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HomeMy WebLinkAbout181 Venetian Bay Cir (3)Job Address: CITY OF SANFORD BUILDING & FIRE PREVENTION �s s PERMIT APPLICATION FEB 0 2 2018 LJ Application No: —to 5 Documented Construction Value: $ _''101 Q U9 Historic District: Yes ❑ No, 1 Parcel ID: chi 5 9- DW) " (D D 2 Residential Commercial ❑ Type of Work: New ❑ Addition ❑ Alteration ❑ Repair a Demo ❑ Change of Use ❑ Move ❑ Description of Work: 3Lc s4, , U I v;)- CD A, P!nn Review Con!act PerEgn: ���,� ��aMc�Yi�e. -- Title' ?RAUCi1c)[l Phone: Fax:l (Y1--�DT1-1WOt4 Email:_- OfC40.i"l ci. C-0 I Property Owner Information Name Phone::�Q - 4 5 Street: If/ VZ41 e �1 � �jla CI (, � Resident of property? Uk5 City, State Zip: Ca(Z CS , F--(- 3-20 -1 Contractor Information Name �l � V, C GFS C) CD, , �f)C - Phone: Street:' 005 Fax: tJ D i -� City, State Zip: State License No.: _C CCU Y-) b��4_ Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Mortgage Lender: Address: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5th Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 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 districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. �otopr Pu"' PETER JAMES ARCOMONE MY COMMISSION # GG 035010 EXPIRES: October 2, 2020 N�lEOF F�o�`a: Bonded Thru Budget Notary Services Owner/Agent is Personally Known to Me or Produced ID _ Type of ID lf�_ V:)(-- Signa ,nc o.- Gontracto-/hgeant �v��r Prin ntractor/Agent's t Signature of Notary -State of Florida Date �p"Ixy Pu", PETER JAMES ARCOMONE * MY COMMISSION # GG 035010 oQ EXPIRES: October 2, 2020 9TF0F F`p? Bonded Thru Budget Notary Services Contractor/Agent is _)_� Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas ❑ Roof ❑ Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Flood Zone: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑ ,APPROVALS: ZONING: UTILITIES: WASTE WATER: ENGINEERING: FIRE: BUILDING: COMMENTS: Revised: June 30, 2015 Permit Application THIS INSTRUMENT PREPARED BY: R---�et; Nvc. \-- C* Name: JA Edwards of America, Inc Address: 7058 Stapoint Ct. Winter Park FI. 32792 Permit Number: ` f� Parcel ID Number: GRANT 19ALOYv SEI'IINOLE.COUNT' CLERK OF CIRCUIT CCOURT & COI'IFTROLLER BK 9065 Po 1333 (1Fss) CLERK'S v 20180IC1541 RECORDED RECORDING FEES `I:•10.00 RECORDED BY jeckenro The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. DESCRIPT 0 OF PROPERTY: (Legal description of the property -and st eet addre s i available) 2. GENERAL DESCRIPTION OF IMPROVEMENT: Re -Roof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: V" i ( VPn2 k. mil? .3 2- interest in property-. Fee Simple Title Holder (if other than owner listed above) Name: 4. CONTRACTOR: Name: JA Edwards of America, Inc. Phone Number: 407.677.7663 Address: 7058 Stapoint Ct. Winter Park FI. 32792 S. SURETY (If applicable, a copy of the payment bond is attached): Name: 6. LENDER: Address: Phone Number: Amount of Bond: 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section 713.13(1)(a)7., Florida Statutes. Phone Number: Address: 8. In addition,,Owner designates. of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: 9. Expiration Date of Notice of Commencement (The expiration is 1 year from 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 I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. (Sign ufi of Owner or Lessee, or Owners or Lessee's utthorized Officer/Director/Partner/Manager) G , State of , 1 011 C la County of M1 The foregoing instrument was acknowledged before me this by ZE S 1 FC� oLej Name of person making statement who has produced identification `l.type of identification produced VPUg PETER JAMESARCOMONE bkyE�( t"'hi G'202010 +XPiRc : i? oLe, R' Sernoes p.. Bonded 7111 Budget Notary FOFVl T— �1 Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I hereby name and appoint: an agent of: (Name of Company) to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): The specific permit and application for work t �_ % . _ , I r1 n /— > '--'(Street Addrdss) n Expiration Date for This Limited Power of Attorney: License Holder Name: C Y—a `_� �tJi SC Ins v.�C—c State License Number: Signature of License 11 STATE OF FLORIDA COUNTY OF =L 3a TI I The foregoing instrument w s a knowledged before me this 12jday of (A C.r) , 200 N % , by Cf�_a who is personally known to me or ❑ who has produced as identification and who did (did take an oath. (Notary Seal) RENEE C, COLLINS * ' . Commission # GG 17M Nl G Expires January 7, 2022 B.-,60 R. SWO NCt y "ImS (Rev. 08.12) Signature _* C#e1sT1At -- 0144-lAtr Print or type name Notary Public -State of W IDI Commission No. ' ' 172 49q My Commission Expires: / 2. AGRErU- NT SUBJECT TO INSURANCE COMPANY APPROVAL Clastolmer: �ir1 G 7 Date. I/F Property Location: Day: City: Zip: Evening: E-Mail: /�'g ROOF SPECIFICATIONS Brand:6AF Style: Color: Ridge Material R / ey: Open Close Tear-O . 1�/ 2 Vents: Box / Shingle Over / Aluminum Fel®R/ Ice &Water Shiel :Per Cod Pitch: Story 1 / 2 / 3 Walkout: YesAbW * Roof Accessories to replaced new and/or painted to match shingle color.! Drop Instructions• SIDING SPECIFICATIONS Brand: Style: Color: Style: Straight Lap / Dutch Lap Exposure: 4" 4.5" 5" other: Elevation being sided (looking at house from street): Front Left Back Right Drop Instructions: GUTTER SPECIFICATIONS Color: Special Instructions: Homeowner Initials: TERMS 1. By signing this Agreement, you authorize JA Edwards of America Inc. to be present during the insurance adjustment and negotiate the settlement with your insurance company. 2. Unless otherwise agreed in writing, your out-of-pocket costs will be limited to your insurance deductible amount. However, you must promptly pay JA Edwards of America Inc. all amounts you receive from your insurance company. If you desire material upgrades or other work done on your property, you will incur additional out-of-pocket expenses. 3. This Agreement is not valid or binding on any party unless and until it is signed by both you and JA Edwards of America Inc. Once signed by you and JA Edwards of America Inc. JA Edwards of America Inc. will be awarded with the job described above and the scope and price of the work will be set forth in the insurance adjuster's summary. 4. Your signature below provides your agreement to all the terms and conditions set forth on the front and back of this Agreement. Please carefully read the entire front and back of this Agreement. 5. Homeowner agrees to assignment of benefits to Contractor (JA Edwards of America) for payments from insurance company to facilitate timely payments to contractor for all works approved in insurance scope. ASSIGNMENT OF INSURANCE BENEFITS: I, the policyholder, named insured or authorized representative, hereby assign any and all insurance benefits, rights, proceeds and any causes of action under any applicable insurance policies to JA Edwards of America for services rendered or to be rendered by JA Edwards of America and, in the regard, waive my privacy rights. This assignment is given in consideration of JA Edwards of America's agreement to perform services as described above, including not requiring full payment at time of service. I also hereby direct my insurance carrier(s) to release any and all information requested by JA Edwards of America, its representative(s) and/or its attorney for the purpose of obtaining benefits to be paid by my insurance carrier(s) for services rendered or to be rendered and authorize JA Edwards and my carrier(s) to communicate as needed with each other in this regard. Believe the appropriate insurance carrier is: First Check: $ `) 7 Check # Date Signature (Customer) Date Balance Due: $ Check # �! %Date Sig - e (JA Edwards ofAmerica Inc. Rep) Date Agreed Price: $ / Ut plus additional supplements & permit fees paid by insurance company CITY OF ORDBuilding & Fire Prevention Division RESIDENTIAL RE-ROOFAFFIDAVIT FIRE DEPARTMENT RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: ADDRESS: ll V P,C� P (C�n \- J�L�I C I b c N o � o sumt. r , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS - SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844). LICENSE #: Q C): J i FD4 \ COMPANY / CONTRACTOR: , �N PI tp(_ { d S D" N-tX6 o� W-� C CONTRACTOR SIGNATURE: (MUST BE SIGNED BY LICENSE HOLDER OR OWNER/BUILDER) A FINAL ROOF INSPECTION IS REQUIRED: DATE: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS. "FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE OF FLORIDA COUNTY OF Sworn to and Subscribed before me this day of identification) Signature of Notary Public State of Florida Print/Type/Stamp Name of Notary Public 20 by: Who is ❑ Personally Known to me or has ❑ Produced (type of as identification. Propeft RecordCard Parcel: 23-19-30-502-0000-078:0 Owner: PARKER BEN JOYCE P & PAUL Property Address: 181 VENETIAN BAY CIR SANFORD, FL32771 A '20 2 %I U es t ".0 Valuation Method CosbfMarket Cost/Market Number of Buildings Depreciated Bldg Value ....... .. . . ... ... ...... .... $1 U,856 $155,394 Depreciated EXFT Value Land Value (Market) $3 7,000 $37 G 00 Land Value Ag Just%larket Value .$201,856 1192,394 Portability Adl Save Our Homes Adj $0 Amendment I Adj $0 P&G Adj $0 $0 Assessed Value $201,856 $192,394 Tax Amount without SOH: $3,663.48 2017 Tax Bill Amount $3,663.48 Tax Estimator Save Our Homes Savings: $().00 * Does NOT INCLUDE Non Ad Valorem Assessments LOT 78 VENETIAN BAY PB 63 PGS 84 - 88 CITY OF Sk�40R-D PERMIT # Building & Fire Prevention Division FIRE DEPARTMENT RESIDENTL4L RE -ROOF SCOPE OF WORK JOB ADDRESS: _ l n wn e"1 an STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -ROOF TYPE: REPLACEMENT CHAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF DECK TYPE (PLEASE SPECIFY): "PLEASE NOTE: ONLY 100 SQUARE FEET OF THE EXISTING DECKIS PERMITTED TO BE REPLACED" ROOF VENTILATION: O OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT OTURBINES SKYLIGHTS: O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 �4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE C M 1\ FL# l 0 »-q O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# 0INSULATED FL# O TILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) "IFAPPLICABLE" ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# O OTHER: FL# CITY OF -Ski4FORD Building &Fire Prevention Division L RESIDENTIAL RE ROOF POLICY &PROCEDURES FIRE DEPARTMENT PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION. THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT. A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE. "PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE SANFORD HISTORIC PRESERVATION BOARD INSPECTION POLICY & PROCEDURES A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE, MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS. THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE: • PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION • COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK • COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT • ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS (PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK) • DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE) o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER) o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS) o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER) o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER) o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS • SKYLIGHTS (IF APPLICABLE) o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION. CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: � I . 1 O PERMIT #: U - Co% ADDRESS: F-TI /HIV ION C I P­1 i L1 ErZAl D I kiM 'AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR FINZi-CONiRA NGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGOING INFORM —ATM IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844). LICENSE #: C C 0 J5' r752 COMPANY / CONTRACTOR: CONTRACTOR SIGNATURE: DATE: ?=// 41 " 8 (MUST BE SIGNED BY LICENSE HOLDER OWNER UILDER) A FINAL ROOF INSPECTION IS REQUIRED: THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION, ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING, UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS. "FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE OF FLORIDA COUNTY OF 5A-M Sworn to and Subscribed before me this 14 day of 20 l by: 6LA- �C.' ! h�t3ElZ Who is Y'Versonally Known to me or has ❑ Produced (type of identification) as identification. o"Ay ruRENEE C. COLLIN$ a Commission 9 GG 172994 Signature of Notary Public * . State of Florida N9 \�= Expires January 7, 2022 rEOFwoe SaidadThNBudgetNotary RWekj2 �/� a6Y-eA_1.P Print/Type/Stamp Name of Notary Public