HomeMy WebLinkAbout14-14940 CITY OF ZEPHYRHILLS
5335-8TH STREET
�si3)�so-oozo 1 4 0
BUILDING PERMIT
Permit Number: 14940 Address: 5722 19TH ST
Permit Type: ACCESSORY BLDG. ZEPHYRHILLS, FL.
Class of Work: SHED INSTALLATION Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-07800-0070
Improv. Cost: 3,200.00
Date Issued: 2/04/2014 Name: STOSH JAMES NICHOLAS
Total Fees: 82.50 Address: 5722 19TH ST
Amount Paid: 82.50 ZEPHYRHILLS FL 33542-4437
Date Paid: 2/04/2014 Phone: 813-629-6175
Work Desc: 10 X 14 SHED
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SHEATHING
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� 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 pertormed in accordance with
Ci Codes and Onlinances. NO OCCUPANCY BEFO C.O.
�d �
ONTRAC OR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
��3-�so-oo2o City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received �— 2 7—� Phone Contact for Permittin __
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Owner's Mame /'�"`^- +�- S �. �J�'� Owner Phone Number �� Z
Owner's Address J 7� �t� T ,� P J Owner Phone Number �—
Fee Simple Titleholder Name �— —� p�er Phone Number
Fee Simple Titleholder Address
JOB ADDRESS 7� � R f' C% 1.0T� �
SUBDIVISION � PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
VVORK PROPOSED � NEW CONSTR 8 ADD/ALT � SIGN � Q DEMOLISH
INSTALL REPAIR
PROPOSED USE �� SFR Q COMM �� OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME STEEL Q
DESCRIPTION OF WORK (, � j S -P
BUIL I SIZE �_ � SQ FOOTAGE�� NEIGHT
BUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
����V
OGAS Q ROOFING Q SPECIALTY [_] OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO
BUILDER .�� COMPANY 'eO1i�rI'E�l�
SIGNATURE I REGISTERED Y/ N FEE CURRE� Y/N
Address License# —�
ELECTR�CIAN 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# �
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y I 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,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Wo�ic Permit for subdivisionsAarge projects
COMMERCIAL Attach(3)complete sets of Buildfng 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 8 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 consVuction.
Directlons:
Fill aut application completely.
Owner&Contractor sign back of application,notarized
If over 52500,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 from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Appflcation Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/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 responsibitity 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
cont�actor 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 Transpo�tation 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/Sewe� Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Fiorida 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 instaltation 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�II 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 flll 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 flll, 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
uniess 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 YOU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT � CONTRACTOR
Subscribedy�nd swo (or affirmed)be ore me this Subscribe/d.�nd b o affirmed)before,me this
�_��_/Gf ey < s"' ��
Who isl re erso ally �wn to me or haslhave produced o 1 arP�personally known to me or haslhave produced
- /C �8e— as identlfication. � �lN���G�-�- as identification.
!` ,, � [it�%� /� �---- �� ES Notary Public
, Notary Public
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Commi on No. =«. ;'_ • 12,2014
Co sion ����� • -
�� ,,� ',�,�' 'y g�d11,nT,o/Fanhru.�ae
:; ',;. Commission#EE 040520 ,
Name of No I � {�, ecinaes-,o�e': Name of Notary type , e or stamped
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: ��'✓l��S ;��`�
Date Received: � - 2 7-� � !t-�
Site: �5�Z 2 � �f� � �
Permit Type: �� '�{ � � ����
Approved w/no comments:❑ Approved w/the below comments: Denied w/the below comments: ❑
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This comment sheet shall be kept with the permit and/or plans.
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Kalvizi Swix� lans Examiner Date.
tractor and/or Homeowner
equired when comments are present)
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
"License e�cient/y. Regu/ate faiNy."
RICK SCOTT
Govemor
September 17, 2013
Donald Flanders
Handi-House Manufacturing Company
P.O. Drawer 830
Swainsboro, GA 30401
RE: Manufacturer Certification, ID MFT-178; Expiration Date: November 16, 2016
Dear ponald Flanders
It is my pleasure to inform you that Handi-House Manufacturing Company, located at 747 HWY 1
SOUTH, P 0 BOX 830, SWAINSBORO,GA 30401, has been approved under the Manufactured
Buildings Program,as provided for under Chapter 553, Part I, Florida Statutes,to manufacture
Storage Sheds, Manufactured Buildings for installation in Florida. i �` ;';�t�''�'
Construction or modification on a manufactured building cannot begin until the Third Party Agency � ��`?
has approved the plans in accordance with the current Florida Building Code. Your Third Party ' � �'.�`� ' ,`.,`j}
Agency is a contractor for the Department and has statutory authority and responsibilities that ,�. � ���7 �
must be met to maintain approved status. You may expect and demand quality plans rev.iew and.` ;'�j'1�,'',' � �k
inspections.
Each Code change will make your plans obsolete until they have been reviewed,approved and
indicated [on the cover page of the plans] for compliance with the Code by your Third Party Agency
for plans review. Please ensure that your plans are in compliance and are properly posted on our
website. All site-related installation issues are subject to the local authority having jurisdiction. �� -� ��
�'f°"\,� ��• P arL_' ��' � �--
,��i � � ��� ��� i �� C����)_
The Department's contractor will make unannounced monitoring visits at least once each year. Yo j � � t i \
�'������ ������ �
must grant complete access to your manufacturing facility and records to remain in compliance with - �'°°"'�
the rules and regulations of this program.
Your certification is approved for three years from this date. You wili receive a renewal notice by
Email generated by the BCIS (www.floridabuilding org)for online renewa(. If you have questions
you may contact me or Leola Baldwin at 850-921-0956 or our FAX at 850-414-8436.
Please visit our website at www.floridabuildina ora to see valuable information on the Florida
Manufactured Buildings Program. A copy of this letter must accompany applications for local
building permits.
Sincerely,
��' ��
Robert Lorenzo
Manufactured Buildings Program
cc:National Design and Inspection, Inc.
2555 SHUMARD OAK BOULEVARD ♦ TALLAHASSEE. FL 32399- 2100
850-488-8466 (p) ♦ 850-921-0781 (f) ♦ W e b s i t e: www.dca.state.fl.us
♦COMMUNITV PLANNING L60�!l-2166(p) E60dlBJ309(n♦
♦HOUSING AND COMMUNITV DEVELOPMENT 660-488-7966(p) 860-922d6T�(�♦
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CITY OF ZEPHYR��ILLS BL`ILDING DEPARTME?v'T
'Owner:
7ob Location/Address:
Parcel I.D. #:
SHOW ALL EXISTIIJG&PROPOSED STRUCTURES GNING DIMENSIONS &SETBACKS
UTILITY BUILDINGS MUST SHOW SIZE &FOUNDATION INFOR,vIATION
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Example 1. Setbacks for Rl &R2 Zoning Example 2. Setbacks for R3 Zoning
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- - - SfREET - - - - - - - - - - - - -- SfxECt -- - - - - - - - - -
11.-26-21-0010-07800-0070 � Pasco County Property Appraiser Page 1 of 1
Mike Wells Pasco County Property Appraiser
Data Current as Of: Weekl A - urday,January 25, 2014
PartelID -26-21-0010-07800-0070 (Car : 01)
Classification
Mailing Address Property Value
STOSH ]AMES NICHOLAS Ag Land $0
5722 19TH ST Land $8,030
ZEPHYRHILLS FL33542-4437
Phvsical Address- See All 2 Building $13,600
addresses�Fi�cstioM,�� Extra Features $671
5722 19TH ST
ZEPHYRHILLS FL 33542-4436
]ust Value $22,301
Leaal Descri�tion (First 4 Lines)
P� � � Assessed (Save Our Homes) $21,785
ZEPHYRHILLS PB 1 PG 54 WESTi/2 Homestead 196.031 - $25,000
OF LOTS 7 &8 BLOCK 78 Non-School Additional Homestead Exemption - $0
OR 3769 PG 1334
ur s �
Citv of Zeohvrhills Taxable Value $0
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 Zoning Units Type Price Condition Value
1 0100 SFR OOR2 4,200.00 SF $1.80 1.00 $7,560
2 0100 SFR OOR2 1,342.00 SF $0.35 1.00 $470
Additional Land Information
Acres 0.13 Tax Area 30ZH FEMA X Residential Code ZHLHLP2
Code
Buildina Information - Use O1 - Single Family Residential (Card: 001 of 001)
Year Built 1955 Stories 1.0
Exterior Wall 1 Asbestos Shingle Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Metal
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Pine or Soft Wood Flooring 2 None
Fuel Gas Heat Convection
A/C Window Unit Baths 1.0
Line Description Sq. Feet Repl. Cost New
1 BAS 716 $25,346
2 FOP 120 $1,062
Extra Features(Card: 001 of 001)
Line Description Year Units Value
1 UDU-M 1997 1 $671
Sales Historv- See All 4 sales
Previous Owner: AYLETT BRUCE G &MARILYN FAY
Month/Year Book/Page Type DOR Condition Amount
Code
07/1997 3769 / 1334 Warranty Deed Improved $35,000
Executor's Deed
02/1996 3573 / 1826 (Personal Improved $0
Representative's)
Executor's Deed
10/1995 3487 / 0460 (Personal Improved $0
Representative's)
http://appraiser.pascogov.com/search/parcel.aspx?parce1=2126110010078000070 1/27/2014
� D2SCI,OSiJRE S'f'A'►'F*�'NT .FOR OW1�R
CZTY OE ZEPFiYRI32I�+S SUIT�D2NG DEPAR'�'�•NT
_ • have read asid fu11y understand atid
agrae �to �e provisions of �this instrument•
The undersigned states and affirms that he or she is desirous of constructing,
renovati.ng, adding to or reroofiag his or her own domicile, 'that he or she
actually occupies, or wi11 occupy by said domicile, and same is not for
•rent, lease or sale. That he or she sha11 comply �.th the followiing condi-tions:
1_ That, the owner and�he or she alone sha11 act as the buildar for a11 phases of
construction.
2. That the owner wi11 comply with a11 provisions of the City of Zephyrhills
ordinances and codes �*-�;neat to the buildiag.
3, That in the enent various phases of construction are subcantracted, he wi11
engage only �properly licensed subcontractors and will personal�y supervise
such work.
4. 2'kiat in the event the Suildixig Inspector shall re?,'re corrections to be made,
the owner �vi11 assume fu11 responsibility to insure •they are made, and upon
campletion will cal3 for a rp�T�ection before proceecling with the building.
5. That the owner sha11 assume full respons�bility for the constsuction aad vPi11
not axpect_ supervision of his work from the City .of Zephyrhills Building
Depart�ent.
6. That prior to final inspection aay additional fees, including reinspection
f�as, must be paid in full. A �ritten requast from ttiis office shall
constitute an official notice rto pay additional. £ess. ,
7. That the ownes sha11 comply with a11 City, State and Federal laws in regard to
social sacurity, workman's compensation, liea laws, etc. , where applicable.
B. That the owner sha11 co�ply with a11 the safety codes issued by the Florida
Industrial Commissioa.
9. State 1aw ree+,;ras coast.r�iction to be done by licensed contractors. You have
applied for a permit under asi exempt�-on to t3�at law. The exemption allows
you, as the owner of' your property, to act as your �wn contractor with certain
restrictions even though you do not have a license. You must provide direct
onsite supervision of tlze coastsuction yovrself. You may build or improve a
one-family or two-family residaace or a farm outbuildiag. You may also build
or improne a commercial building, provided your costs do not exceed $25,000.
The building or.residence�must be for yovr own use or occupancy. =t may not
be built or substantially improved for sale or lease. If you sel:l or lease a
building you have built or substantially improved yourself within 1 year aftES
the constructian is complete, the law will presume �that you built or
substanti.ally improvad �if for sale or laase, which is a violation of this
eaemption. You may not hire an ualiceasad person to act as your contractor or
to supervise people working on your building. 2t is yovr responsi.bility to
make sure that people e�ployed by you have licenses rez,;red by state law and
by county or muriicipal liceasa.ng ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not.
licensed to perform the work being dnne. Any p�rsoa working on your buildi.ng
who is not liceused must work under your diract supervisioa and must be
employed by you, which means that you must deduct E.I.C.A. and vrithholding }=T
and provide workers' compensation for that employee, all as p=esaribed by law.
Your constrtiction must comply with all applicable laws, ordixaances, building
codes, and zoning re ations.
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ADDRESS
PHONE
W=TNESS ' PEFtMIT #
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02/04/14 D. Bonllla, Dply Clsrk
�iiULA 5.0'NEIL,Ph.D.PR5C0 CLERK L COMPTROLLER
02/04/14 8:4 1 of 3
OR BK ��± �� PG �02
NOTICE OF COMMExt'FMFNT
Permit No.
Propetty Identification No.1 J" e�`^o� � ���p p 7 �o �j o 7 D
Tf�LINDERSIGNED hereby givcs notice that improvements will be madc to certain roaf property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in the NOTICE OF COMMENCEMENT.
1. Description of Property(legnl duerfptio 2 e//f y(f�l�1�S ��I P 6 o c/c �i%
a) Street Address: ��7 a o� ��"��1 G?�Q��c T
2. Genaal description of improvements_,1 D -� / �
a" Owner Infortnation
a Nameandaddress:�,o,�.,etv. STOt/a �7`� � /YT�� S'�a'L�T
> Z.P.�I,.,es/`(�S F�A
b) Name and address of fee s�mplo t�tleholder(�f other than owner)
c) Intaest in property
4. Contractor Infortnation
a) Name and address: n0�.0 S �O/ � O R�9�+��� 'TA��/C��
b) Telephone No.: =d!3 -G R G �L 2 Y 9 Fax No.(Opt.)
5. Suroty Information
a) Name and address:
b) Amount of Bond:
c) Telophone No.: Fax No.(Opt.)
6. I.ender
a) Name and addross:
7. Identity of person within the State of Florida designated by owner upon whom noticcs or other documents may be served;
a) Name and addras: .
b) Telephone No.: Fax No.(Opt.)
8. In addition to himself,owna designates the following person to receive a copy of the Lienor's Notice as rovided in Section Q ~ W � �
713.13(1)(b),Florida Statutes: P c/) W ��—y � � �}?
a) Name and address: O � � tL = w �
b) Telephone No.: Fax No.(Opt.) � Z V � F— O �
9. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is Q O Q = Q c� � �
specified): d (,
� w ,L ~" c.wn �- o
WAIZIVING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF a O F=.. 0 Q �
COMMENCEMENT ARE CONS[DERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13, � � � U U
FLORIDA STATUTES AND CAiY RESULT IN YOUR PAYING TWICE FOR IPROVEMENTS TO YOUR PROPERTY.A 2 = O O LL � e
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST �� a W � Y
INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE U Q O � p �
COMMENCING WORK OR RECORDING YOU NOTiCE OF COMMENCEMENT. = V U Z J
STATE OF FLORIDA a � ~ J a U
COUNTY OP PASCO ' . 0 � U m � �
� W � Z O J
�S' OF Owner or Owner's Authorized OfTica/DirectodP�ImedMmsea O� � � Q }. W
t S � JWOO o0
Print Name � O Q � �
Th�going instrument was acknowledgcd before me this�day of��IILCLL'�/ .20�by � � Z � �
��`'�� ��0� � ofauthori � Q
�-. 4'f/ PJL� name of « ty�°'g•°��•�^'stee,anomey in facq for � w J J
( party on behalf of who ' ment was exxuted). a � = li Z^
� �r F— S � Z
Personally Ktwwn_OR Produced Identification_ Notary Signature (n F-- }— Q � ` p. �l
Type of Identifcation Produce���[�'Pru C'e�3� Name(print)
; ' n 12, ��'� *' *
Verification ursuant to Saction 92.525,Florida Statutes.Under '
p penalties of perjury,1 declare t " ts slaled �j
in it are true to the bcst of my knowledge and betief. ''�l,q(„ ��� � �� *
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