HomeMy WebLinkAbout12-12825 CITY OF ZEPHYRHILLS
5335-8TH SIREET
(si3)�so-oo20 �28
BUILDING PERMIT
Permit Number: 12825 Address: 38719 12TH AVE
Permit Type: RE-ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-04100-006A
Improv. Cost: 5,968.00
Date Issued: 2/22/2012 Name: ZAMBITO H DEE DEE
Totai Fees: 65.00 Address: 38719 12TH AVE
Amount Paid: 65.00 ZEPHYRHILLS, FL. 33542
Date Paid: 2/22/2012 Phone: 813-713-3005
Work Desc: REROOF SHINGLE 22 SQ
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TAPE JOINTS ROOF INSP
FINAL LL,�� v�
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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 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 requiremer�tsbf 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.
"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 wmmencement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
/
/
CONTRAC R SIGNATU PERMIT OFFI R
ERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Parcel: 11-26-21-0010-04100-006A 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, February 18, 2012
Parcel ID 11-26-21-0010-04100-006A (Card: 001 of 001)
Classification O1 - Single Family
Mailing Address Property Value
ZAMBITO H DEE DEE Ag Land $0
38719 12TH AVE Land $21,910
ZEPHYRHILLS FL 33542-3702 Building $51,175
Phvsical Address - See All 2 addresses (First Extra Features $823
Shown)
38719 12TH AVE lust Value �73,908
ZEPHYRHILLS FL 33542-3701 Assessed (Non-School Amendment
�eaal Descri�tion (First 4 Lines) 1) $73,908
See Plat for this Subdivision�"' Taxable Value ;73,908
CITY OF ZEPHYRHILLS PB 1 PG 54
LOTS 6A 7A&8A BLOCK 41
OR 8126 PG 1259
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price CondRion Value
�� 0100 SFR OOR2 8,055.00 �F $2.72 1.00 $21,910
Additional Land Information
Acres 0.18 Tax Area OZH FEMA Code X Residential Code ZHLHLP2
Buildina Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1986 Stories 1.0
Exterior Wall i Above Average Enterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall i 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 Q 252 $2,737
2 � 1,240 $53,878
3 � 204 $3,085
4 S� 340 $5,909
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 � DWC 1986 559 $573
2 UDU-M 1987 1 $250
Sales History
Previous Owner MCQUAID ELSIE
Year Month Book/Page Type Amount
2009 07 $126/ 1259 WD $50,000
2002 08 5037/0363 WD $0
1986 r 09 � 1539/0628 WD $45,000
http://appraiser.pascogov.com/search/parcel.aspx?sec=11&twn=26&rng=21&sbb=0010&b... 2/22/2012
� CONTRACT Hernando: (352) 686-3330
---"- (352) 754-8880
N ��
Commerciai & Residential Citrus: (352) 341-1400
R 0 0 F I N G. I N C. "Home of the FREE Roof Inspection"* Pasco: {727) 816-9278
,aasa Po��e oe�eo�B��d. www.alansroofinginc.com Toll Free: (800) 309-5667
s�ooks���►E, FL 34601 Fax: (352) 754-8902
LICENSE.NO.CCC046942
Please PrinY � �/� �Q�"��
NAME � .v 1"� i �C'� � ' � '_ PHONE � yI� �11 �5C0 ,� DATE � ��" ��
ADDRESS � S� )� � /a �"� /'��'[' .CITY � . ZIP � � 5`�-�
M.HOME HOUSE
OTHER COMMERCIAL JOB#
BRAND AND DESCRIPTION
OF PRODUCT �~`^��'°� Co.��i,•.t COI.OR � �H.c> >
`��'�' i cC o-•�(I. PITCH
1 PULL A CITY ao� OR COUNTY PERMIT SQ.RENAIL WOOD ��
2. TEAR OFF •�•�,_ SQ OF OLD SHINGLES SQ.OF FLAT ROOF SQ.OF OLD TILE
� 3. DRY iN � 1 LAYER_ 2 LAYERS FT./ SQ.TILE
4 INSTALL �� FT GALV VALLEY METAL `<� FT 55#SELF ADHERING UNDERLAYMENT FT.METAL OVER RIDGE
5. INSTALL �` FT.ALUM./�FT STEEL DRIP EDGE FT PAN/ FT L. FLASHING COLOR
6. INSTALVREPLACE 6�' Ff OF R.V �' QTY./ FT.OFF RIDGE VENT�_PLUGS COLOR
7 REPLACE 1 v2 IN _�2 1N..�3 IN LEAD BOOTS 4 1N._�10 1N.GRV'S ELEC RISER
❑ 8. STARTER STRIPS
9 IAY�—SQ.OF NEW FIBERGLASS SHINGLES / ��• CAP FT.H.R. �
❑ 10. INSTALL SM./ LG. DEAD VALLEY
❑ 11 INSTALL TPO LAYER OF INSULATION
12. INSTALUREPLACE 2 X 2�2 X 4 4 X 4 SKYUGHTS CFYLIC �� LOW E SELF FLASHING
DOM CM C�LASS
13. HAUL OFF ALL TRASH AND RUN MAGNET AROUND GROUNDS
14 AlL WOOD WORK WILL BE EXTRA PER ATTACHED WOOD BILL
❑ 15. SPECIAL INSTRUCTIONS �
Ufi- �� v �Y6y , on
3 shc� �� o� asr w�a! .Z�,c�,
❑ 16. ALAN'S ROOFING,INC.HAS MY PERMISSION TO CONTRACT WITH AN ENGINEER OF IT'S CHOICE TO
CONDUCT ANY OR ALL INSPECTIONS THAT MAY BE REQUIRED UNDER LOCAL OR STATE LAW.
TOTAL DUE UPON
COMPLETION �L".� �. OC_�
ACCESS.Cu6tomer agrees to allow access to the property and realizes that heavy eqwpment is being used.
CoMractor shall not be liable for,without I�mitatbn,damage to driveways,sidewalks,lawns,sprinkler systems,gardens,sephc systems and any other s W dures thereol,as a resutt of rooflop oryob delrveries
DAMAGE,ETC. Should customer become aware o1 demage to property by Contractor,his egents,or employees during the rnurse of installaGon ot the root,sa�d damage shall be brought to the atlention of the
Contractor priorto the time ol peyment lorthe roof In questio�.If Customer falls to noNly Contrectorot said damage,wkhin 5 working days of occunence,t�en shall waive all rights agamst Contractor conceming saitl
demage.Alan's Rooting,inc.is not responsible for rooflng neAS penehaUnp A/C lines In the attic.
OELAVS,ETC. Hereby aqcnowledges ihat Contractor may be subject to delays occasioned by inclement weather,lebor disputes,and matenal supply shortages which are beyond Me control of tha Contractor and
hereby accepts delays occasioned by one or all ol these circumstances in the installatlon of his roof.Further agrees to pey Contrador an artrount to equel 10%ot the talal contrect price should th�s contract be
cancelled for any reaeon pnor to the inflfation of work on roof,bvt after midnightnf the Mircf business day aher signing.
�
PAYMENT CONTfiACT:Customer hereby aprees Mat if the emounts due an�1 owning hereunder are not paid when due,also shall be liable to pay all costs ot cancellation,including,but not I�mReO to.reasonable
atlomey's fees and costs,which emounts,together with all sums and owing hereunder,shaU'bare mterest a!1�h%per month.We aaept MasterCard and Ysa credR cards.Our credk caM fee wdl be 2,5°b at hme of
payment. /�,/
ACCEPTANCEPROPOSAl.7hea epACea citicationsandconditionsaresatlslacloryand SALESMAN SIGNATURE � `��a'� �'"��'�t��` �
herebyacceptetl.Allco su ' om na mentapproval. _
CUSTOMER SIGNATU OATE a-��I a MANAGEMENTAPPfiOVAL
Construction Industnes Recovery Fund:Payment ma available from the construction industries recovery fund if you lose money on a projeci pertormed under contract,where the loss
results from specified violations of Florida Law by a State Licensed Coniractor For intormation about the Recovery Fund and filing a claim,contact the Flo�ida CILB at the following
teleohone numbe�and address:850-487-1395,Florida Construction Industrv Licensinq Board.1940 N.Monroe Street.Tallahassee,FL 32399
. � i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii
2012024305
Rept:1415562 Ree: 10.00
DS: 0.00 IT: 0.00
� 02/15/12 C. Cook, Dpty Clerk
Key No. Pertnit No.
NOTlCE OF COMMENCEMENT : �RU�Q s o'NEIL,Ph D PqSCO CLERK & COMPTROLLER
THE UNDERSIGNED hereby gives notice that!mp rovement w11I be made ' 02/15/12 08:47am 1
to certaln real property and in accordance with Chapter713,Florida State=` OR BK � r��� p�����
Statutes,the following iiifortnaUon is provided In this Notice of
Commencement:
?......._.__ ...__this apaca raserved for recorder
.«.._................... -".._..._.'--------"•'-'._._...•--....__........_...___.._..._..._..._._....._.
7. DescriptiQn of Property: Parcel No. p � /�t,e tl s�-3?S
ir� !�l � al botc -oy-�vo -006�- 38�1 Ia. 7'H /-lva, 'Ze h• ��.
c��'�'y�R 2.apkynh.'l/s P3 i A6 5 4�
(Legal descrlptfon of the property and atreet addresa if available) �r 5 6 4'�3� 9 R (d to tYC�('l
2. General Description of Improvement r L�ro o j= o+^ $i�E PE t�5 9
3. Ownar IrrfortnaBon: Name__ 2�.�n b!}C '
Address t � �4 �����,.�u r 'Fa�� p
Irrterestin rop •
Name of Fee 5imple i e o er � e an owner.
� Address � a e ip
Contractor. Name - � d
Address:
Ph�ne N�, ax o. � �c e � y 1��[
5. Surety: Name A//�
Address
Arnount o on : one o. � ax o. �e �p
6. Lender. Name_/�/ /�
'Address a�—Z�
Phone No. � o p
7. Petsons wfthin the 5tate of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
! 713.13(1)(a)(7),Elc�ida Statutes:
Name_ /V'/J� Address City State
Phone o.T��— Fax No.
B. in addition;r.himself or herseif,Owner designates � of �
to receive a copy of the Ltenor's Notice as provided�'n 3ectfon 71�.� 1} ), on a tatutes.
Phone�[o.of person or errtity designated by owner.
9• Expiration date of Notice of Commencement(the eacpiration date is 1 year from tha date of recording unless a difFerent date is specified.)
WARIVING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSI�ERED 1MPROPER
PAYMENTS uNDER CHAPTER 713,PART t SEC 713.13,FLORtDA STATUTES AND CAN RESULT tN YoUR PAYiNG TwICE FoR�MPROVEnnEnrrs To YouR PROPeRn.
A NOTICE QF COMME�ICEMENT MUST BE I�ECORDED AND POSTED ON TH�JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAItJ FINANCING,
CONSULT W H YOUR DER OR AN ATTORNEY BEFORE C�MMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
x� -� ��
gna o wner or e s onze cer �rectoN .artner anager igna o s e ce
'*"Signature Required b e below by`.Y`mark""'
STATEOF FL-• COUNTYOF � p�seo
The foregoing instrument was acknowtedged before me this_�day of �6 .20�by_ �t-e �e, Z prh �,��)
as . —�ame o�on)
for
ype o authoribr e.p_,o ce,trustee,auomey in ct) Name of perty on bOhalf of who InatrumcM waa exeauted)
��� ��� � .
�ignature o otary Print,Type or mp ame o otary
Personally K�:�wn k/OR produced Identification
Type ot Iden�,,,;ation Fr"d3ucad:
Verification pursuant to Section 92.525,Florida Statutes:under penalties of perjury,I dedare that t have read ihe foregoing and that the facts stated in it are
e the t of rny owledge and bellef.
.
gnature o a ra erson � n ng ove
�,� TODD KLUKOWSKI
�`'�
.a •'� AAY COMIdISS10N�EE153700
EXPIRE9 Dscembsr 15.2015
]�M�si eew
NOC-Pt8.WPD(71//0'n
9/24/07 ug
ST��:i� �� FLOd�IPJA, COUNT'Y C3� PASCt3
THlS!S TO L'�F2TIFY THAT THE FOR�GQING IS/�
TRUF,qt��D GQRRECT COPY OF THE nOCUMENT
ON Fli_E OR 0� p�1�sl_IC RECOF�D li�T�l+4 O�FICE
:�'�'�TNEy-I��Y HAND A D OFFICIF�L S�A!_THIS
I`J DHY OF ,/I,u. ��
PA LA S O'NEfL. L RK & Cn P7ROLLER
B v L,EF''..iTl' C�ERK
e�saso-oozo � City of Zephyrhills Permit Application raX-u,a-��u-�u�,
, , Building Department
Date Recelved Phone Contact for Perm(ttin -
Owner's Name z-�L� �� � �e Owner Phone Number � �'�3 � ' �3 -' 3 n�`-s
Owner's Address 3 �7/ �o��� �� Owner Phone Number � �'�� ' ?�� - 3��
Fee Simple Tltleholder Name 2 4-�.�n b���6 �e���=C- Owner Phone Number� �13 ' �� �� �6 o S
ia�t►, 33 s'�
Fee Simple Titleholder Add�ess 3 �' �� �'✓Q Z� 6 �,•'�� 'i
JOB ADDRESS 3 � �( � l a � �✓e 2� ��,,!/ 3 3 S �j' LOT# 6A -7A.
SUBDIVISION � � PARCEL ID# 1 1 ' v�6 "� I 'dU� C� � U l vU -Uc5 ,fi .�}-
(OBTAINED FR08A PROPERTY TAX NOTICE)
WORK PROPOSED e NEW CONSTR B ADD/ALT Q SIGN [� MOVE �] DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q OTHER(---�
DESCRIPTIONOFWORK % rG�^^o�e r G,,n �l o-n� !{e. I cc w�'�"h N�w o �`
, 3n � �e�T
BUILDING SIZE SQ FOOTAGE HEIGHT
�� � � � 9 6� ���j VALUATION OF TOTAL CONSTRUCTION
t?at•��
0 ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
Q PLUMBING $ �'/ 2�Z,J
Q MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
0 GAS � ROOFING Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS � FLOOD ZONE AREA QYES QNO
BUILDER COMPANY A�I�y'J �°p�`•
SIGNATURE �2EGISTERED / N FEE RRENT Y/N
Address � '(�`'f 9�' Po�c� (,Q� �� ,� v,�le =L 3�bc�! License# CC CO y' 6'��'�
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N
Addres5 � LJcense#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRENT Y/N
Address License# �
MECHANIGAL COMPANY
51GNATURE REGISTERED Y/ N FEE CURRENT Y/N
Address Llcense# �—
OTHER COMPANY
SIGNATURE REGISTERED Y! N FEE CURRENT Y/N
Address Ucense# �
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Buliding Plans;(1)set of Energy Farms;R-O-W Permit for new constructlon,
Minimum ten(10)working days after submittal date. Required onsite,Co�structlon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisions/large projects
COhihAERCiAL Attach(3)complats sets of Suil�!ng P!ans pliis a Life Safety Page;(1)set of Energy Forms.R-O-W Permfi for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Pians wi SUt Fence installad,
Sanitary Facllities&1 dumpster.Site Work Permit for ail new projects.All commerclal requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"'*PROPERTY SURVEY required for all NEW constructlon.
Directions:
Fitl out applicatlon completely.
Owne�8 Contractor sign b�ck af appUcation,notarized
if over$2500,a Notice of Commencement is required. (A/C upgrades over i5000)
'" 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 AppBcatlon Only) •
Reroofs Sewers Service Upgrades A/C Fences(PlotlSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
+ . ... _.. .
"y4 .
4
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NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictians"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance witli any
appiicable 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 Iocal 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 intend�d contractor are uncertain as to what iicensing requirements may apply for the
intended work, they are advfsed to contaet the Pasco County Building Inspection Divtsion—L[censing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contracfor(s) sign
portions of the "contractor Block" of this,application for which they wiil be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properiy licensed and is not entiNed to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Re�course Recovery Fees may appiy to the constructlon of new 6uildings, change of
use in existing buildfngs, ar 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 °certiflcate 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 �AW(Chapter 713, Florida Statutes� as amended): If valuation of Vvork is$2,500.00 or more, I
certify that i, the appiicant, have been provided with a copy of the "Ftorida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agricultu�e and Consumer Affairs. If the appiicant 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" prio�to commencement.
CONTRACTOR'B/OWNER'S AFFIDAVIT: i certify that all the information in this application is acaurate and that all work
will be done in complfance 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 wiil be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land developmenPregulations in the jurisdiction. I atsv
certify that I understand that the regulations of other government agencies ma a I to the intended work, and that it is
m y r e s p o n s i b i l i a���ttof Environtmental Protect on Cyp ess Bay h e a d s S W tl a n d A r e a sn a n d E n v i r o m e n t a l yt S e n s i t ive
Dep
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 ServiceslEnvironmental Nealth Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
Federal Aviafion Authorfty-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fiil is not ailowed in Flood Zone"V"unless expressly permitted.
If the fill materiai is to be used in Flood Zone "A", it is understood thak a drainage pian 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 wali
construction, I certify that flll will be used only to fill the area within the stem waii.
If flil mate�ial is to be used in any area, I certify that use of such fill wili not adve�sely affect adjacent
properties. If use of fili is found to adversety affect adJacent properties,
the owner may be cited for violating
the cvnditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fili, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER,#�ctiontS I fu derstand that a�s parat permit tmay be fequ9 ed fortielectrical work,
this afFidavit prior to commencing con as, or other installations not specif�cally included in the application. A
plumbing, signs, wells, poois, air conditioning, g
permit issued shall be construed to be�i �`irocaesenor shall i suaincehof a pe mitprevent thehBu li ding iOfficiai from thereafter
set aside any provisions of the techni
requiring a correction of errors in plans, co{`g commen eidl within sixa onths of perm t i s aince,uo aif wolrk aUthoerized by
unless the work authorized by such perm
the permit is suspended or abandoned Build neriOffi ial fo6a period not to exci edtninetyr(90) days and will demo strate
may be �equested, in writing, from the 9
the ob is considered abandone .
justifiable cause for the extenslon. If work ceases for ninety(90)consecutive days, \j
WARNING TO OWNER: YOUR FAILURO YOUR PROPERIY.T�F YOU INTEN.D TO OBTA N F NANCINGTCONSULT
PAYING TWICE FOR IMPROVEMENl`S T p E C ENT.
WITH YDU EN � ATTO EY BEFORE R CORDING YOU
FLai21Di,JURAT��.s. `.e�; � � ,.�-
j ,. CONTRACTO s�
OVYNER OR A(iENT o or ed)before m this
Subscribed and swom r affir dZb re me this Subscribed and b � ,� ��` ..J _
t+� • y__!L
by G' ""`''=—
Who(s/are personally known to m r haslF�ae���on.
Who ts"—%are personally knowa.t� mas ide Hflpd nroduced
���r �,�j�_ ' � ' � 7'��Notary Public
�� �,(,(ivti ' �-l7 -'1 1 Notary Publk _---
Commisslon No. ,
Commission No.
Name of Notary tYPed�P�inted or stamped
Name of Notary tyPed,printed or stamped
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