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Home My WebLink About12-12915 CITY OF ZEPHYRHILLS / . 5335-8TH STREEf �/ ' (sis)�so-oozo 12915 BUILDING PERMIT Permit Number: 12915 Address: 7631 GALL BLVD Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: ADD/ALT COMMERCIAL Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 34-25-21-0110-00000-0010 Improv. Cost: 4,000.00 Date Issued: 3/26/2012 Name: WAL-MART Total Fees: 82.50 Address: 7631 GALL BLVD Amount Paid: 82.50 ZEPHYRHILLS, FL. 33542 Date Paid: 3/26/2012 Phone: (479)204-1063 Work Desc: REFIGERATOR CASE FIXTURES CHANGE OUT ��L� \ DUCTSINSULATED FINAL �-lD-�Z 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. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your properly. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. � CONT CTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER �,�j_/L�4��- �o�-, ��.b� . �,�-- �,�., -�^ y ,�r '_ "='��! ` ��%;,,�i-, �, , � /� ''"- ,;, ' ; �;_.' � � Fee Simple Titleholder Name l f�"��r-ri "PS I Owner Phone Number L_ Fee Simple Titleholder Address � o�( �� b�'S� N2yl '�1 d:��.� � � �� 6 ^"q,'j";f c� JOB ADDRESS � I k/ � Z e L� LOT# �� SUBDIVISION PARCEL ID# (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEW CONSTR� ADD� � SIGN � � DEMOLISH INSTALL PAIR PROPOSED USE � SFR �COMM � OTHER TYPE OF CONSTRUCTION � BLOCK Q FRAME � STEEL � DESCRIPTION OF WORK G� 7'•, 1I�'� �-/l�I�I O'� BUILDING SIZE SQ FOOTAGE HEIGHT T1� 1'TTITT T �BUILDING $ VALUATION OF TOTAL CONSTRUCTION �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY � W R.E.0 OPLUMBING $ `��G-�� N�� .� `.—___'�'_� �MECHANICAL $ L/D�• O� VALUATION OF MECHANICAL INSTALLATION �GJ(s 7 �t f ( ~� � �GAS � ROOFING � SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO �"��` ` F-:-r�.--r•:�-+--^�--:--'-1-i-i-' . BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# � ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# � MECHANICAL ,i � � J COMPANY �� y7�� `�"�v��4 SIGNATURE '� REGISTERED Y N FEE CURRE� Y N Address ��l / 4r ICJ/� ��M � ,fa 7'f� License# ��C � S 7 S,�(� OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N Address License# C 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 I 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 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. ��1..1�'.-+' 'T'��+'�'��4�1--��'.�'.�0�'...C...'..'—L• `.—'. '�'+�-:�I..��'.�+' '�w-:.��'� . Directions: Fill out application completely intenaea worK, tney are aqvisea to contact tne rasco Lounty tsuiiaing inspection uivision—ucensing Section at i�i-ts4i- 8009 Furthermore, if the owner has hired a contractor or contractors, he is advised to f iave 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 pe�mitting 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�nrork 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 1 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 ir�tended 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-Seawalis, 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 c:ommenced. 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 NOT CE OF COMMENCEMENT. � FLORIDA JURAT(F S 117 03) OWNER OR AGENT CONTRACTOR J � � �` Subscribed and sworn to(or affirmed)before me this Su scr'bed and sworn�o(or aff{�med)before me thi bY 9 �2. by ��Qrc : c�. me� z � Who is/are personally known to me or has/have produced Who is/are personally kn wn to me or has/have produce�j BARBARA NELSON as identification. f��S[}V)4(�l� �ri01� as identificatitsf4:�;:, i . •} Commission DD 828918 . :. Expires November 3,2012 - •knded ThN Tmy Ftln Yrwnw 8003857019 �:�e-.ra, ,...y._., �¢ N� DHR Mechanical Services Tampa O�ce DHR Mechanical Services 7940 Rutilio Ct Suite C Qrlando 801 Central Parkway New Port Richey,FL 34653 Sanford,Florida,32771 Tel 727/849-3344 Fax 727/849-3377 Tel 407/265-0777 Fax 407/265-0770 FI.Certiflcation#CA C057606 FI.Certification#CA C057606 "Commercial/Industrial Refrigeration" `Design/Build Specialists" SPECINIC PnWFR OF�TTQRI�I�Y FOR CONT1iACTOR LIC�NSING FOR CITY OF Zephvrhills I, Garricic T. Meitzner, of Pasco County, Florida, the undersigned, hereby grant a limited and specific power of attorney to the following person(s): AUTHORIZED P-ERSON(S) AUTHORI2ED P�j�� N(S)S1C�NATUI�E DL# Tliomas Jolinson J525-825-72-134-0 The attorney(s)-in-fact shall have the full power and authority to undertake and perfo�7n only the following acts on my behalf REGISTER MY CONTRACTOR'S LICENSE, APPLY FOR, SIGN FOR, AND PICK UP PERMITTING DOCUMENTS for DHR Mechanical Services- Orlando. Inc. Contractor's License#CA C057526 to include such incidental acts as may be required to carry out and perfonn the specific authority granted herein above. This power of attorney is effective upon execution. This authorization may be revoked by me at any time, and shall automatically be revoked upon my death or change of company name. Any City of Zephyrhills employee may accept and rely upon same until receiving written notice of revocation hereof. Signed this t�'day of March Garrick T. Meitzner, CA 57526 STATE OF FLORIDA COUNTY OF PASCO Sworn to and subscribed before me this 9th day of March, 2007 by Garrick T. Meitzne�; personally known to me/presented an ID. � � �� Notary Public, State of Florida Commission No. Expiration: . ,:'r�:, BARBARA NELSON � .,. "•.�z Commission DD 828918 � ;,� Expires Noverr�ber 3,2012 ','�;;�`�� e«�aaanwr�yF.tnwur�o.eooaes��oio Ma r. 26. 2012 10: 03AM No. 2624 P. 1 ;;,,: .;r:. ��' ,:,., �j �{ ...,,. ,. �,,,,�; v&r4�� Eti0 � �t �• .. � WA�-MART STORES,lNC. "' 2001 SE. 10T�-!STREET '" BEtVTONVlLLE,AR 72716-5570 CONTRACT EXECUTION PROCED11RE5 FOR MECHANICAL SERVICES AGREEMENT Ddte: 2/15/lz To; GARRICK MEI7ZNER DHR M�chanical d/b/a Shumate Mechanical From: Katherine Cox Contract Administrator Subject: Instructions for Contract: CAPXREF-3 #5upercenter{SUP)706-601,ZEPHYRHILLS FL If the Contractor fails to meet any of the following dates,Wal-Mart shall,except to the extent otherwise required pursuant to applicable law, have the right to obtain the items on behalf of Contractor, to withhold any and all payments of#he Contract Sum and to terminate the Contract immediately. Contractor hereby acknowledges,agrees and covenants that,if ContractoP is awarded the Contract to perform the Work and Cantractor begins performing any of the Work before �eceiving a fulfy executed copy of the Contract that has been signed by duly authorized afficers of Contractor and Wal-Mart, then commencing performance of the Work shaU serve as, and shall be deemed to con5titute, Cvntractor's acceptance of, and agreement to be bouhd by,the terms and conditions of the ContraCt Documents included in the Invitation to Bid to the same extent and with the same effect as though such documents had been fully executed, and Contractor shall fully comply with the terms and conditions thereof. In such an event,once the Contractor has received a fully executed cvpy of the Contract that has been signed by duly authorized officers of Contractor and Wal-Mart, the terms and conditions af the Contract Pocuments, as executed by the parties,shal!supersede this provision and shall govern the performance of the Work and the obligations of the parties with respect thereto,and the effective date Qf the fully executed and delivered Contract shall be the date on which Contractor was awarded the Contract by telephone notification. PAYMENT INSTRUC710NS: ■ When applying for payment, send the origlnal Applfcation far Payment, any change orders and all other documentation required under the Contract Documents to the attention of the Compliance Contract Administration Attn. Katherine Cox. All applicable items on the payment form are to be filled out _ � completely when applying for paymentr�» _� _ � _ i CHANGE REQUEST INSTRUCTIQPIS: ■ All Change Orders submitted for processing throughout the course of the Project should be to the Compliance Contract Administration Attn:Katherine Cox. ■ Change Orders can only be submitted for payment aker they have been slgn�ed and apprnved by an authorized officer of Wal-Mart. Yellow copies must be enclosed with the cor�esponding application for payment. Page 1 Ma r. 26. 2012 10:03AM No. 2624 P. 2 INVOICE INSTRUCTIONS: • All miscellaneous invoices submitted to Wal-Mart for payment/processing throughout the course of the Project should be to the attention of the Compliance Contract Administrativn Attn:Katherine Cox. CONTRACTOR ACTIpN ITEMS; Remit by GC Documeni Upload within 24 hours of award of Contract: • Certificate(s)of insurance, including general liabiiities, automobile liabilities, workers' cpmpensation and � builders risk,in accordance with the Contract Documrnts,naming Wal-nnart as additionai insured with the store number and focation mentloned � Performance and Payment Bonds(Bonds must be on Wal-Mart form) ■ Budget Summary 8reakdown(Must be on Wal-Mart form) Remit by email to ehe Contract Administrator within two(Z)business days of award of Contract: ■ Electronic Contract Acceptance . ■ Unless previously completed and accepted by Wal-Mart as part of the annual contractor qualification p�ocess,a completed,executed and witnessed copy of the Compliance Certification form shall accompany the Contracts. If this project does not require a construction storm water permit, please remit by GC Document Upload within seven(7)days of award of Contract: • Subcontractor Listing in Excel format. If the Contractor fails to meet any of these dates,Wal-Mart shafl,except to the extent othervvise required pursuant to applicable law,have the right to withhold any and aN payments of the Contract Sum and to terminate the Contract immediately, Page Z Ma r. 26. 2Q 12 10:04AM No, 2624 P. 3 {,, �;�a "��5��;;;. �"'" ;��a��'{�` � � ....:.:::... .... �'��:... WAL-MART STaRES,lNC. * 2001 SE.107H S1"R�EY � BENTONVILLE,AR 72716-5570 AGREEMENT BE7WE�N OWNER AND CONTRACTOR 7HIS MECHANICAL S�RVICES CONTRACT {"Contract") is made this day of 2/15/12, by and between Wal-Mart Stores, Inc. ("Wal-Mart"),a Delaware corporation,with its principal place of business at 702 S.W.8`"Street, 8enconville, AR 72716,and DHR MECHANICAI,SERVICES ORLAND,a Corporation wiih affices at Sanford{"Contractor"). WHEREAS, Wal-Mart desires to contract w;th Contractor,and Contractor desires to contract with Wal�Mart,for Contractor to provide to Wal-Mart certain refrigeration installation and related services at The Project is: Wal-Mart Supercenter(SUP) CAPxRE1�-s #�706-601,ZEPHYRHILLS FL . SAP Proj Pef#USMV-Q05779 Site/Address#QZ4Z Purchase Order q 3�z�63]�6 The Owner is: Wal-Mart Stores,Inc. Department 8974 2001 S.E,lOth Street Bentflnville,Arkansas 72716-5570 The Construction Manager is: Duane DSVis "fhe Contractor is: DHR MECHANICAL SERVIC�S QRLqNDDeA SHUMATE MECHANICAL 801 Centraf Park Dr Sanford, FL 32771 Phone: 3525889726 SAP Vendor�1000058138 • The Architect is He�derson Engineering N4W, THEREFORE, in consideration of the mutual promises in this Contract and other good and valuable consideration,the receipt and sufficiency of which the parties acknowledge,Wal-Mart and Contractor agree as follows: 1. DE CRIPTION OF WORK. Contractor shall provide the materials,equipment,supplies and personnel,and perform the services and fabor, in each case that is necessary to complete the work set forth in the 5cope of Work and Specificatlons {the • - •-��-'-"��ecificataons"-}i�sued-at O��t To-Bid-(such-wor•k-is-E011e��ively-r•efer•red-to-he�ein-as-tMe"Wor•k"��:T•he�eap�of�llo�k-aFld---- �—� Specifications are incorporated by reference herein and made a part of this Contract. RePerences to this Contract shall be deemed to include the Scope of Work and Specifications. 2. CHANGES TO THE WORK. All Work shall be performed in strict accordance with the provisions and terms of this Contract. Any alteration to, deviation from, or additional work not described in, the Scape of Work or Speclflcatlons shall be made only by a written Change Request executed by an authorized o�cer of Wal-Mart (a "Change Order"') describing such alteratlan, Page 1 . Ma r, 2b. 2012 10'04AM No, 2624 P, 4 In the event of any dction or proceeding brought by either patty against the other under this Contract, the prevailing party will be entitled to recover all costs and expenses,including court costs and reasonable attorneys'fees. 36. EXHIBfTS. Intentionally Omitted 3'7 DEFAUl.T. The occasion of a default, breach or an event which with the passage of time,giving of notice or either of them would constitute a default, In any of the terms or obligations of Contractor under another contract or agreement with Wal-Mart, or any subsidiary,division or affiiiate of Wal-Mart,shall constitute an event of default hereunder, whereupan Wal-Mart shall have the right to pursue such remedies as are provided for herein or at law or in equity, concurrently, cumulatively or successively against Contractor unt;l afl damages arising by reason of such default have been paid in full. 38. CONTROL OF PERSONNEL. Notwithstanding any provision in this Contract to the contrary,Wal-MarY does not assume responsibility for the conerol of the construction personnel of the Contractor, for assuring compliance by ConCractor with the obligations set forth hereln, or for implementation and enforcement of such obligatlons, all of whlch shall remain solely and exclusively the responsibility of the Contractor, and Wal-Mart shall not be deemed ta be a joint employer of any employees of Contractor by v;rtue of any of the terms and conditions hereof. Contractor: �f�I� l��qrl��cro-� Print Name: �1"/'� CK /v l �� '�� BY' 7itle: G n 9 oate: � � � � f 2 Page 19 a �� i3''� �' � <�� .� �. City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor omeowner: �� a,y.7�� (�� , Date Received: ,� �� -/� Site: rj� `�" j �� --�� , Pennit Type: ,� ,� , _�� Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comm t heet s 1 be kept with the peimit and/or plans. � " Z/-/ 7% Kal ' Switz — s Examiner Date Contractor and/or Homeowner (Required when comments are present) W � - i iiiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii 201204122 � Repl:1421g99 Rec: 18.50 DS: 0.00 IT: 0.00 03/14/12 D. Bonilla, Dpty Clerk NOTICE OF COMMENCEMENT Permit No. PRULfi S 0'NEIL,Ph D PRSCO CLERK & COMPTROLLER Property Identification No. 03/14/12 08��a� 1 of 2 OR BK � P� 3?57 THE LJNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section 713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property(legal description:) "7��' �Q f a)Street Address: 7631 GALL BLVD,ZEPHRHILLS FL 33541 2.General description of improvements:_CapEX Refi igeratlOn 3.Owner Information a)Name and address:_WAL-MART NON-REBT PROPERTIES,2001 S.E. 10�STR,BENTONVILLE AR 72716-0550 b)Name and address of fee simple titleholder(if other than owner)_N/A — ' c)Interest in property �ontractor Information � a)Name and address:DHR MECHANICAL DBA SHLTMATE MECHANICAL,7940 RUTILIO CT STE C,NEW PORT R[CHEY FL 34653 b)Telephone No.: 727-849-3344 Fax No.(Opt.)727-849-3377 5. Surety Information a)Name�d sddress: N/A - b)Amo�t of Bond: c)Tclephone No.: Fax No.(Opt.) 6.Lender a)Name and address: N/A Phone No. 7.Identity of person within the State of Florida designated by ow�er upon whom notices or other documents may be served: a)Name and address:Thomas Schoendorf 7631 Gall Blvd,Zephyrhills FL 33541 b)Telephone No.:_813/782-1957 Fax No.(Opt.) 8.In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes: a)Name and address: same as above b)Telephone No.: Fax No.(Opt.) 9.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is Specified):_2/15/13 WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13, FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF �� COUIVTY aa � Signature of Owner or Owner's Authorized �c r to a an er AMANDA SMITH Remodel Contracts Administration MANAGER The foregoing instrument was acknowledged before me this 2� day of `��CQ.�,20_12,by�`4►�(,� , (nt�''� Print Name as��Jr►_O�� (type f authority,e.g.officer,trustee,attorney in fact)for 1(�� V�L (name of party on behalf of whom instrument was executed); Personally Known�OR Produced Identification Notary Signature �'`' �� Pvttisty A�exed�t6 Type of Id�ntification Produced Name(print) ��mry Ca![3cnta� okary��YC-A,�.��nsas MyG:a�inusir:n tizp.c74;iY1i�8i4 Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I dec are t at°�'`�ave a '1�'�oregoing and that the f ts stated in it are true to the best of my knowledge and belief. 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