HomeMy WebLinkAbout15-15947 CI O�'ZEPHYRHILLS
+ 5335-8TH STREET
. ' (813)780-0020 947
ENCE PERMIT
' PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 15947 Address: 5942 13TH ST
Permit Type: FENCE ZEPHYRHILLS, FL.
Class of Work: FENCE/NEW Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-02000-0120
Improv. Cost: 6,450.00 OWNER INFORMATION
Date Issued: 1/26/2015 Name: SELBERT MICHAEL & POOLER JONICA
Total Fees: 55.00 Address: 5942 13TH ST
Amount Paid: 55.00 ZEPHYRHILLS FL 33542-3665
Date Paid: 1/26/2015 Phone: 813-997-1312
Work Desc: INSTALL 332 X 6 PVC FEN E
CONTRACTOR S APPLICATION FEES
FENCE OUTLET OF TAMPA INC (407)851-6 60 FENCE 55.00
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.� Ins ections Re uired
' FINAL -
REINSPECTION FEES: Reinspection fees will omply with Florida Statute 553.80 (2)(c)when extra inspection
trips are necessary due to any one of the fol owing reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corre ions not made when inspections called d)work not ready for
inspection when called e) permit not pos ed on job site� plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this p rmit, there may be additional restrictions applicable to this properly 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 m nagement, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
Complete Plans, Speci cations and Fee Must Accompany Application.
All work shall be perform d in accordance with City Codes and Ordinances
� -
CONT CTOR PERMIT OFFI
PERMIT EXPIRES IN 6 M NTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPE ION - 8 HOUR NOTICE REQUIRED
PROTE CARD FROM WEATHER
. ��'�' � � 7�372
F�N C E O U T L ET �'r �osa/I Con�rac� � 967i S.Orange Blbssom Trail�Orlando,FL 3288T
Tel(407)851-6660�Fa�c(40�43&3181
www.fenceoutleton(Rne,CQtCi � � 1724 West Broadway SL,Suite 100�Ovtedo,F132T65
Tel(407)359-9092•Fa�c(40�366-2335
CUSTOMER NAME '������� �Q� � � � 201 S.Felkenberg Road�Tampa;FG 33619
t� �'�. TeI(813}fi513623�Fau{8i3)65i-3655
ADDRESS �1�Z �� �
�L � C�� 11507 US Hwy 19•Port Richey,FL 34668
S`�/Z � Tei{727}857-7590•F�{727}857•7591
� 12984 Tamtami Trait S.�Norkh Port,Ft 34287
Tel(941)34&6800•Fax(941)34&6801
PFlONE: NC1ME# tir10BlLE -�f-� °��7"�3�Z-. E-MAt�
OWN PRpPERTY? YES NO❑ DATE �`�A ��
0 �ERS N,AME
3 Ratl FtatTap
PVC 3�L WOOD LUMINUM CHAIIV L1NK
PVC Fest Woad Feet Aluminum Feet Chain Link Fee#
PVCCOCOR_._`"' ` _ CyPress p PT Pine p Pres 1us❑ Height 4'❑ 5'❑ 6' � Neigh#�4'❑ 5'0-6' -
Height 4' ❑ 5' � 6' f3 BOB❑ STKD� VS Style #2�3 C7 #300 �t303C1 3 Rail Box Sp � Other Height
T&�Privacy 1� Damed❑ Scailo ❑ Residentia(❑ C inercial ❑ � Residen5a( ❑ Co ercia!❑
p��;��..�.] Other Style �
Other S ie Height 6'C) '� Munici'�al ❑ ndustrial p LT Comm❑ I ustrial❑
f� Galvanized }ack Viriyl ❑
Gate_(_, Size b X S� Picket 1/2"x 4" 1'"x 4" ❑ � Black(�Whi Other, 3 Ra' S ea.Top.
Gate_Size Runner 2" "❑ Post Size � Green�ny
6ate �xe Gate g�Ze Gate ize
Gate_ Size Gete Size
Flat Cap L�' Bal Capl ❑ Gat Size Gate Size 2 Rail Pool Code Gate Size
Gothic ❑ New Eng. ❑ hic Top ❑ Traditional Top ❑ � e_ S9ze � ��������`� � _S��
IIIIIIIIIIIIIIIII
C o a c h m a n❑ T e a r D r o p Other❑ W���I
Good Side in C"�T Ou# B ST�J oZ/ c1,��^�.
Fencs to Foi€aw Contour of Ground �
Fence to be Level ❑ ���
Remove existing Fence � Ft. No C�1%
Fence E.ine to 6e Cleared by Fertce Outlet ❑
Fence Line to be Cleared by Owner C� 6 7 �
Comer Lat Yes [�Y No ❑ ,�
Permit Needed Yes � No ❑ a ! ` .
C 2c 1+ r�S;/J 3� t� � �7.; HOUSE (�
Jurisdiction C�� o F' Y �f
Special instructions:�,�•:-�LrJ �,�t�t•1��.
�vr�rr�,t,`i�► C)� �vL {P^t,atP�.�ti L
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Fence Outlet will assist the customer,upon request,in detertnining where the fence i to be erected,but under no circumstances does Fence Outlet assume any responsibilityr conceming property.Ifnes or in
any way guarantee thelr accuracy.tf praperty pins cantwt be located,tt.is recomme ed that the custamer have the prtipeitp,surveyeil.
Fenae Oattet wiJ!assume the responsibilitp Eor Iocating anderground cabtes and uUli'es;however,FEnce OWiet ts not raaponstbts kN a�ry sprinidecs or oNrer tmmarked bulled Ilrias or obj���
Payment is due at the time of completian of work,and a finance charge of'1112%per month shall be applied to all accounts not,paid in full within 1Q days of.completion,All material will remain the property of
fence ouliet unUl payment is received in full. Right otaccess and removal is granted to Fence 4uNet in the ev6tiCof nonpayment per the terrtis of this contract.The customer agrees to pay all interest and any
casts iacurred in the caitectlon of thls debt!nc[uding ccasonable attamey fees. -
lf fhe buyer refuses to altow the setler to begin work oc comptete work atready begun or to accept materiais eontracled for Buyer agrees to pay Setler tlquidated damages of a sum equai to 331t3%of entire
contract price,plus cost of materials and labor already fumished or in progress. W mty may.be voided if sign is reieoved.
Cu me ass mes(ui sl6 for Ini am �s ass on a val fh! nd o!
pCC08DInG T0 tLO�Dp'S COhS1RllCTIOn IIEn l��(SEC1101(S 11 .001113.31,FIOflID�S�ITUIES),iNOSE IpNO UlO�N On Y�U�PROPE�iY OR PNOBIDE(�1EN�IlS
a�D��E�Ot P�D 1�FOlL NIIUE��I�N110 E�fORCE 1NEI�CI�1 F����lYI�E�1�6AI�ST V�O�-P��PER�II 1NIS�ill�IS��0���S��CO��'R�C110�[IE�. IF
�OUN GDnil�C10�OR A SUBGQn1�AC1Q�fA11S t0:rA9 SUBGO ��CiflftS;SI�•COni��CiQ�S,:QR mAlEfllAL SUPPLIEflS 1�-�E6LECIS i0 mAI�E Q18Efl iE6A�LR
8EQU18ED P�YmE�'S. TNE F�OPIE i�INO�RE 0�lED m0i�ll��Y 1 ON TO YOUfl PNOPE8IY FOR PpVmE�1,E�fn IF Y0U NpUE PpID YOUR COn18pCTOR iil fUIL. If VOU
FRI!10 PAY YO��CO�T��CiO�,YO�B.CO�i��CI�E�I��Y�LSO N OE��1E�0�YQOR P�OPE�N:'��1815�IE�1�1F A[��1S EI�YB��P�OPE�11I COOID BE SQ�D
AGAInSt YOUR�Illl i0 PAY fOR.UIBOB,m�ERlALS,OR O1NfR EROlCES iNAi Y01�COIIiR�C10ft Q��SUBC0�18ACi0�mAy NAUf fMlED 1Q�0lL flQRlDA'S
CO�ST8UC1i0�L(EII[��I IS COi�PEEK�iID IT(S RECBm�(E�DED T �fi I�IIE�EUEfl�SPECIFIC P8081E�1��iSES,�OU CO�SUIT��aitORfll�1:
NO!CE TO PURCMASERS OFWOOD FENCE5:
Wood fence materials are rough mi0 cat pEeces.Wood fence has a tendency M shrt k and tp in of,humld weathei and stitatl gaps wII(appear befween 6oards.Cracks in the wood ate a common aod
accepted occurrence.Fence Ouflet wili on�y guarantee the workmanship on wood f nce for o a���M� (
I NAVE RF�►D AND UNDERSTAi�D THE ABOVE CLA►USE: �
CCiNTRACT ANEOtINT: �` •`� g��v� APP D D ACCEP°fED FOR GUSTOMER
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nav�pav��rtT. � ����R oA,�
BAtANCE DI�E ��u.,��,.�A{t�t cusra�ea oaT�
�1PQN COMPL�TION $
AC D FOR FENCE OUTl.E
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DATE STARTED DATE CWdPLETED � SPERSOM DATE
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�ucr�e t co �....... /1f If1TC 1IAl H1 CAD neve �
813-780-Od20 City of Zephy hills Permit Applicatian Fax-813-780-0021
I Bui ding Department
Date Receiveii phone Gontac for Permitting
Owner's Name '�'� Dfl�Q.�' Owner Phone Number ��3 � ��" ` �3�2
Owner's Address �J Z 1 � s�' �-�1iu w Owner Phone Number
� Fee Simple Titiehotder Name Owner Phone Number �- 1
Fee Simple Titleholder Address
JOB ADDRESS J t �. �3��' ��" F LOT# �� l�{� `)
suea�vis�o� � � PAR EL ID# 1-2 -'�s -OCut�-- 0�(�0� C�t o -� -- - -
—— - - � (08TAINED FROM PROPERTY TAX NOTICE)
WORK PE20PQSED � NEW CONSTR 8 ADDI LT � SIGN [� Q dEMO�ISH
INSTALL REP IR
PRQPQSED USE Q SFR Q GQM � � OTHER
TYPE OF CONSTRUCTIQN Q BLOCK Q FRA E � STEEL Q
' DESCRIPI'ION OF WORK g�u.liwu,i' �� 6' �, �,qte � ` Ow�, O�p a�C i Si W.
BUii.DING SIZE �^ � SQ FOOTAGE HEIGHT C��
QBUiLDtNG $ � bti VAl.UATt N OF T4TAL C4M1lSTF2UCTICIN
QELECTE2IGAL $ � AMP SEFi CGE � PRQGi2ESS ENERGY Q W.R.E.C.
QPIUMBfNG � � � �,,.('�� i]
OMEGHANICAL $ VALUAT! N QF MECNANICAI INSTALLATlQN
� I l l
���
QGAS Q ROOFlNG Q SPE tALTY � OTNER 5
FINISHED FLOOR ELEVATIONS �� FLO D ZONE AREA QYES NO �Y
3
BUIl.DER c� �t � - OMPANY C � (- �
' SIGNATURE y/GIw�J� G'6a��„�M GISTERED Y/ N FEE CURRB� Y/N
Address A� �. t�) iQ u Gl 3 License# �— �
EI.ECTRICIAN OMPAEIY
SIGNATURE EGISTERED Y/ N FEE CURRE� Y/N
I� Address License# �� �
� P�UMBER � O[�IPANY
SIGNATURE EGISTERED Y/ N FEE CURRE� Y/N
IAddress L.ieense# �— � �
MECHANICAL OMPANY
51GNATURE EGISTEFtED Y/ N FEE CURRE� Y/N
Address License# �— ��
�TtlER OMPANY �
51GNA7URE r EcisTEa�o Y/ N FEE CURRE� Y/N
Address l.icense# �` �
3EStDE1V'flAL Attach{2}Piot Plans;(2)sets of Building Pians;{1}s t of Energy Forms;R-Q-W Petmit far new construc�on,
Minimurn ten(14}working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Sitt Fence installed,
Sanitary Faciltties&1 dumpster;Site Work Permit fo subdivisionsAar�e projects
:OMMERC1i4L Attach(3}cornplete sets of Building Plans plus a Life Safefy Page;{1)set of Energy Fosms.R-O-W Permi#for new constructlon.
Minimum ten(10)working days'after submittat date. Required onsite,Conskruction Plans,Stormwater Plans w/Sflt Fence installed,
Sanitary FacOities 8 1 dumpstec Site Work Permit fa all new projects.All commercial requirements must meet compliance
3tGN RERMIT Aftac(�(2)sets of Eng3neered Ptans.
""'PROPERIY SURVEY required far ail NEW cons ction.
}Erect�ons:
Fill out applic�tion completely. '
Owner&Contractor sign back of application,notarized i
1f aver$2500,a Notice of Carnmencemen#is reqaFred. {AiG up rades ov�r$�504} �,
` Agent(for the contractor)or Power of Attomey(for the awner)woul be someone with notarized letter from owner authorizing same �
�VER TNE C4tJE1TEi2 PERMtTTtPtG {Front of Apptication Only) ,
teroofs if shingles Sewers Service Upgrades A/C Fenc (PIoUSurvey/Footage)
Drlveways-1+Jot over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that ihis permit may be subject to"deed° restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRAC'TOR 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 Iocal 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 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 IMPACTIUTILITIES IIIAPACY AND RESOURC� REGOVERY FEES: The undersigned understands
� that Transportation Impact Fees and Recourse Recovery Fees may agply to the construction of new buildings, change of
� use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fe�s and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the projecX does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance writh applicable Pasco County ordinances.
CONSTRIJCTION LIEN U4W(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—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.
CONTR�4CTOR'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 installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the 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, WaterMlastewater 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 Nealth Unit-Wells, Wa"stewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:�
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
� - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
, licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for Iots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OIflINER, 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 Buildirig 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 HAAY RESULT IN YOUR
PAYING TIIVICE FOR IMPROVEMENTS TO YOUR PROPEftTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUL7'
WITIi YOUR LENDER OR AFV ATTORNEY BEFORE RECOItDING YOUR NOTICE OF COMIVIENCEMENT.
FLORIDA JURAT(F.S.117.03) ..
01AfNER OR AGENT JfW�1 Qw��,.�n CONTRACTOR
Subscribed and sworn�or affirmed}�before me ihis Subscribed and sworn to(or affirmed)before me this
by ewzc.< 1�..�rau� �a br
Who islare personally known to me or has/ ve produced Who Is/are personally known to me or has/have produced
as IdenUficatlon. as identification.
Notary Public Notary Public
Commission No. Commfssfon No.
PJame of Notary typed,printed or stamped Name of Notary typed,printed or stamped
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SURVEY W0�VN.D WRFIOUi SHEET 2 OF 2 �1RVhY0R'S AND OBO�SURVEI'OR'S SFAL.
(SEE SFiEET 2 OF,2 "SUF�VEYOR'S REPORI'NCIE�4) PR01flDED BY OTHERS A SURVEY OF IOfS 7Z 13. 74 IWD 7� BLOCK 20 OF THE RECORD
BJECf PROPERIY SHOWN HEREON APpEARS T0 LIE IN FLOOD ZONE 7(;IV�ING 10 THE NATWWIL Fl.00D ��.� � W PLAT BCOK 1, PAOE 64 OF TFiE PUBLIC ��PASCO
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Permit Na. Percel IO No ' ' •
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NOT! E OF COMMENGEMENT • '
Staieof �-7�+ti�� Counryof ��-�l� .
THE UNOERSIGNED hereby g(vss noUCe that lmprovement wi be made to ceAa3n real property,and in axordanca wilh Chapter 713,Flaida Statutes, �
the iflliawing infaanatioa is provided in this NaGce o!Commen ment �y
1. DescriptionotProperty: Parcelldentifi�alionNo. L aF2e -t � P(rS`;jl6iS 1� l�1 i��a t�to��a v�
streetAadress: S^7k /'3� S ZC • ! F/ �S'/
a I.1�'t'(,��qb 5
2. General Descriptlon otimprovemerrt �N� +t +� O� � �"h rtL VG Ck GG
3. Uwner Informellon or Lessee information if the less contracted for ihe tmprovement:
�o n;G�4 ole✓ .
S�t�t ��'.�'� zc. k ! �`/ S'�t
Address Q��`✓ City State
lnferest in PropeRy:
hiarne of Fee Simple TAlehoider.
pfdilferentfrom erlist¢debwe)
Address }�^�� ��, l C�_ City 5tate
4. Contractor. Y" G. �.
�o� �' ���lc�f5e,l- !� - -C'a w�,D� F/
Cdontractors TelepM1one No.. �Ij• iP S�^ � � � Staia
�'� ' S. Surety: _ '
Hame '
Address Ropt:1655907 IT�cO.00 ��
Amount of Band:E ��' 0'�g p t, C i erk
0i1261201� D. $. , P Y
6. tender.�
Name
Addtess Gty State
I.enders 7elephone No.:
; 7. Persons within Ibe State cf Ptoiida des(gnated by the awne�upon whom notiees or othet documents trtay be served as provided by
section 713,13(1)ta}(7),Fta�iea stamtes: ,
I Name ' .
PAUIR S.0'NEIt,Fh.O.PRSCO GLERK & GOMPTROI�Et�
! � Address �1����0���s'3'�9m PG �f i��
7elephone Number of Desipnated Person:
8. in addition to himseH,Ure rnmet desigmates ot,_�
� � to ive a copy of lhe lJenors NoUce az provided in Sec6on 773.13(1)(b),Flnrida Slatutes.
� Tetephona Number t+f Pesson or Entily Designatsd by Ovmer:
9. E�iration date a(Natice of Commencement(lhe e iratinn dete may npl be befae the catnpleGon oi consWction and final payment tp Ihe
' � conUaGor,but wiil he one year trom the date af recor iny unless a difterent date is speeiffed):
� '` ' WARNtNC.,T4 OWi�1ER: ANY PAYMEN7S MADE Y THE OWNER IiFTER THE EXPlRATtON flF 7HE NOTtCE OF C4MMEFtCEMENT
� • ARE CONSIDERED IMPROPER PAYMENTS UN ER CFiAPTER 713, �ART i, SECTION 713.13, FLORIDA STATUTES ANq CAN
� • RESULT IN YOUR PAYING 71MCE FOR IMPRO MENTS TO YOIJR PROPERTY. A NOTICE QF COMMENCEMEN�' MUS7 BE
; ' ' RECORDED AND POSTED ON THE JOB 31TE BEF RE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
'. , WlTt#YdllR LENDER OR fW ATTORNEY BE�ORE QMMENG[NG WORK OR RECORDING YOUR NOTIGf OF CONSMENCEMEFt7.
„ ��+ Under penalry of perjury,I deolare lhat I have reatl Ur foregoing no0ce of crn.��ancement and that the facts stated lherein are We lo the 6est
' of my knowledga and bellei. '
• S7ATE 4F FLORIDA f• �
• ' COUNTY OF PASCO
, � gnature f er a essee,or Ownefs ar I.esseo's Authonzed
OKcer/DirectorlPaMer/Manager
� SignaWys 7itlelOffice
The foregang instrument was ackna+nlledged Gefare me this o" day oi Qk 411 yp l�5y �C?�'1i L W- �80�L✓
' as (lype of authority,e.g.,officer,Gustee,aftomeY in fact)far
�
, , (n pt p on e I(W vfiom insfnunent was executed).
Persanal{y Known(�Q$Produced Ideniifu�iian� Nolary Si�nature �
�, Type oi Identification Produced / � (�) Name(Prinq 4+ - �Q�1M1 LL _ � r�'
' i�il�r"I'�*w
�,�n Netar!Publle 3t9S��1 FltlHtld
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* l31�►�..�, .�'9TA�TE QF�L.OI�eD/�, COVA��T�'(�F�'��C',k"�s
� s � ��, TN1S fS Tp C`�RTiFY THAT 7H�FQR�GQl�lG 1S�q
� ,��"9"� 7RUE AND CC7RRECT COPY QF TME�OCUM�N7
' • '�� ON FlLE OR aF PE1Bl�lC RECt�RD IN TNIS OFFICE
� • . ��� •� � WIT SS MY NANQ A D QFFICIA�.SEAL THIS
� � c� r--.�z. 4� --��?�DAY QF 2
� '"�^^ r P`r.`.� ��, PAULA S ' IL T OLL
gY� �".:�µ 6 Q��� BY
���.,� @� �' d CI.ERK
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