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Home My WebLink About14-15690 I CITY OF ZEP YRHILLS ' �� , { 5335-$T.H EEi' (si3)�so ao2o 156 BUILDING PERMIT �� '� 'PERMIT�lNFC?RMATION��M;��"�s�< , ` - �� :£ �.;:�,LQCATION'INF�ORIIAATION�:. ��`° :�,�. `� Permit Number: '{5690 Address: 5729 5727 20TH ST Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of 1Nork: 434-ADDIALT RESIDENTIAL Township: Range: Boak: Praposed Use: NOT APPLICABLE L.ot(s): Block: Section: Square Feet: Subdivision; CITY OF ZEPHYRHlI.�S Est.Value: Parcel Number: 11-26-21-0010-07800-0050 . �.,r�. .-w�-�-�--,-- � --- . . .. ��. mprav. ost: . �; ��,;� _��-�:.�`�pAW.,NER,IIVFQRM'�A�I.C?N� �� Date Issued: 9126/2014 Name: F&R BLOCK HOMES E.LC Total Fees: 80.00 Address: PO BOX 566 Amount Paid: 80.00 ZEPHYRHIE.LS FG 33539-0566 Date Paid: 9/26/2014 Phone: Wark Desc: INSTA�L 2 EXTERIOR DOORS � ��CONTRACTOR S � - - - APPLICATION�FEES � �:�:� �°�;:�1= �� ,�..�, OWNER B DING tEE 4 .OQ AFTER T�E FA �� 4 .00 �V �j � � /1� v �� '�o, � � � �1 �, ;.,_ ,,�. . Ins" ection '�Re` uired - � �. ��,� ,��- �FOt7 R� 2ND ROU P�U� ISC IRIS �tATlO CEILIjN rt ,� - FOQTER BQND DUCTS INSULATED EWER MISC. ROUGH ELECTRIC LINTEL ISC MISC. � 1ST ROUGH PLUMS PRE-METEF2 1�4SUTATIQN WALL MiSC. DUCTS INSTALLED WA7ER ISC DRIVEWAY PRE-SLAB SHEATHING ISC. MISC. CONSTRUCTION POLE FRAME ISC. MlSC. REINSpECTION FEES: Reinspection fees will comply ith Florida Stafiute 553.80 (2)(c) when extra inspectian trips are necessary due to any ane of the fatlawing r asons: a)wrong address b)condemned work resultmg from faulty construction c) repairs or corrections n t made when inspections called d)work not ready for inspection when called e) permit nafi pasted on j b site� plans not at jab site g)wark nat accessible. NOTICE: In additian to the requirements of this permit, the may be additiana! restrictions applicable ta this property that may 6e found in the public records of this county, and ther may be additional permits required from other governmental entities such as water manageme t, state agencies or federal agencies. "Warning to owner: Your failure to recard a notice f camrnencement may resutt in your paying twice for improvem�nts to your property. If you intend to a�tain financing,consult with your lender or an attorney befare recording your atice af commencerr�ent." Camplete Plans,Specifications Mus#Accompany App ication. All work shall be performed in accardance with City Codes and Ordinances NO CiCCUPANCY BEFO C.O. CONTRACTOR SlGNATURE PERMIT OFFI R ' PERMIT EXPIRES IN f MONTHS WITHOUT APPRQVED INSPECTION CALL POR INSPECTION 8 H4UR NOTICE REQUIRED PROTECT CAR FROM WEATHER 813-7H0-0020 City of Zephyrhi Is Permit Application Fax-613-780-0021 Buildi g Department Date Received Phone Contac!f•r Permitting -- Oxvner's Name —^�^ r� ��,�L ��oQ"+`C.S ��— Ovuner Phone Mumber 1��3' �77��yU Ouvner's Address P�(� S c�' t-�,� �S L Ovener F'hone Number ' Fee Simple Titleholder Name � Ovvner Phone R9urnber � Fee Simple Titleholder Addres� • � ,�JOB ADDRESS �, � S 1 LOT# �� SUBDIVISION PARCE !D# - ^ y - (OBTAIPIED FROM PROPERTY TAX NOTICE) WORIC PROPOSED e NEW CONSTR e ADD/A 0 SIGN Q Q DEMOLISH INSTALL REPAI PROPOSED USE Q SFR Q COMM 0 OTHER 71fPE OF CONSTRUCTIOM ,Q- � BLOCK Q FRAM 0 STEEL Q DESCRIPTIOfd OF MIORK �k% /�0��J BUILDIMG SIZE SQ FOOTAGE 11EIGHT - �BUILDING $ VALUATIO OF TOTAL CONSTRUCTION 2�c� QELECTRICAL $ AMP SERVICE 0 PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ OMECHANICAL $ - VALUATIO OF MECHANICAL INSTALLATION � QGAS Q ROOFING Q SPECI�4LTY Q OTHER FINISHED FLOOR ELEVATIONS FLOO I ZONE AREA QYES NO BUILDER C MPANY {"� `�--- O C,i,�-l 1u(f�Q� SIGNATURE R GISTERED Y/ N FEE CURRE� Y/N Alddress License# ELECTRICIAN C MPANY SIGMATURE R GISTERED Y/ M FEE CURRE� Y/N Address License# PLUMBER C MPANY ' SIGNATURE R GISTERED Y/ N FEE CURRE� Y/N Address License# RIiECHANICAL OMPANY SIGNATURE R GISTERED Y/ N FEE CURRE� Y 1 N Address License# OTHER OMPAMY SIGftlATURE EGISTERED Y/ (V FEE CURRE� Y/N Address License# ItESIDEMTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)s t 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 Facllities 81 dumpster;Site Work Permit fo� subdivisions/large projects COII�IIMERCIAL Attach(3)complete sets of Buildfng Plans plus a Lif 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 f r all new projects.All commercial requirements must meet compliance SIGN PERIlAIT Attach(2)sets of Engineered Plans. ""•PROPERTY SURVEY required for all NEW construction. -- Directions: Fill out application completely. Owner&Contractor sign back of application,notarized If over 52500,a Notice of Commencement is required. (EUC u grades over�7500) •• Agent(for the contractor)or Power of Attomey(for the owner)wou d be someone with notarized lette�frotn`owne�'auttio�izing_'§ame";:°,''""`� _ ; OVER THE COUNTER PERMITTING (Front of AppUcation Only) . .� , ��•'��-�`'•' �� ' ` Reroofs if shingles Sewers Service Upgrades A/C Fen es(Plot/Survey/Footage) , . . , �-" '` = �';= •- �-�� ` � �:r°,..�_� ��;-,,...�,_...... .. ..r;'t,,S �,��.� Driveways-Not over Counter if on public roadways..needs ROW '` �"��' � � y GdO�'ICE OIF �EE[� RE�'TR9C1"IOPl�: The undersigned understands that#his permit may be subject to"deed" restric#ions" uvhich may be more restrictive than Counfy regulations. The ur�dersigned assutnes responsibili#y for campEiance with any � applicable deed restrictions. UN�iG1ENS�D Ct)N'�R��YO�� R4�D Ct�N�'��T�9� �f��P��9�IL9YY��: !f the o+nrner has hfred a contractor or contractors to undertake work, #hey may be required to be licensed in accardance trvith state and lacat r�gulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation I under state Iauv. !f fhe ovuner or intend�d contractor are uncertain as to vtrhat licensing requirements may apply for the intended work, they are advised to cantact the Pasco Caunty Building Inspection Division—Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractar or contractors, he is advised to have the contractor(s) sign portions of the "conkractor Block" of this application for which they wiii be responsible. tf yrau, as#he awner sign as the contracto�, khat may be an indication that he is not properly licensed and is nat �ntitled to permitting privileges in Pasco County �"9�Rl�PO�'TA7'It�F9 Iii��6�CTIlJY9Ll�'6�� ii1�P�►G�'�►��1 �E�I�U��C� Ft��6fERY i��S: The undersigned understands thaf Transpartation impact Fees and Recourse Recovery Fses may appty #a the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco Caunty C7rdinance number 89-OT and 90-07, as amended. The undersigned afso understands, that such fees, as may be due, wi11 be identified at the time of permitting. lt is further understood that Transportation Impact �ees and iZesource Recovery Fees must be paid priar to receiving a "ce�tificate of occupancy" c�r final power release. If the project does not involve a certificate of occupancy or final pawer release, the fees must be paid priar to pertnif issuance. Furthermare, if Pasco County WaterlSewer Impacf fees are due, they must be paid prior to perrnit issuance in accordance with applicable Pasco Coun�y ordinances. CONSTR�IC'CION �.1��1 L�1iit(Cha��r 713, �IaPie�a��t�tts��, �� mend�c��: tf valuation of v�rork is $2,500A0 ar more, [ certify lhat I, fhe applicant, have been provided with a copy of the "Florida Conskruction Lien Law—Hameowrner's Pr4kection Guide" prepared by the �IoPida Department af P�griculture and Consumer Affairs. !f#he applicant is someone other than the°owner", I certify that I have obtained a copy of the above described document and promise in goad faith to deliver it to the "owner"prior to commencement. CQN'T��►GTO�'�lC?t�(�IER'� �►F�t��V1�': 1 certif}r that a41 the infortna#ian in this applicafion is accurate and that all tinrork will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby rnade to ab#ain a permi# ta do v+rork and installation as ind9cated. R certify that no work or installation has commenced prior to issuance of a permPt and that all work vvill be performed to meet sfandards of all laws regulating ' construction, County and City codes, zoning regulafions, and land development regulations in the jurisdiction. I also certify thaf I ur�ders#and fhat the regulations af oth�r gavernment agencies may apply to the intended vyork, and that it is my responsibi(ity to iden4ify what actians I must take to be in compliance. Such agencies include but are not limited to: - Department of Environmental Protectio�-Gypress 8ayheads, 1l4letfand Areas and Environmen#ally Ser�sifive Lands, VIlater/VVastewater Treatment. - Southv�rest �lorida Water �ianagem�nt District-VVeEIs, Cypress Bayheads, Wetland Areas, Aftering Watercourses. - Army Corps of Engineers-Seawalls, Docks, iVavigable Vilatenrvays. - Deparfinent of Health & Rehabilifative ServicesJ�nviranm�ntal Health Uni#-Wells, Waste�ntater Treatrrtent, Septic 7anks. - US Er�vironmental Protectian Agency-Asbestos abatem�nt. - Federal Aviation Authority-Runways. f understand that the followring restrictions apply to the use af fill:� - Use of fill is not allowed in Flood Zone"V'" unless expressly permitted. I - If the fill material is to be used in Flood Zone "N", it is understood that a drainage plan addressing a � "compensating volume° vuill be submitted at time of permitting vvhich is prepar�d by a professional engineer licensed by the State of Florida. � - If fhe �11 materia! is to be used in Fload Zone "A" in connectian w'sth a permitted buitding using sterrt wrak! construction, I certify that fill will be used only to fill the area within the stem wall. - If fill material is ta be used in any area, ! certify that use o# such fill virill not adversely affect adjacent , properties. if use af fill is iound to adversely affect adjacent properties, the ouvner may be cited for violating the conditions of the building permit issued under 4he attached permit applicatian, for lots less than one (1) acre which are e(evated by fill, an engEneered drainage pian is required. If I am the Ad'a�NT FOF2 Y'FifE OliNiV��, I promis� in gaod faith to inform the owner of#he p�rmitting conditions set forkh in this a#fidavi# prior to commenc'tng construction. 1 understand that a separate permit may be requ9red for electrical vtrork, plumbing, signs, welfs, pools, air conditioning, gas, or ofiher installa#ions not specifically included in the applicafion. A permit issued shall be construed to be a license ko proceed with the work and not as authority to.violate, cancel, alter, or set aside any provisions of the technical cades, nor shall issuance of a permrt prevent the Building (3ffieial from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permi# issued shall become invalid unless the work autharized by such permif is comrn�nced within six months of perrrtit issuance, or if rrvork aufhorized by khe permit is suspended or abandoned for a period of six(6) months after#he time the work is commenced. An extension may be requested, in writing, from the Building Officia! far a period not ta exceed nie�ety (9Q) days and wil! demans#rate justifiab(e cause for the extension. If�nrork ceases for ninefy(90)consecutive days, the job is considered abandoned. �lARR11R7� 1"�} �{�t�l��: YO�J'� ��11�t1�� TO 9Y�CC?R� � �Q�'IC� Qt� ��(�6��WCE�(EWT �tdiY 4Y��l1L.T !�1 lft��9�2 fP�YIRIC T�YVtlCE IFUR Ifi��OVIEi1N�l�� YC8 XO�D� fPF�O�'EFt`Y'�. I(�1(OlJ IR�'G'EWD YO O�7�IW fFOiN�►�ICIR9(�, CORI�IJ�..T �NIYH Y�U�Z ��ND�R�I��l��Ct��IiEY��i�� d�C��l�lG Y�Ul��OT�C3�C1�C��'l��RICIEilfil�NT. FLORIDA JURAT(F.S, 117.03) � � C11Rth]�R OR Af3E�T �O�II'RAG3'O�2 Subscribed and swom to(or affirmed)before me this Subscribed and swom to(or affirmedj before me this by by Who islare o Ily known to me or haslhave produced Who Islare personally knovun to me or haslhave praduced as Iden'ficatlan. as tdentificakion. ,•'"� �� $* OEL E BACON Public Notary Public :* Commissl z� Expires June 29,201$ Commission No. �� u�a Name o otary typed,printed or stamped Name of Notary typed,printed or stamped ei3aeo-oozo City of Zephyrh Ils Permit Application Fax-813-780-0021 Buildi g Department Date Received Phone Contact f r Permitting __ Owner's Name —�- �IDC �G oi'il°�S � Owner Phone Mumber p j�� 7�8—�U y Oubner's Address � W�( ��D � �� Owner Phone Number � Fee Simple Titleholder Mame Owner Phone Idurv�ber Eee Simpie Titleholder Addres�" JOB ADDRESS �S �o�`J c�On` �' LOT# � SU�DIdISION PARCEL ID# ~ . (OBTAINED FROM PROPERTY TAX NOTICE) WORFC PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN Q � DEMOLISH INSTALL REPAIR PROPOSED USE Q ` SFR Q COMM 0 OTHER TXP�OF CONSTRUCTIOM Q� BLOCK Q FRAME Q STEEL Q ' DESCRIPTIOId OF HNORK � DE�2.S BUILDING SIZE �Q FOOTAGE HEIGHT QBUILDING $ �'l�� VALUATION F TOTAL CONSTRUCTION O{ QELECTRICAL $ AMP SERVI E 0 PROGRESS ENERGY Q W.R.E.C. QPLUMBING $ OMECHANICAL $ VALUATION F MECHANICAL INSTALLATION OGAS Q ROOFING Q SPECIA TY 0 OTHER FINISHED FLOOR ELEVATIONS FLOOD ONE AREA QYES NO IBUILDER CO PANY �� 'J��-k ��QS �IGMATURE REGI TERED Y/ N FEE CURRE� Y/M d�ddress License# ELEC�RICIAN COA�IPANY SIGMATURE REGI TERED Y/ N FEE CURRE� Y/N Address License# PLUIMBER CO PAtdY SIGMATURE ' REGI TERED � Y/ N FEE CURRE� Y/N Address L(cense# MECHAMICAL CO PANY SIGf�ATURE REG STERED Y/ N FEE CURRE� Y/fV Address License# OTHER ' � CO PANY SIGfdATURE REG STERED 'Y/ IV FEE CURRE� Y/N Address License# FtESID�MTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set f Energy Forms;R-O-W Permit for new construction, Minimum ten(10)working days after submittal date. Re uired onsite,Construction Plans,Stormwater Plans w/Silt Fence instailed, Sanitary Facilities 8 1 dumpster;Site Work Permit for s bdivisions/large projects COMMERCIAL Attach(3)complete sets of Building Plans plus a Life S�fety 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 al new projects.All commercial requirements must meet compliance SIGfd PERMIT Attach(2)sets of Engineered Plans. - ••"PROPERTY SURVEY required for all NEW constru tlon. Directions: Fili out applicatlon compietely. Owmer 8 Contractor.sign back of applicallon,notarized If over 52500,a Notice of Commencement is required. (A/C upgr des over�7600) i7:..:;,,., :,, ._- .. „� � _ � � � ..�....�,,.;.,.,.. ' •• Agent(for the contractor)or Power of Attomey(for the owner)would b someone with notarized le'tter from owne�'authorizing, r.n�!. .: , • �, >.;`:;*;.,.•- ::;,. ,,,.,.�..� _ 4�;., . : ' ONER THE COUNTER PERMITTING (Front of Appl(cation Only) � ' _ _ , ',. �_ - .�; Reroofs if shingles Sewers Service Upgrades A/C Fences PIoUSurvey/Footage) � •�� - . ,. , , „':;,".,: ' 5.......�.� . _..... .-.. .... � ... ,. ....._.....,.. Driveways-Not over Counter if on public roadways..needs ROW td�T'IC� �� G1�ED R��'�RECTlO�1�: The undersigned understands that this permit may be subject to"deed" restrictians" which may be more restrictive than County regulatEons. The tandersigned assumes responsibility far compEiance v�rith any applicable deed restrictians. � UN�.ICEMSED �ON'TR�C'�OIiZ� �I�� C�i�°��C�'O� f�f��F't)N5�f�1�1'fl��: If the owner has hired a cantractor or contrackors to undertake work, #hey may be required to be licensed in accordance wtith sfate and iocai eegulations. if fhe contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanar violation under stafe iarrv. If fhe or�vner ar intended contractoc are uncertain as ta vuhat licensing requirements may appty for the intended work, they are advised to cantact the Pasco Counfy Building Inspection Division—Licensing Section at 727-847- 80Q9. Fur#her�are, if the owner has hired a contractor or confiractors, he is advised to have the contractor{s} sign portions of the "conkractor Block" of this application for which they vvill be respansible. If ,you,�as the owner sign as the eantractor, thak may be an indication that he is naY properly licenssd and is not entitled to permitting privileges in Pasco County. �'E�N��OR�'A7'ION IBfi�AC�'1lI�ILI'YIfE� �iifl�A��'A�9� ��U�� R��OV�RY f�E�S: The undersigned understands fhat Transportation tmpact Fees and �tecourse Recovery Fees may apply to the constructian of nevsr buifdings, change of use in existing buildings, or expansian 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, v�rill be identified at #he time of permitting. It is further understood thaf Transportafion (mpact Fees and F2esource Recovery Fees rnust be paid prior to receiving a "'ce�tificate of occupancy"' or final povuer release. If khe projec# does not involve a cer#iflcate of occupancy or final povver reiease, the f�es must be paid prior fo p�rmit issuanee. Furthermore, if Pasco�County �NaferlS��nrer lmpac� fees are due, they rnust be paid prior to permit issuance in accordance with applicable Pasco County ordinances. C�}W�7Rl1CT90N �1�� 11�i1(Chap��7'�3, �1�ci��t�ta�+��, �s ��end�d}. !f valuatian of v�rork is $2,500.00 or more, ! certify that I, the applicant, have been provided with a capy of the "Florida Constructian Lien Law—Hameowner's Profectian Guide" prepared by the Flarida Department of Agriculture and Consumer l�ffairs. !f the applicant is someone other than the °owner", 1 certify#hat I have obtained a copy of the above described document and promise in good faith to deliver it to the "ovvner"prior to commencement. Ct��17"�2��7�R'�lO��R'� k�i��llD.�iV�Y: 1 certify fha# all the infarmation in this applicatEor� is accurate and #hat al! work will be done in compliar�ce with all applicable laws regulating cons4ructian, zoning and land development. Applicatian is hereby made to abtain a permit ta do uvork and installation as indicated. 9 certify thaf no vuork or installation has commenced prior to issuance of a permit and that all work wilf be performed to meet standards of aU laws regulaking constructian, Counky and City codes, zoning regulatians, and land developmenk regulations in the jurisdictian. ! also certify that 1 understand that the regulations of ather governrnent agencies may apply ta fhe infended rtvork, and that it is my responsibility#a iden�ify whaf actians I must take fo be in compliance. Such agencies include but are not limited ta: � - Depa�tment of Environmer�tal Protection-Cypress �ayheacls, 1�lefiland Areas and Environmentally Sensitive Lands, VVaterNVas#ewater Tre�tment. - Sauthutrest Florida Water �!lanagem�nt District-Wells, Gypress Bayheads, Wetland Areas, Rltering Watercourses. - Nrmy Corps of Engineers-SeawaUs, C)ocks, iVavigable Watenrvays. - t�epartment o� Hea1fF► � �tehabilitative Services/�nvirortmental F��a1th Unit-V1le11s, V�astewrater Treatment, Septic Tanks. - US Enviranmenfal Prafection Agency-Asbestos abatement. - Federal Aviation Authority-Runways. C understand that the Following restrictions apply ta the use af fill; - Use of fill is not allowed in Fiood Zone"V" unless expressly permitted. - If the fill materia! is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" wi11 be submifted a� time o� permitting vvhich is prepared by a professional engineer licensed by khe State of Florida. - If fhe fill material is to be used in Fiood Zone `"A" in connection vtirith a permifted building using stem v�raEl construction, I certify that fill will be used only to fill the area within the stem wall. - !f fill material is to be used in any area, I certify that use o# such fil! wrill not adversely affect adjacent properties. If use of�ii is found to advers�ly affect adjacent properties, the owner may be citec3 for violating the conditions of the building permit issued under the attached permit applicatian, for lots less than one (1) acre which are eievated by fill, art engineered drainage plan is required. If I am the Af��IVT �OFt�'HIE OWlY��i�, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. ! ursderstand #hat a separate permit may be required for etectrical v�rork, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the appiication. A permit issued shal! be construed to be a license to procesd uvith the woek and not as authority to.violate, cancel, alter, or set aside ar�y provisions af the technical codes, nar shaH issuance of a permit prevent the Buiiding �fficial frorn thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permi# issued shall become invalid unless the wark autharized by such permit is cammenced �nrithin six manths of permit issuance, or if uvork authorized by the permit is suspended or abandoned for a periad of six(6) months after the time the work is cornmenced. An extension ( rnay be requesEed, in vtrriting, from th� Building Clfficial for a period not to exceed ninety {90) days and tnril! demonstrate justifiable cause for ihe �xtension. If work ceases for ninefy(90)consecutive days, the job is considered abandaned. 6�iA�WIRI� T�3 �{�Jtd��: 1(Clt1� i��►1��3R� �� Z��O�D � f��l'QC� O� �Q�Fii�ii�N�(�fi�iEP1T iil9�►Y R��llL,T 1�1 �ft�LD@2 f�d�YlfdG 7�filICE �OR Ifi��'G�OVI�fW��➢�"� 1�01(0�0� �ff�flfPER'Y�. IfF YOU 9WY��IU YO O�Y,k11�1 �16V�►iV�CIPIG, COi1i�UL.�' ViflT�i'Y�t1F2 �ENDIEIf� If��1�!�i71� CY��$2�COY2I�INIC�Y��9� f��YlG�Gl�C{��EMC1E�tli��1�. FLORIDA JURf1T(F.S. 117 3� t71R►P}�F2 4F2�G��17 CO�E7'�tACT't?F2 Subscribed and swom to(or affirmed)before me this Subscribed and sworn to(or a�rmed)before me this by by Who islare personaMy kn n to me or haslhave produrec! Who(slare persanally knowtn to me ar haslhave produced as Identification. as identification. ,��Y„ , �o � .a N -�" �°_ om ' o PV ary Public Notary Public " :;; Expires,lune 29, .�'.OfT1R1�SS� f,,;r�'4°•`'�, ��d�ThruTroyFainlnsurance80U�95d01B CommfssionNo. r u�a�� Name oC Notary typed,printed or stamped Name of Flotary typed,printed or stamped