '