HomeMy WebLinkAbout215 Belgian Wayf
FEQ1 ���� CITY OF SANFORD
BUILDING & FIRE PREVENTION
i PERMIT APPLICATION
BY:— - -_
Application No:
Documented Construction Value: $
Job Address: �i /�� Historic District: Yes ❑ NoU._
Parcel ID: Residential Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑
Description of Work:
Demo ❑ Chanize of Use ❑ Move ❑
Email:
r Property Ow er Information �(
Name aeF� Phone: `-C_V — 7E
ll �
Street: % G "fi Resident of property?
City, State Zip:
Information �--�
Name 1. d�� � ?_' .��� J �` Phone�-1-0�
Street: 775 Fax:
City, State Zip , 1 State License No.: 4!�!!`C d z
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
Mortgage Lender:
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: 51h Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
r
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.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print tractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Notary -State f o Date
ANNE17E M BAN`
Lrm.��7
NotCa"m!'ssion#GGcfF ofF piresJan1 _?2m.Com aoonalNContractS PersonaKnown to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas❑ Roof ❑
Construction Type: Occupancy Use: Flood Zone: _
Total Sq Ft of Bldg:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
SCPA Parcel View: 18-20-31-505-0000-0960
Page 1 of 2
Property Record Card
Parcel: 18-20-31-505-0000-0960
Property Address: 215 BELGIAN WAY SANFORD, FL 32773
Value Summary
20118 Working
Values
2017 Certified
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value
$133,540
$125,916
Depreciated EXFT Value
Land Value (Market)
$34,000
$34,000
Land Value Ag
Just/Market Value **
$167,540
$159,916
Portability Adj
Save Our Homes Adj
$0
$0
Amendment 1 Adj
$0
$0
P&G Adj
$0
$0
Assessed Value
$167,540
$159,916
Tax Amount without SOH:
2017 Tax Bill Amount
Tax Estimator
Save Our Homes Savings:
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$167,540
$0
$167,540
Schools
y $167,540
$0
$167,540
City Sanford
$167,540
$0
$167,540
SJWM(Saint Johns Water Management)
$167,540
$0
$167,540
County Bonds
$167,540
$0
$167,540
Description
Date
Book
Page
Amount
Qualified
VaGlmp
WARRANTY DEED
3/1/2017
08883
0564
$156,300
No
Improved
SPECIAL WARRANTY DEED
3/1/2017
08883
0568
$159,900
No
Improved
SPECIAL WARRANTY DEED
8/1/2016
08788
1691
$100
No
Improved
CERTIFICATE OF TITLE _
7/1/2016
08722
0951
$100
No
Improved
CERTIFICATE OF TITLE
4/1/2014
08240
1318
$100
No
Improved
WARRANTY DEED
12/1/2002
04649
1581
$143,900
Yes
Improved
WARRANTY DEED _
2/1/2002 _
04334
1890
$390,000
No
Vacant
Method
Frontage
Depth Units'-
Units Price
Land Value
LOT
1
$34,000.00
$34,000
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=18203150500000960 2/16/2018
? State of Florida -. /I
County of V-elasiaSP—►�/A1A'45
Permit Number
111111111111111111111111111111111111 I111
G9'4ff MALOY, SEI'IIFIOLE* (-*O'gIITY'_.._.._.._.._.._
NOTICEOF COMMENCEMEFtY, OF CIRCUIT COURT' & C:OtIF'rkDLLEk
Y, 9076 F'9 679 (I ss )
CLERK'S 4 2018►:i18079
RECORDED 02/15/2018 04:19:
�49 F'11
Tax Parcel N��
The UNDERSIGNED. hereby gives notice that improvement will be made to certain real property,
Chapter 713, Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
with
i
1. escr� ion of Property: (Legal description of the property, and street address if available
�EL Fie )
Q �.
2. General Description of Improvement:Z°l'/lp�
3. Owner Information: '
a. Name and Address: - p S ��
b. Interest in Property:
c. Name and address of fee simple titl holder (if other than owner): '
4. Contractor: Nameand Address:/�D!.�ieT/jl,�A�Ua2 �7$/� a 1scl, Rd, s4/1.F0 ,'F i
a. Phone No. Fax No.
5. Surety: Name and Address:
a. Phone No. Fax No.
b. Amount of Bond: $ .00
6. Lender: Name and Address: ALA t" Lr
a. Phone No. Fax No. '
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13 (1)(a)7., Florida Statutes:
a. Name and Address: _ /YI
b. Phone No. Fax No.
8. In addition to himself, Owner designates /1 f of
To receive a copy of the Lien Notice as provided in Section 713.13(1) (b), Florida Statutes.
a. Phone No. Fax No.
9. Expiration date of Notice of Commencement (the expiration date is one (1) year from the 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 1, 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 POSTER ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTA NG, CON T WITH Y R LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING UR OTI OF C ENCE �-- -�
Sign ture wne Print Name of Ow er
STATE OF ORjOUNTY F CAe
Affirmed and ubsbefore me thisg ay of 20� �y—�N2GYl ��`\�c ►who
Personally Icno t`r',w,ho has produced 'F \ � � y `� n S� type of ID) identificat ion a
�CN
Signature of Nota ate of Florida
tA
Print, Type or Stamp Name of Notary
I
p OWE C,C4
®v tla Ca Na
ROBERT N. BARBOUR
a� -- @e MEISCH ROAD
State Certified: SANFORD, FLORIDA 32771
GENERAL CONTRACTOR
*CGC010734 407-323-7583
Commercial Residential Industrial
State Certified:
ROOFER
*CCC017531
Additions
PROPOSAL SUBMITTEDTO
PH NE
DATE
/—/� -M
ST
JOB NAME
C TE AND ZIP CODE
JOB LOCATION
ARCHITECT
DATE O
J013 PHONE
- We hereby submit specifications and estimates for.
/✓�V �%il crl 5 7, 744E ZCG t - V /4r DRV;At
42 y0;g 1' 9-/s
T�9 ea r�erT, d Ale /t°s
New car; e
N e4AJ V iq-//px,�c�er l a Dina en
-
/Vew / s ►4LL S
tv a) Ve
/�fi en� a r 4�� OR W.•// /Rc e
&
Pat ]]rep use hereby tofurn ishmaterial and labor —``complete, in accordance with above specifications, for the sum of:
07 •' 6 1,f/ n pS ,e/1 vel and 46 o,b P.ilt Sh i QS dollars ($ %may— • ).
Pqyment to be made as follows: t p er ; y p/ED
All material is guaranteed to be as specified. Ali work to be completed in a workmanlike man- fy
ner according to standard practices Any alteration or deviation from above specifications # t
involving extra costs will be executed only upon. written orders, and will becomean extra Authorized
charge over and above the estimate. All agreements contingent upon strikes, accidents or Signature '
delays beyond ourcontrol.Ownerto carryfire, tornado and other necessary insurance. Our
workers are fully covered by Workmen's Compensation Insurance. - NOTE: This proposal may
withdrawn b t accepted within 19 ys.
4ktie{ tame of 11rop as a I -The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized to Signa r
do the work as specified. Paym t /will Oe made as outlined above.
Date of Acceptance: - ` Z:== � ' I � 1) f 1 l Sig ture
_T� A
24
�..,.._.._.._.._._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.:_.._.._.._.._.._.._.._.._.:_.._.._,._.._.._.._.._.._..
GRANT r9t�L.0Yr SEI�I1'IOL.E GOUhflY
NOTICE OF COMMENCEMEiI`K OF CIRCUIT COURT h COCIFTROLLER
State of Florida �' '9076 Ps 679 oPq''
CLERK'S r 2018018079
County of Ve siaSe-m/ 1e RECORDED 02/15/2018 fi4:19149 PN
Permit Number Tax Parcel Nt�
5 fro' 94
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. J?escr jgion of Property: (Legal description of the property, and street address if available)
2. General Description of Improvement:Z°/'�p�'
3. Owner Information:
a. Name and Address: d /wen S
b. Interest in Property: nj to
c. Name and address of fee simple titleholder (if other than owner):
4. Contractor: Name and AddressD%QT
a. Phone No. �D% 3�3 -75�3 Fax No.
5. Surety: Name and Address: n(b/k47
a. Phone No. Fax No.
b. Amount of Bond: $ .00
6. Lender: Name and Address: No t t 67
a. Phone No. Fax No.
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13 (1)(a)7., Florida Statutes:
a. Name and Address:
b. Phone No. Fax No.
8. In addition to himself, Owner designates ►1(/4— of
To receive a copy of the Lien Notice as provided in Section 713.13(1) (b), Florida Statutes.
a. Phone No. Fax No.
9. Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
Different date is specified). 9—sz)—/8
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 1, 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 POSTE ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTA NG, CON LT WITH YO R LENDER OR AN ATTORNEY BEFORE COMMENCING WORK 1
OR RECORDING UR OTI OF C ENCE
f
Sign, ture wne Print Name ofOw er
STATE OF ORIDA, OUNTY f)F �,�r, I Y� J
Affirmed and ubscribed before me this—ji, —daay of �,, ^ 20� by � 2C�(1 S) � ��;� ���\GWho is
Personally kno to or who has produced F \ 4,2 : �j \; c ntype of ID) identification.
� �h �
Signature of ota i to of Florida PU* A,'
Q�
vso 1S.3 - q1•�� '
rJ\ a� `
Print Type or Stamp Name of Notaryl
L......................................................................................................................................................................... i. r_ _.._.._.._.._.._.._.._.._.._..
$CPA Parcel View: 18-20-31-505-0000-0960
Page 1 of 2
AAP
on,crn
Property Record Card
PROP Parcel: 18-20-31-505-0000-0960
xccc Ra Property Address: 215 BELGIAN WAY SANFORD, FL 32773
Parcel Information
Parcel 18-20-31 505 0000 0960
Owner�BOYCE-TAYLOR, JEANNE
Property Address 215 BELGIAN WAY SANFORD FL 32773
Mailing 3895 LAKE EMMA RD #167 LAKE MARY, FL 32746
Subdivision Name BAKERS CROSSING PHASE 1
Tax District S1-SANFORD
DOR Use Code 01-SINGLE FAMILY
Exemptions
Value Summary
�orking 2017Certified
Values Values
Valuation Method Cost/Market Cost/Market
Number of Buildings : 1 1
Depreciated Bldg Value $133,540 $125,916
Depreciated EXFT Value
Land Value (Market) $34,000 $34 000
_
Land Value Ag
Just/Market Value "' $16' 540 $159,916
Portability Ad/
Save Our Homes Adj $0 $0
Amendment 1 Adj $0 $0
P&G Adj $0 $0
Assessed Value $167,540 $159,916
Tax Amount without SOH: $3,045.04
2017 Tax Bill Amount $3,045.04
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad Valorem Assessments
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=l8203150500000960 2/19/2018
CITY OF
IL A
A dRD
FIRE DEPARTiMENT
JOB ADDRESS: � I
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
STRUCTURE TYPE: * SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY: '�// 9(0)
*'PLEASE NOTE: ONL Y 100 SQUARE FEET OF fHE EX STING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: � OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
Aft
SKYLIGHTS: O YES A" NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12-4:12
O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
® SHINGLE
j��
[ /( 1 `b
'
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TILE
FL#
OOTHER:
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#
O INSULATED
FL#
O TILE
FL#
O OTHER:
FL#
{T_ CITY OF
FIRE DEPARTMENT
Building & Fire Prevention Division
--RESIDENTIALRE-ROOFPOLICY & PROCEDURES -
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 OWNERBUILDER) SIGNATURE: �� DATE: �' z ��/
CITY OF
S-A'�;FORD- Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDA IVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT ADDRESS:
V
AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
NSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
'ONENTS 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 REQUIREMEEN/TSS (BASED
%ONJF.SS.. CHAPTER 553.844).
LICENSE
COMPANY / CONTRACTOR: !I / Y SA e-6 C7 V'r
CONTRACTOR SIGNATURE: DATE:
(MUST BE SIGNED BY LICENT�teLsiy
DEROR OWNERS PILDE
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 �i 1M i 1� 0
Sw to d Sub ribed before me this day of �� �✓�(.�- 20 by:
Who is 00ersonally Known to me or has ❑ Produced (type of
i entifica 'on) _ as identification.
gnature of Notary Public
State of Florida
Print/Type/Stamp Name
of Notary Public
CAROLE PR-'.-!--:-: ;AN
MY COMMISSIC..:.c i+ 169830
EXPIRES Octot er 2O. 2018
0071 398-0153
FloridaWiw, -