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Home My WebLink About14-15535 CITY OF Z PHYRHfLLS 5335-8 H STREEi' (s�3)� o-oozo 155 5 BUILDIN PERMIT ��`��.��.:.��:PERIVIIT�IN�t}RMATiON ` ` _"; :;� , � :.' '' ;LQGATION<INF�ORMi4T10N;��'�,..��h��,�� '.�"�� P�rmit Number: 15535 Address: 7631 GALL BLVD Permit Type; RE-RC70F ZEPHYRHlLLS, FL. Class of Work: ROOF REPI.ACEMENT Township: Range: Booic: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivisian: CITY OF ZEPHYRHI�LS Est. Value: Parcel Number: 34-25-21-0110-00000-001Q Improv. Cost: 363,722.40 _ ;:`"�'�:f:}1NNER�INFORMATItJN.��.$�N ��.�:x Date Issued: Name: WAL-MART Totat Fees: 1,915.50 Address: 7631 GALL BLVD Amount Paid: 1,915.50 ZEPHYRHILLS, FL. 33542 Date Paid: 8/05l2014 Phone: 479)204-1063 Work Desc: RERQOF TPO MEMEBRANE -- ' ,` " APPLICATION FEES �.�; . CONTRAC:T.OR(S) , . .. ° -. -�: Nfl TH AMERICA ROOFI G E VICE REROO COMMERGIA 1,915.54 � � � � � � . ��° i 2 -- �� - � �¢ �� ,� �:_��:,,a��,°n,�� . . �Ins ectioiis� e uired � s 3 °�w-,•� � ..°�: ��'��,��;. �:w -r��::x�s� ,�;.�� DR IN ROOF iNBP TAPE JOINTS ROOF INSP FINAL REINSPECTION FEES: Reinspection fees will comply wi h Etorida Statute 553.$0{2)(c) when e�ctra inspectian trips are nece�sary due to any one of the fotlawing rea ons: a)wrong address b}candemned work resulting from faulty constructian c) repairs or corrections not ade when inspections called d)work not ready for inspection when ca8ed e} permit nat posted on job site f} plans nat at jab site g�work not accessible. NOTICE: In additian ta the requirements of this permit,there ay be additional restrictions applicable to this property that may be found in the public recards of this caunty, and there ay be additional permits required from other governmental entities such as water management state agencies or federal agencies. "Warning ta owner: Your failure to record a notice o cammencement may resutt in your paying twice for improvements to your property. If you intend to ob m financing,consult with your lender or an attorney befare recording your no ice af commencement." Camplete Pians,Specifications Must Accompany Appli tion.All wark shall be pertormed in accordance wi#h Ci Codes and Ordinances. O OCCUPANCY BEFO C.O. CTQR SiGNATURE PERMlT 4FF! R PERMIT EXPIRES IN 6 MONTHS ITHOUT APPR4VED INSPECTION CALL FOR INSPECTION - $ HQUR NOTICE REQUIRED PROTECT CARD ROM WEATHER }-_�.11 *U . Z aisaao-oozo City of Zephyrhills ermit Application Fax-813-780-0021 j Building D partmeni ! � i Date Reoeived � � �_�r_r�T Phone Contactfor Pe ittinq� — Owner's Name � '' Owner Phone Number 0 t,, Owner'§Address ic Owner Phone Number Fee Simpla Titleholder Name Owner Phone Number Fee Simple Titleholder Address ' JOB ADDRESS � � LOT i/ � SUBDIVISION PARCELIDi1 Y° �� '' r a .(OBTAINED FROM PRdPERTY TAX NDT�CE) WORK PROPOSED e NEW CONSTR B ADDIALT SIGN � � DEMOLISH INSTALL REPAIR' PROPOSED USE Q SFR Q COMtvt OTHER IYPE OFCONSTRUCTION Q BLOCK Q FRAME STEEL Q (�p.,,JE�SqC�RIyP'7�dN OF WORK 1 YYLY� � � BUILOING 51ZE /� SQ FOOTAGE� HEIGHT � �B�-_ ILDI� �� VALUAT�ON OF T TAL CONSTRUCTION ; �� QELECTRICAL $ AMPSERVICE Q PROGRESSENERGY Q W.R.E.C. QPlUM81NG $ �� QMECHANICAL � VALUATION OF M CHANICAL INSTALLATION � �� QGAS �` ROOFING Q SPECIALTY OTHER FINISHED FLOOR ELEYATIONS FLOOD 20NE REA QYES NO � BWLDER ! MPAN � +t� j SIGNATURE I FiEGISTE Y N fEECURREI. ! Address � License# � 0 i ELECTRIClAN COMPAN �— � � SIGNATURE REGISTERE Y/ N FEE CURRE� Y 1 N i Address License� PLUMBER � R OMPE � Y f N FEE CURRE� Y 7 N � , SIGNATURE Address License q `� MECHANICAL COMPAN ; SIGNATURE REGISiERE Y/ N FEE CURREA Y!N � Address Litense H ' OTHER � COMPAN SIGNATURE � REG�STERE Y I N FEE CURREt� Y J iJ Address license t1 Ilillllill�lllllllltllllllllllllllllllllllllllll ( IIIIIIIIIII.IIIII111 RESIpENTIAL Altach(2)Plot Plens;(2)sets of 8uilding Plans;(1)set of Ener y Fortns:R-O•W Permit/or new construction. Minimum ten{10)warking days'after submiflal date. Required nsite,ConsWction Plans,Stortnwater Plans wt Siit Fence installed, Sanitary FaciGlies 8 1 dumpster,Slte Work Permit for subdivisi nslfarge projeds COMMERCtAL Atfech(3)complete sets of Building Plans plus a Life Safety Pa e:(1)set of Ener9y Forms.R-O-W Permit for new construction. Minimum[en(10}working'days after subm(tlal date. Requlred nsite,ConsWCtiomPlaos,.5tortnvrater Pians wl Silt Fence installed, Sanitary Faci�ities 8 1 dumpster.Site Work Permil For all new p jects.All coinmercial requiremerits must meet comptiance SIGN PERMIT At1acH(2)sefs of Engineered Plans. ' '' ""PROPERTY SURVEY required for all NEW construction. Directions: Fill out:applica8on campletely. Owner 8 Confraclor sign back ot application,notarized Ii over$25D0,a Notice of Commencement is required. (AIC upgrades ov c$7500) " Agent(for the contractor�or Power of Attomey(for the.owner}would be some ne with nalarized ietter trom owner authorizing same OVER THE COUNTER PERMITTIkG (front of Application Only) Reroofs if.shingles Sewe�s Service Upgrades AIC Fences�(PIodS eylFootage) _ , , _, „ , ._, Oriveways-NOt over Counter H on public rondways.:needs ROW ' � ' � .. . . ' . ., , ., , . , � , � �r�.I `; i} i NOTICE OF DEED RESTRICTIONS: The undersigned understartds that this permit may be subject to"deed"restrictions" which may be more restrictive than Couniy regulations. The undersigned assumes responsibiliiy for compiiance with any applicable deed restrictions. , UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a c6ntractor or j contractors to undertake work,they may be reguired to be licensed in accordance with state and local regutations. If the 3 contractor is not licensed as required by faw, both the owner and contractor rnay be cited for a misdemeanor violation E under state law. If the bwner or intended conUactor.are uncertain as to what licensing requirements may apply for the intended work,tliey are advised to contact the Pasco County Building Inspection Division—Licensing Sectiori at 727-847- 8009. Furthermore, if the owner has fiired a contractor or contractors, he is advised to have the contractor(s) sign portions of the"contracto�Block"of this application for which they wili be responsible. I(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 tMPACTIUTILITIES IMPACT AND RE50URCE 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 buildi�gs,as specified in Pasco County Ordinance number 89-07 and 90-07,as amended. The undersigned aiso 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"ce�tificate of occupancy"or final power release. If the projec[iioes 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 Counry ordinances. CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowners Protection Guide"prepared by the.Florida Departmenf 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'S/OWNER'S AFFIDAVIT: I certify that ali the information in this applicahon is accurate and that al!work wiit be done in compliance with all appiicable laws regulating construclion,zoning-and land devetopment. Applicatlon is hereby made to obtain a permit to do work and instaliation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be perfoRned to meet standards of alI iaws regulating construction, County and City cotles, zoning regulations, and land development regulations in the jurisdiction. I aEso certify that I understand that,the regulations oF other government agencfes may apply to the intended work,and that it is my responsibility to idenfify what actions 1 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-Weils, Cypress Bayheads, Wetiand Areas, Altering Watercourses. - Army Corps of Engineers-Seawails,Docks,Navigable Waterways. - Department of Health & Rehabilitative ServiceslEnvironmental Health Unit-Welis, Wastewater Treatment, Septic Tanks. - US Environmental ProtecGon Agency-Asbestos abatement. - Federal Aviation Authoriiy-Runways. I understand that the foltowing restricUons 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 Fiood Zone "A", it is.understood that a drainage Rlan addressing a "wmpensating vdlume"will be submitted at time of pertnitting which is prepared by a professional engineer licensed by the State of Florida. - If the fill material is to be used in Flooii 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 fil[ material is to be used in a�y area, I certify that use of such fiil will not adversely affect adjacent ` propeRies. 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 permil appticaGon,for lots less than one(1) acre which are elevated by fill,an engineered drainage plan is requirecl. If i am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in fhis affidavit prior to crommencing consVuction. I understand that a sepa.rate permit may be required for electrical work, plumbing,signs, wells, pools, air conditioning,�gas, or other instailations not specificaliy included in the application. A permit issued shall be construed to be a license to proceed with the work and no.t as auihority to violate,cancel,alter,or set aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building O�cial frbm thereafter requiring a correction of errors in plans,construction or violations.of any codes. Every peRnit 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 extensian may be requested,in wriUng,from the Buiiding O�cial for a period not to exceed ninety(90)days and will demonstrate justifiable cause for the extension. If worlc ceases for ninety{90)consecutive days,the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMEtVCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROV ENTS TO YOUR PROPERTY. IF YO 7EN TO OB� AIN FINANCING,.CONSULT # WITH YOUR LENDER OR AN NE BEFORE REC RD1NG YOUR TI OF C MMENCEMENT. PLORIOA JURA7(F.S. 03) �� OWNER OR AGENT CONTRACTOR I 0��ubscribed and sw r ryirme be n nd s�,o_�o� irm d) efor �is �y `^ � �N�b lT la�� Who.is re pe onalty k�ovm to me�heslMeve-predaecA. ho i are persona y know me or haslhave produced . as fdenGtication. - as idenlification. yp�,,I' � �/,��.�- ,/� . , ��ty,�/ry Public ,� Notary Public Commission P7o.�� a� ��q C mission No. UeV�C�0 I , � � � Name of Nolary typed, rir��Qras�p�b I i C, N o r t h C a r o I i n a GWENDOLYN M TER Buncombe County Benton County M Comm s o Expires � Commission IVumber 12390278 ��---- fVotary Public - Arkansas My Commission Expires November 8,2022 , • ii � � � � I I � July 16, 2014 City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 RE: Wal-Mart#706 Supercenter 7631 Gall Blvd. Zephyrhills, FI. 33540 Re-roof project To Whom it May Concern: North American Roofing has been awarded wit the Wal-Mart#706 reroofing project. The project manager Francisco Sanchez will be in ch rge for the entirety of the project. Please let this notarized letter show that Francisco Sanche has my written permission to apply for, pay for and obtain a building permit for this project. Sincerely, U� Dwight Marwede Director of Technical Sales The foregoing instrument was acknowledged befor me this 16th dav of Julv 2014,who produced as identification is personally known to me. r otary Public JULIE RE L PRAiT Notary Public, orth Carolina Buncomb County Buncombe County M Commi � ��es �� State of North Carolina � i �� • �.� :i, :ii �i i �� • �� ' . O� �r\� tl/ � ' "=�� i - City of Z phyrhills BUILDING PLAN VIEW COMMENTS /�6�'�� Contractor/Homeowner: �j — .��— " � Date Received: � � s�te: � ��3/ �� l�� Permit Type: �� Approved w/no comments` Approved w/the below comments: ❑ Denied w/the below comments: ❑ ; I This comment sheet shall be kept with the permit and/or lans. ' �ia,�'�' `.�.L`�� JUL � 0 2014 Kalvin Switzer—Plans Examiner Date Contractor and/or Homeowner (Required when comments are present) ii � � � � � � � July 31, 2014 City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 RE: Wal-Mart#706 Supercenter 7631 Gall Blvd. Zephyrhills, FI. 33540 Re-roof project To Whom it May Concern: North American Roofing has been awarded wit the Wal-Mart#706 reroofing project. This letter of authorization is to provide Carlos Cach with administrative rights. Please let this notarized letter show that Carlos Cacho has my ritten permission to apply for, pay for and obtain a building permit for this project. Sincerely, Dwight Marwede Director of Technical Sales The foregoing instrument was acknowledged befo e me this 31th dav of Julv 2014,who produced as identification is personally known to me. N ry Public JULIE REEL PR'ATT Notary Public, North Carolina uncombe County Buncombe County M om i-ss n �pires ��=P-- State of North Carolina � � �� :i, :ii �i � �� • �� . _ -- -- ------ ----- ------ _- — ---- - ---- ��j � ■ � �.:� � - - � -�-- � � -- -� -- ------ - -------- 41 Dogwood Road Asheville,NC 28806 Julie Pratt Project Administrator jpratt(c�naroofm .�com. 800-551-5602 ex. 125 /p ,'. Q �� / Direct: 828-348-2225 � I fj� � � Fax:828-687-1230 L�� C� J P Letter of Transmittal � �� Date: July 22, 2014 To: City of Zephyrhills Attn: Building Department—Jacqui Boggs 5335 8th Street Zephyrhills, F133542 RE: Sam's Club #706—re-roof permit VIA: � Hand Delivered: Emailed: Mail: Ovemight: X Quantity: Date: Descri tion: 1 Building Permit Application 1 State of Florida Contractor's license 1 Co y of Business tax recei t from Putnam County 1 Set of Manufacturer s ecs 1 Letter of authorization from ualifier for erson to ick ermit up REMARKS Jacqui—please let me know if the information enclosed is correct. lease let me know if there is anything else you may need in order to pemut this project. Signature: Julie Pratt ■ Corporate Office:41 Dogwood Road •Asheville, NC 28806 � 800-551-5602 •828-687-7767 • Facsimile: 828-687-1230 � e i SYIVTEC SYSTEMS FZ�t�[�Irb' (J;`s,�"L`:. �,:f 9 �.. -:�•1..!1 �� *' ; (_!_`�,^ j�_;;:` � .L� ^' , . ?' .�j i!�f 'I'�i 1., Sure�VUel� '� � ��f��L� ��a . _, t�1�� _. �. - � - _ � _ ._ � ` � �i•'•�=��'�,:�li'•:G r'+:f ' . ; i.(; ,'��. . '.�!;_I); � LA� S EX�;�;itti�f.�� Ct�DL,.:��,?i:;�;.`�,L:'i_�t_[i.i: ;"�.,�I`;. ��'••JV Reinforced f�embrane l��- � - - �--�---- .:�, -- - - - - /� _ .. . � C'I�r�'(_ji ._�i(i}'I;�l�i�.:. �.:��.��L��\l.i=.J Carlisle's Sure-Weld tan and white TPO membrane can contribute toward '' � _, - LEED��(Leadership in Energy and Environmental Design)credits.Tan and white Sure-Weld are ENERGY STAR='*-qualified and California Title �-�"�� 24 compliant. .-.� . Features and �enefits �.� » Outstanding puncture resistance ��:�'y� » Chlorine-free with no halogenated fiame retartlants .��` „�„�^=� _ » Plasticizer-free;does not contain liquid or polymeric plasticizers ,;,� » Excellent low temperature impact resistance » Excellent chemical resistance to acids,bases and restaurant exhaust emissions » UL 2218 Class 4 hail rating Overview » Exceptional resistance to heat,solar UV,ozone and oxidation Carlisle's Sure-Weld membrane is a premium heat-weldabie single-ply » Hot-melt extrusion processed for compiete scrim encapsulation thermoplastic polyolefin(TPO)sheet designed for new roof construction » Sure-Weld is 100%recyclable and re-roofing applicafions.Sure-Weld High Slope(HS)membrane is (refer to Carlisle's Recyclability Statement) formulated with additional flame retardant(compared to standard TPO)for higher-slope fire code approvals.Sure-Weld EXTRA is 80-mils-thick for » Enhanced with the OctaGuard XT"'weathering package significantly higher strength and weatherability. �`�� DCTRGURRD XT Carlisle Sure-Weld TPO membrane features advanced polymerization �, _.� �J WEATHERING PACKAGE technology that combines the flexibility of ethylene-propylene(EP) rubber with the heat weldability of polypropylene.All Sure-Weld TPO membranes include OctaGuard XT'"',an industry-leading,state-of-the- InStall8t1011 art weathering package.OctaGuard XT technology enables Sure-Weld 1, Sure-Weld Roofing Systems are quick to install,as minimal labor and TPO to withstand extreme weatherability testing intended to simulate few components are required.The systems may be installed utilizing exposure to severe climates. labor-saving devices that make sheet welding fast,clean,consistent Physicai properties of the membrane are enhanced by a strong polyester and easy to learn,while reducing strain on the roofing technician. fabric that is encapsulated between the TPO-based top and bottom plies. p, The Carlisle Mechanically Fastened Roof System installation starts The combination of the fabric and TPO plies provides Sure-Weld reinforced with the insulation fastened with a minimum of 5 fasteners per 4 by membranes with high breaking strength,tearing strength and puncture 8 ft.board.The Sure-Weld reinforced membrane is mechanically resistance.The relatively smooth surface of Sure-Weld membrane fastened to the deck using HP-X`"Fasteners and Piranha Plates"'or produces a total surface fusion weld that creates a consistent,watertight, HP-XTRA Fasteners antl Piranha XTRA Plates.Adjoining sheets of monolithic roof assembly The membrane is environmentaily friendly and Sure-Weld membrane are overlapped over the fasteners and plates safe to install. and joined together with a minimum 1'iz-inch-(4 cm)wide hot-air weld. Sure-Weld Stantlard antl HS products are available in highty reflective 3. The Carlisle Fully Adhered Roofing System application begins white,tan and gray,in both 45-mil and 60-mil thicknesses.Sure-Weld with the insulation fastened at the required density(max.1 every 2 EXTRA(including HS)is available in 80-mil thickness,in white,gray and sq ft)necessary to resist the appropriate wind load.The substrate tan.Sixteen special colors are also available(see Carlisle's TPO Color and membrane are coated with an appropriate Sure-Weld Bonding Palette brochure) Available widths are 4-,5-and 6-ft perimeter sheets Adhesive and the membrane is roiled into place. and 8-,10-and 12-ft field sheets. Review Carlisle specifications and details for complefe insfaNation information. 800-�79-6832 I P 0 B x 7000 I Carlisle. PA 17013 I Fax 717-245-7053 I www.carlislesyntec.com ,_ , � : . � �11111IIIIIIIIIIIIIIIIIIfllllilllllllllllll�lllllllllfillllf IRcpt:1619547 Rec: 10.00 DS: 0.00 IT: 0.00 ' 07/30I14 L. Korb, Dpty Clerk 3 , Pe(mit No. P rcel ID No -- - " - - � FRULq � 0'NEIL,Ph D PASCO CLERK & COMPTROLLER ! NOTICE OF CO ' ENCEMEHT 07/30/14 01:'20 m 1 of 1 Sleteot�t.(q'Y�r L.c C untyo( f�l � ( OR BK �r �� PG �� THE UNDERSIGNED hereby gives notice Ihal improvement wil(be made to c rtein real property,and fn acwrdance wilh Chapter 713,Fiorida Statutes," lha following Infortnalion is pravided in ihis Notice o(Gamme��p nt: 1. Description of Properly:,Parcel Identification No. �.'�!� �" ��"y Street Add�ess: �.f'�� .e..e t�lvd � 2, GeneraE Descriptlon of Impmvetnent 1� � � _. i. , 3. Owner Infortnatlon or Lessee InEormation If the Lessee conlracled fu lhe imprrnement: � _ �Y j ;C7 �, (9�.�„�,�-2� `�7�_2. � Address Ciry State Interesl in Property: Name of Fee Simple Tltleholder: � ' (If different trom Owner fisted a6o ) Address „�r� i Cily� " Stata � 4, Conlractoc V1 Name /� _I _� �y ��C1w�Rt .�S[�.�.+ Adtlress .��q�, City r/�S te - Coritraclors:TelephqneNo.: G/"✓ �� d � 5. Sufety: � . Name i - Address Gty State Amount of Bond: S TelephonE No,: -' ' 6, Lender, Naine. Address City State , Lende�s-Te7ephone.No.: 7. Persons within the State of Flo�rid designaled by 1he ovmer up n whom nolices or other documents may be served as provided by . - S�U'.ort Z13.13(1)(a(7�Florid'a Sta les; \ - Nama. I 1 �i�c1c.� �o�Uv-��IS �1,33�y/ ddress �— Slate Telephone Numher of Designa[ed Person: � '�� ^ � �� 8. In addiBon ta himself,lhe owner'designates °f— to receive a copy p Ihe Ltenors Notice as pravided In Section 713.13(1)(b),Florida Stalutes, Telephone Numher of Person or En6ry Designated by Owner f i 9, E�iralion date of NoQce ot Commencement(lhe e�iralton dale m y no[be befu2 lhe comple6on of construclion and final payment to the ? conUaclor,hut will be one year from the date o!recording unless a di erent date Is specifiad): WAf2NING TO OWNER: ANY PAYMENTS MADE 8Y THE OWNE AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDEREQ IMPROPER PAYMENTS UNDER'CHAPTE 713, PART 1., SECTION 713.13, FLORIDA STqTUTES. ANO CAN , RESULT fN YOUR,PAYWG NVICE FOR IMPROVEMENTS TO YOUR PROPERN. A NOTICE OF COMMENCEMENT MUST BE ' � RECOf�DED AND POS7ED ON THE JOB SITE BEFORE THE FIR INSPECTION. IF YOU INTEND TO.OB7AIN FINANCING,CONSULT ' WITH YOUR LENDER OR AN ATiORNEY BEFORE COMMENCIN WORK OR RECOROING YOUR NOTICE OF COMMENCEMEM' Under penalty of perJury.I deGare thal I have reed!he faregoing no .of commencem n that the facts stated thereln are Uue to lhe 6est of�1 krQvrleng��d 6efief. STATE OF��O 16�Pc. �� COLINTY OF��n = Signa(u of OvJner ar e or s or Lessee's Authnrized Officetl IrectodPaMedManaga[ Signalo s TitlelO�ce /� � /� The foregoing lnstrument was acknawledg0d efore me1Y s Qday o( ,20�by �--`�+�1'-"�� —" �� as '�r"� (type of aulhoriry,e.g:,o(fice�,Ws1ee,attome in facq for � " � � Gi n, (nam� rly on behalf a(whom in ment vras e�c ted). . V Personelly Known b,9$Produced IdenUficatlon❑ Notary ignature�� I ti Type af Identificalion Produced Name( rint) - . GWENDOLYN M TERRY Benton County C mmission Number 12390278 Notar.y Public - Arkansas wpdeta/bcsfnoUcecammencemen[.pc0530qe My ommission Expires November 8�2022 i , ��a��9,%.��B�oQ= �*ar�.�� asC- o"�..V'C�?fJ.*1y �iJ'�,Y0�71 1 01'- I'"/-1JliV �s y��,�,� 1`f�,S IS'i"C7 C�RTZrY TFiAT TF{E FQREG01�1G(S A ,�-`� w��0'd, 1'FtU�;�fJ[J COF��ECT COPY C3F THE DOCUMEN7 � • � 0�!FlLE OR C7�'PUBLIC R�CORD IN THES OFFIGE �^ �, � WiTN��t�/Y Fi,�1�D kND OFFICIAL�EAL TMIS � ° In C�oc!"We�rttst �, �j(9 DAY�F / ,�-•, �2 Cr 1 > = _ , � PAUL,�S. O't4EiL, C �R'r:&`COMPTROLLER � ; \.� / �Y 1��7 � � �Y t��P�J3Y CLERK �`��F��'�� _