HomeMy WebLinkAbout110 Somerset Oaks CtApplication No:
Documented Construction Value: $ � TM
f-\ L
Job Address: 97-t- Oats (17
Parcel 1D:2 2 - q- so -,50,z- 0= -
Type of Work: Newl AdditionF] AlterationF]
Description of Work:
Plan Review Contact Person
Historic District: Yes [I No 0
64- Residential X Commercial
Al -
El
Repair, Demo [I Change of UseEl Move[]
Title: UNY
Property Owner Information
Name Phone:
Street: wood - 7-,jc,*t \MV Resident of property? City, State Zip: L
Contractor Information
NamePhone: 02)
-K
Street:W.' k P-- uiyd Fax:
City, State Zip: State License No
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: 51hEdition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
+fhe 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 AFFIDAV T: I certify that all of the foregoing information is accurate and that all work will
be done in com i 1 nc ith all applicable laws regulating constrluc ion and zoning.
ature of.Own gent ate ( Si a re fItmaractor/Agent Dat
Print O er/ gent's Name — —�
Print or Agent's Name vvv
Srgtta ofZ1 S�vfL5rAi:_i_�Jl,tv�r�LSLAV1Cai�ae Sian' 1 Pt�tttrtda--- —
t <
MIC HAEL JAMES L AVIGNIA
! r F SFr Xk�t My � C VH%'1 S1'
f ) fiber � ?016 i
i� s,... ,torr�,.r'3,2 ,8
Owner/A nt is Personally Known to Me or Contra for/A nt is Personally Known to Me or
Produced ID Type of ID Produced ID 1 Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: BuildingEl Electrical ❑ Mechanical ❑ Plumbing❑
Construction Type: Occupancy Use:
Total Sq Ft of Bldg:
Min. Occupancy Load:
Gas❑ Roof ❑
Flood 'Lone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads — Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised: June 30, 2015
Permit Application
JP
ROOFING
& REMODELING
1606 E Central Blvd
Orlando FL 32803
CM 3303191 CGC1621712
407-302-0218
Job#
Name_ A r+ f 15 ��¢,2 HMrf tP7 ��65 911 3 _ Polo
Address to S 6t ALT# Aettt''S-Ate PE a,,Aw.(,GM Claim#
City,St,Zip C—A"V t'd- -t'1' 3).771 Ins. Co. �I — r f'� Deductible
Insurance Agent Agent's Phone Number Deposit
ROOFING )
TYPE OF EXISTING ROOF. /lit ROOF PITCH:-12 NUMBER OF STORIES: LAYERS:
RIDGE VENTS (LF): 48" OFF -RIDGE VENTS: 3 OTHER VENTILATION:
ELECTRICAL BOOTS BOOT JACKS _ _ 1.5" 2— 2" 1 3"_4"
GOOSENECKS:_4" 3 6"_9'_lo" DRIPEDGE: CHIMNEY FLASHING (II
DEAD VALLEYS:. SKYLIGHTS ( YES o f SATELLITE DISf (1 S or NOSTEP FLASHING (L:F)'
GUTTERS: 6' OR 1' SOLAR PANELS: PANEL SIZE: - WATER or ELECTRIC
ACCESS FOR DUMPSTER ( YES or NO)
INTERIOR DAMAGE ( YES or NO) fit yes see additional)
OTHER:
CONTINGENCY AGREEMENT
Customer agrees to contact the insurance company and make a claim for repair ar replacement of damage to the property. Customer agrees to notify City Rooting & Remodeling
of the claim number, and the phone number of the claim adjuster assigned to the claim. The customer agrees to allow Cily Roofing & Remodeling to meet with the insurance
adjuster at an agreed upon Gme to discuss damages and scope of the claim, and negotiate a price for r/replaent that is agreeable to the insurance company. If the
agreed upon price ('contractamounl') is reached, the Cuslomerexclusively authorizes City Roofing&.mplete alwork as agreed upon. City Roofing &
Remodeling will be authorized to obtain labor and materials for the replacement or repair in exchangehe insurance company of the contract amount. The
contract amount means to Replacement Cost Value ('RCV) listed by the insurance company, plu a fit allowed .paid for by the insurance company,
plus the deductible and depreciation, if any.
We hereby propose to furnish material and labor- complete In accordance with abo specificallons for the sum of. I
$ Per insurance Scope of Loss for full replacement cost value on Insurance Scope of Los heel Including Contractor's Overhead and Profit, plus deductible,
any upgrades, Insurance supplements and decking or fascia replacement as needed.
Proposal written by: RiI :dm iI Dale: Cell#:207 909 24 0 7—
PLEASE MAKE ANY PAYMENT OA SUPPLEMENT PAYMENT TO: CITY ROOFING 8 REMODELING
I AGREE TO PAY THE FULL MONETARY VALUE PAID TO ME BY THE INS CO TO: CITY ROOFING AND REMODELING
Customer DATE
Scanned by CamScanner ;
adz.
Scanned by CamScanner
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 1S 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)
i
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), CERTIFYINP FBc CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE:
DATE:
CITY OF
SkNFORD Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. ' " I ' ISSUE DATE:aW
0—kX_;
CONTRACTOR: ciew e
JOB ADDRESS: OS®Qr % Lt
s'
TYPE OF WORK:
PROTECT FROM WEATAR
• Post this Permit and all required documents in a conspicuous place outside
• Digital Photographs are required - please follow re -roof policy and procedures guide
• All trash, debris and dumpsters must be removed from job site at final inspection
• Permit expires six (6) months from date of issue
ROOF
INSPECTION TYPE APPROVED REJECTED INSPECTOR
FINAL ROOF
FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION
FEE AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL
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.
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. FBC 105.3.3
REVISED: 4-17 Inspection Line 407.792.6069 or 855.541.2112
PERMITTING REQUIREMENTS —NO PLAN REVIEW REQUIRED 51 1
v
TIIIS 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 ORADDRESS 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), CERTIy;YINjG BC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OiVNFR/BUILDER) SIGNATURE:
DATE: r
JOB ADDRESS:
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE
0 MOBILE HOME 0 APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WTFH NEW COMPONENTS)
RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
**PLEASE NOTE: ONLY 10 0 SQUARE FEET OF T11F EYIS TING DECK IS pERAtITTED TO —BE —REP'
LACED**
ROOF VENTILATION: OOFF-RIDGE 0 RIDGE OSOFFIT OPOWEPEDVENT
SKYLIGHTS: O YES ONO fF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL
------------------------------------------------------------------------------------------------------ I ------- m ----------------
M A 1W VOnv AREA
ROOF SLOPE: 0 LESS THAN 2:12 02:12-4:12
�6 4:12 OR GREATER
OTURBINES
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
ISHINGLE
FjL#
_oMETAL
FL#
0 MODIFIED BITUMEN
F.L#
0 TORCH DOWN
I, i Lit
0 INSULATED
F i L#
OTILE
F I L#
OTHER:
FL# '2
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPP11CABIE"
ROOF SLOPE: 0 LESS THAN 2:12 0 2:12-4:12 0 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
OSHINGLE
FL#
OMETAL
FL#
0 MODIFIED BITUMEN
FL#
0 TORCI I DOWN
FL#
0 INSULATED
FL;#
OTILE
FL#
0 OTHER:
FL#
a
THIS INSTRUMENT PREPARED BY:
Name: Richard
Hyman
Address:
NOTICE OF COMMENCEMENT
Permit Number: 18 L5L
Parcel ID Number. 22-19-30-502-0000-0410
(Ittll(ttlti 11t1t tlltt Ill!! ll��[ 1111 I��I
GRANT NALOYr SEMINOLE COUNT'!'
CL..ERK OF' CIRCUIT COURT 2< COMPTROLLER
BK 9074 F'•9 39
CLERK'S r 2018016323
RECORDED 02/12/2012 12:31.01:2
RECORDING FEES :10,00
RECORDED BY tsmith
The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordence with Chapter 713, Florida Statutes, the
following Information is provided in this Notice of Commencement.
1. 0L8r 1TION OF PROPERTY: (Legal description of the property and street address If available)
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Re -roof due to damage frctm Hurricane Irma
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: Arthur Fischer - •1719 Dogwood Forest Way, Lake Mary 1=L 32746
Interest in property: Owner
Fee Simple Title Holder (if other than owner listed above)
4. CONTRACTOR: Name: Richard Hyman Phone Number. 407-392-0218
Address: 1606 E Central Blvd, Orlando FL 32803
5. SURETY (If applicable, a copy of the payment bond Is attached): Name:
Address: Amount of Bond:
6. LENDER: Name: Phone Number:
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes.
Phone Number.
8. In addition, Owner designates
to receive a copy of the Lienoes 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 INSPECTIOY�. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COM NCIN WORK OR 60RI51NG YOUR NOTICE OF COMMENCEMENT.
Arthur Fischer
ts<enat«e orowner«Lasser, a InerlManagwy«) Mrs a•s (Print Name and PmNde Slgnator/s TidefO111m)
—may Audadzed OlaoadDirectorlP«
State of dCt County of mw1 rr__
The foregoing Instrument was acknowledged before me this V day of � O�i� .20 LIZ
by L-�" 1�k, Tl� r 'r� Who is personally known to meKOR
name of person nm" statement
who has produced Identification ❑ type of identification produced:
•'""�"°'` 4'ti;,,.FIA.EL ,:AV1ES L.4VItONA
MY COMMISSION #FF 162615
EXPIRES September 23. 2018
M1OT;.
(407) 30&0153 F10f1d.1N0uuyScrvic0.c0m
CITY OF
,' SkNFORD Building & Fire Prevention Division
- RESIDENTIAL RE-R 0 OF A FFIDA VIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: 4 — (
ADDRESS: � , � C�
a L��1
AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGMStR, 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 #:
COMPANY
CONTRACT
(MUST BE S
_M1330ESp
/ CONTRACTOR. lJC � U � t �'
OR SIGNATURE: DATE:
IGNED BY LICENSE HOLD R R/BUIIyIJ R)
INAL 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 L 1 1 111 ov
Ij
Sworn to and Subscribed before me this day of 20 by:
Who is Personally Known to me or has 0 Produced (type of
I A
I7I7
as identification.
Signa Iure oljNktary Public
State {f Flor [(407)
RY'n"°L :. Rf3iCNAEL ,1`aM , l�`e`JIGNA
^ MY COMMISSION #FF162615
In
ICk o - o?EXPIRES September 23, 2018
[� viTn
Print/Type/Sts Name 3e8-0153 Floridallotarv5ervicecom
of Notary Public