HomeMy WebLinkAbout12-13333 . CITY OF ZEPHYRHILLS
• 5335-8TH STREET
, (sis)�so-oo20 13333
BUILDING PERMIT
Permit Number: 13333 Address: 38514 9TH AVE
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-10300-0170
Improv. Cost: 7,000.00
Date Issued: 8/17/2012 Name: GRADOWSKI, ROBERT & DEBRA
Total Fees: 285.00 Address: 6141 20TH ST
Amount Paid: 285.00 ZEPHYRHILLS, FL. 33542
Date Paid: 8/16/2012 Phone: (863)559-5246
• Work Desc: REMODEL INTERIOR ONLY NO MODIFICATIONS TO OUTSIDE UNLESS APPRV
JAMES O MORTON ELECTRIC CO.,INC. PLUMBING FEE 60.00 MECHANICAL FEE 60.00
HIGH LOW PLUMBING SERVICES LLC
BAHR'S PROPANE GAS&A/C,INC.
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FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
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)wndemned 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 property. 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 performed in accordance with
Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O.
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CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Pasco County Property Appraiser- Physical Address List for: 11-26-21-0010-10300-0170 Page 1 of 1
, �'`'�� -
Welcome : Records Search : Parcel Details : Physical Addresses ��j ( j� 2 1 s' '7 c�(3
Physical Address List for Parcel: 11-26-21-0010-10300-0170
Displaying 2 records View in groups of: 10 25 �0 �Q �QQ
Street Number Street Name • Unit
5546 10TH ST
38514 9TH AVE
Pasco County Property Appraiser
Page Layout Modified: 2/17/2009 1:10:37 PM
The Local Time Is: 9/19/2012 9:47:15 AM
http://appraiser.pascogov.com/search/physadd.aspx?parce1=2126110010103000170&eas=... 9/19/2012
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
B�ilding Department
Date Received n j7 ' '� � �`
' ��v �- � � Phone Contact for Permittin X 1 � � j✓ - 7� � �
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Owner's Name °� (_^� <l'" C �� �(�'�� �1� � Owner Phone Number l� L� ����� ����
Owners Addresa � �' � j �� �� Owner Phone Number �
Fee Simple Titleholder Name Owner Phone Number -�
Fee Simple Titleholder Addresa
JOB ADDRESS .��� .: , � `1 r� '� J� ��
LOT#
SUBDIVISION PARCEL ID�
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR e ADD/ALT � SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK � FRAME � STEEL Q
DESCRIPTION OF WORK �!U�L\L TL' �lJ Y���.l�/L L_ I " � ;+�f �i � ��--�-,'Q I�' � '�� �4
i �
BUILDING SIZE `� /� 1�7 SQ FOOTAGE ����,I'. HEIGHT '
OBUILDING a VALUATION OF TOTAL CONSTRUCTION � `
�L1/�/,�/,���'• � ��r`iC�
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
Q PLUMBING $ � !1��i�
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QMECHANICAL a VALUATION OF MECHANICAL INSTALLATION �L ,��5
, �,.�l��o�.
QGAS Q ROOFING Q SPECIALTY Q OTHER '3 ��S��r
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FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO '� l3 3��
BUILDER ✓ �� COMPANY � ,I'�� <J��°1 i/l�/'� �E I (��-� �L�
SIGNATURE ��'�-��-��/'���� rr��� �I REGISTERED N FEE CURRE� Y/N
Address �-l'--� �'3 r,1��'����,�� ti �� • ;"'�:,���• �'j. �...� �7 License# -�'�� �..i f � �'c'
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x ELECTRICIAN �D �� COMPANY �� � L` l � !O�`
SIGNATURE .� � REGISTERED / N FEE CURRE� Y/N
Address License#
X PLUMBER ` , COMPANY � OG✓ %�'I (/��'!1 /%1
SIGNATURE J�- REGISTERED / N FEE CURRE� Y/N
Address License# ��y��3 7� �
MECHANICAL ~ � COMPANY S `'d /II C�
x SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# (, rT C.1� 3 / / `
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
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,StoRnwater Plans w/Silt Fence instalied,
Sanitary Fadlities&1 dumpster,Site Work Permit for subdivisionsAarge proJects
COMMERCIAL Attach(3)complete sets of Bufldtng 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. Requi�ed onsite,Construction Plans,Stormwater Plans w/S(It Fence installed,
Sanitary Facilities 8 1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance
31GN PERMIT Attach(2)sets of Engineered Plans.
•"'PROPERTY SURVEY required for all NEW constructlon.
Directlons:
Fill out application completely.
Owner 8 Contractor sign back of appliption,notarized
If over s2500,a Notice of Commencement is required. (A/C upgrades over i7500)
'• Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMIT7ING (Front of ApplicaUon Only)
Reroofs ii 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 ta"deed" restrictions"
which may be more �estrictive than County regulations. The undersigned assumes responsibility for complianGe with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONS181LITIES: If the-owner has hired a contractor or
contractors to undertake work, they may be required to be Ifcensed 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 unce�tain as to what licensing requlrements 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
Counry.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transpo�tation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansio� 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�nal 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. Fu�thermore, 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 T13, 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 Depa�tment 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 applicatlon is accurate and that all work
will be done in compliance with all applicable laws �egulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I ce�tify 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 unde�stand 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 ln 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 Watervvays.
- Department of Health 8 Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Envi�onmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of flll:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill materiat 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 fiil material is to be used in Flood Zone "A" in connection with a permitted building using stem wali
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 a�y area, I certify that use of such filt will not adversely affect adjacent
properties. if use vf 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,
p{umbing, signs, wei�s, pools, air conditioning, gas, or other installations not specifically included in the apptication. 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 JUF2AT(F.S. 117.03) � ,/` ��
CONTRACTOR ���''�_'�e—�� `-<_ !`-`j'!/..�,��/`�
OWNER OR AGENT �.�
Subscribed and swom to(or aiflrmed)before me this Subscrjbed and swor�to(or a�rmed)b re�e this /�, /,�_ �
b .c. -G i A i`= , >/%�F�, r�:•i•-
y � t-<L by „_, �'_. _ %.
Who is/are personaily known to me or haslhave produced Who Is/are personallx known to me or has/have produced
as identlfica8on. �17 S�� �'�+" � C� � '�'`��`" as ider1dflcation.
Notary Public 1� � Notary Public
" . " JACQt1EL
Comm�fon �1� �'' B�S
Commissfon No. •
��F��g' Expires December 12,2014
Name of Notary 10t9
Name of Notary typed,printed or stamped �
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
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Contractor/Homeowner: Q'�,< ` /�/ ✓ l
Date Received: _(�-� ��''l �
Site: �->� � ��/� `�i •
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Permit Type: _��� �►�'G.� /S��'Il��'A-1 Z T � �
Approved w/no comme Approved w/the below comments: Denied w/the below comments: ❑
�`{'�' I fv(�E' � �r c C�i c.:S� ��C r; � ��'1 /CS
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This comment sheet sha11 be kept with the permit and/or plans.
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Kalv' Swi er � ans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
, � G � � � �°�`� � �°�"� C� ['�, L.�...�
7324 Ponderosa Drive Cell: (813) 215-7413
Tampa, FL 33637 Office: (813} 481-7262
License # CGC1519903 bawconstructllc@aol.com
PROPOSAL
Bob Gradowski August 9, 2012
55461Uth Street
Zephyrhills, �{.
We propose to do the following work in a timely and professional manner at
the above mentioned address.
• Draw the floor plan of the unit showing the layout of the plugs,
switches, lights, smoke detectors, electric panel, air handler, existing
plumbing, and new hold down hardware.
■ We will submit plans for the purpose of pulling the building permits.
■ We will frame a closet in the bathroom for a set of stackable washer/
dryer combination
■ We will install hurri- bolt hardware system for hold down to meet
current code and will install hurricane clips to existing rafters.
■ We will frame a closet under the loft in the BJR area and the front of
both loft areas with an opening in each for access.
■ We wi11 foam fill any noticeable openings in the perimeter of existing
structure.
■ We will supply 4'X12' X1/2" drywall to hang, mud, tape, and texture
to the existing walls, bottom and face of 1ofts, and vaufted ceiling.
■ Remove drywall from covered walls in kitchen per inspector.
■ Frame in ceiiing of bathroo
We will do the above mention�d work for the sum of Four Thousand Three
Hundred Dollars ($4300.00). The first payment of($2,150.00) due at signing of
contract. The final payment of($2,150.00) due after passing of final inspection.
Permit and Notice of Cornmencement fees to be paid by owner.
Thank You,
Bruce Alan Womack
President
� � , l.L� C � Ri S°t`� U C T 1 O �, L L C
7324 Ponderosa Drive Ceil: ($13) 215-7413
Tampa, FL 33637 Office: (813) 4$1-7262
License # CGC1519903 bawconstructllc@aol.com
BAW CONSTRUCTION, LLC
7324 Ponderosa Drive
Tampa, FI. 33637
Cell: (813) 215-7413
Office: (813) 481-7262
�ail: bawconst�-uctllc@aol.com
CGC1519903
The job should be completed within three weeks time if your sub-contractors get
there inspections in a timely manner.
Thanks,
Bruce A. Womack Date
_._G� �.
Bob or Debbie Gradowski � %�-�s i'/.� `;:�-- Date �"'• ;<' ` %� �.
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Sales, Service � IFlStallati s TA�EN gY ,�� � i�
" DATE/TIME F'ROhfISED
�, 4441 Allen Rd. • Zephyrhills, FL 9 CUSTOMEI�#/LOCATIOIV �743�i
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6141 �OTH STREET �546 1�T'H ST
�- ZEPHYRHILLS FL 33541 ZEPHYRHILLS FL3.3541
. � PAYNE AIR HANDLER.
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RECOND CARRLER COND**u/c'7/f�**
I�EED RE—COND A/C, EhIERGY CALC, DUCT AFFIDAVIT, �BCITY�RERMIT�RULLED$UNDER THE
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FILTERS x x Changed Monthly �
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LIMITED WARRANTY: All materials,parts and equipment are warranted by the manufacturers' CALL �
" or suppliers'written warzanty oniy.All labor performed b the above named ������������ �
30 days or as otherwise indicated in writing.The above named com an mal�spno other warrantesr TOTAL �
express or impiied,and its agents or technicians are not authorized to make any such warranties on �CA$H ❑CK# • i
MATERIALS
_ behalfofabovenamedcompany. D DEBIT ❑CREDIT ❑OTHER
I have authority to orGar Me work outlinetl above which has been satisfactorily completed I agree t�at Seller MAINTENANCE I
reWms htle to eqwOmenUmatenals furnishetl unhl final payment rs matle I(paymen�re not made as agreea, PROG. W/ C I
seller can remove saitl eqwpmenVmatenals at Seller's expense Any damage resulhng from said removal shatl C�IM#
not be the responsibility ol5ellec NET 30 DAYS A 7 1/2%SERVICE CHARGE WILL BE ADDED MONTHLY TO �
ALL UNPAID BALANCES OVER 30 DAYS NO REFUNOS DATE COMPLETED
TECH: TAX �
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Resutts are intended for use with Rheem heatmg and moling systems only
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System equipment selection wi!!be made using the foitowing Manuai 5 derived values.
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AI!caiculat�ons are based upan approved hvac industnry standards anti proeedures,and cempfy with all�ocai.
state and federal code rectuirements.Aii computed results are Estimates Praduc:pravirJzd by Eneray D�siUn
Systems and idea Tree
Pasco County Parcel: 11-26-21-0010-10300-0170 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, August 11, 2012
Parcel ID 11-26-21-0010-10300-0170 (Card: 001 of 002)
� Classification 08 - Multi-Family - Less than 5 units
Mailing Address Property Value
GRADOWSKI ROBERT& DEBRA L Ag Land $0
6141 20TH ST Land $30,240
ZEPHYRHILLS FL 33542-2716 Building $28,038
Phvsical Address - See All 2 addresses (First Extra Features $2,199
Shown)
5546 lOTH ST ]ust Value �60,477
ZEPHYRHILLS FL 33542-4123 Assessed (Non-School Amendment
Le4al Descrintion (First 4 Lines) 1) $60,477
See Plat for this Subdivision
Taxable Value $60,477
CITY OF ZEPHYRHILLS
PB1PG54
LOTS 17 18 19 &20 BLOCK 103
OR 8635 PG 496
Land Detail (Card: 001 of 002)
Line Use Description Zoning Units Type Price Condition Value
� 0100 SFR OOR2 8,400.00 SF $1.80 1.00 $15,120
� 0109 SFR OOR2 8,400.00 SF $1.80 1.00 $15,120
Additional Land Information
Acres 0.39 Tax Area 30ZH FEMA Code �Residential Code ZHLHLP2
Buildina Information - Use O1 - Single Family Residential (Card: 001 of 002)
Year Built 1972 Stories 1.0
E�cterior Wall i Above Average Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Min Roof(Corr. or Sh M)
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Carpet Flooring 2 None
Fuel None Heat None
A/� Window Unit Baths 1.0
Line Description Sq. Feet Repl. Cost New
1 BAS 480 $16,368
Extra Features (Card: 001 of 002)
Line Description �-Year Units Value
No Extra Features
Sales History
Previous Owner FEDERAL NATIONAI MORTGAGE
Month/Year Book/Page Type C de Condition Amount
12/2011 8635/0496 Warranty 18 ��
Deed Improved $34,900
11/2011 8635 / 0493 Warranty 12 Improved $0
Deed
10/2011 8607/ 1089 Certificate lZ Improved $0
of Title
http://appraiser.pascogov.com/search/parcel.aspx?sec=11&twn=26&rng=21&sbb=0010&b... 8/14/2012
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� 2012135018 �
. ' Rcpt:1453640 Rec: 10.00
DS: 0.00 IT: 0.00
08/09/12 C. Cook, Dpty Clerk
�RULq S 0'NEIL,Ph D PqSCO CLERK 8 COMPTROLLER
08/09/12 02:59 m 1 of
OR BK ���� P� ���G
� v
NOTICE OF COMMENCEMENT
Permit No.
Property Identification No. �� 2�' -2 j C�C� I C� j U 3p lj Q( 7 Q
T'HE UNDERSIGNED 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 the NOTICE OF COMMENCEMENT.
1. Descriptionofproperty(lega/d sc�'p 'o :�GT>'or'ZYP�f�2�1�«.,s t��8/o�s g 1,is �7/8 l92� �,/�3
a) Street Address: 5 / �'
2. General description of improvements �N N�.�'�T�� Ytt) LL �
3. Owner Information �� �Q�����t �r�� �� ������
a) Name and address: J
� b) Name and address of fee simple trtleholder(if other than owner)
c) Interest in property
4. Contractor Information � �'
a) Name and addres,s: � CO �/S'�.,�ID/l) � �, /32. /��CNQC�I�OS✓��Q. 1/�/a'11�1� �Q. 3��.
b) Telcphone No.: C 3 — � Fax No.(Opt.) I
5. Surety Information
a) Name and address:
b) Amount of Bond:
c) Tolq�lioee No.: Fax No.(Opt.)
6. Lender
a) Name and sddt+ese:
7. Identity of person within the State of Florida designated by owner upon whom norices or other documents may be served;
a) Name and address:
b) Telephone No.: 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),Fiorida Statutes:
a) Name and address:
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):
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 1,SECTION 713.13,
FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IPROVEMENTS 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 YOU NOTICE OF COMMENCEMENT.
,
STATE OF FLORIDA /�� �<<:..�r�� '�� � r e
COUNTY OF PASCO ��/� /��'�.,r�
.
Si ro OF Owner or Ow�'�ar's Auth°`'�Officer/Director/Pariner/Manager
��i�.i��'.i`" /T. ��"./�/ri'���
Print Name
The foregoing instrument was aclmowledged before me this��day of �l�'(�.5� 20 2 1
as GLuV.f�cn-�4r. , �by 3�r-t.ce 1 �`�rv�cic-
ame of �tYPe of authority,e.g.officer,trustee,attomey in fact)for
party on behalf of who�'mstntment was executed).
f `
Personally Known_OR Produced Identification� Notary Signature i.2 ,�,__
Type of Identification Pmduced�i►+R�" �a� �,�Ss�-- Name(print) �C E �i r�e
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that the facts stated
in it are true to the best of my knowledge and belief.
FORMS/NOC.rvsd2pp7
�+'�� JACQUELINE BOGES
Signatim of NaMaI pereon S' A
� ��es�ecernber 12,2014
«�� Baide0lhuiroyFaNk���p.��019
STATE G;- ���t�IGA, COUNTY OF P�SCb
THIS IS TU C;ERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD �N THIS OFFICE
WiTNE MY HAND A OFFICIAI.SEAL THIS
DAY OF � � C—L�
PAU O'NEIL,_CLER� COMPTROLLER
/ '
B DEPUTY CLERK
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