HomeMy WebLinkAbout313 Willowbay Ridge St•�°�,
Job Address:
Parcel ID: �
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: f S" J -a Or
Documented ConstructioValue: $ ,y
ClYn�Dln
Historic District: Yes ❑ No ❑
Residential'! Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair FXf Demo ❑ Change of Use ❑ Move ❑
Description of Work: .=.-P — y_0oF-.
Plan Review Contact Person: T►111 ► ��n C�1�� ( Title:_ediTco
Phone: . 3lQ u'u,000 Fax: Email: ^i n Ca na
Property Owner Information
Name _VQJU ky) �)'s
Street: W
City, State Zip: '1
Name Heritage Construction & Roofin
Street: 1544 Seminola Blvd. Suite 136
Phone:
Resident of property? :
Contractor Information
Phone: (407)366-6000
Fax: (407)366-6065
City, State Zip: Casselberry, FL 32707 State License No.: CCC132650
Arch itectlEngineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
E-mail:
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: 5th Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application ��
NnTICE: 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.
XI I., / )1,4>, ft
Signature ofOwner/Agent D to
C et, ) �n L� *'r
Print Owner/A
i $ e o Florida Date
Ei
Notary Public StaDFloridaLesley G GarzaMy Commission Expires07/07/20Owner/Agee
Produced ID Type of ID
V-711
Si a re of Contractor/Agent Date
Print
L<�J
-3/2�/
,q�V Pu Notary Public State of Florida
?°�Lesley G Garza
_ ,, a My Commission GG 009517
Expires 07107/2020n -,.,A
Contractor/A
Produced ID
Type of ID
BELOW IS FOR OFFICE USE ONLY
ly Known to Me or
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas[] Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
# of Heads Fire Alarm Permit: Yes ❑ No ❑
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Revised: June 30, 2015 Permit Application
Construction & Roofing Inc.
1544 Serniola Blvd. Suite 136
Casselberry, FL 32701
PH: 407-366-6000
FX:407-366-6065
Info@Heritageer.com
CGC1505045 CCC1326650
V66 211 224Z
Account Manager: —A"_
INSURANCE COMPANY,INFORMATION
Company:4WS��
Policy
Claim #:
MORTGAGE COMPANY INFORMATION
Company.iQkkK ZOAAVAI
Loan Number:; '
Y—Owner's Insurance COMP —any does not agree to pay for a full roof replacement this contrsket'shall h.
voidable
Assignment of Insurance Benefits for the Full Roof Replacement Only. I hereby assign any and all insurance rights, benefits and proceeds
under any applicable insurance policies to Heritage Construction & Roofing, Inc. ("Heritage"), the scope of which shall be limited to a Full Roof
Replacement. I make this assignment and authorization in consideration of Heritage's agreement to perform services, supply materials and otherwise
perform its obligations under this contract, including not requiring I payment at the me of i I also
and all information requested by Heritage, its representative, or its full Y111 t time service. I hereby direct my insurer(s) to release any
attorney for the direct purpose of obtaining actual benefits to be paid by my insurer(s)
for services rendered. In this regard, I waive my privacy rights. If payment is made directly to the Owner/Agent/Itnusured(s), it shall be endorsed over to
Heritage immediately upon receipt. I agree that any portion of work, deductibles, betterment or additional work requested by the undersigned, not
covered by insurance, must be paid by the undersigned on the day of installation. Deductible: It is the Owner's responsibility to pay all Insurance
Deductibles. Owner's out-of-pocket expense will not exceed the deductible amount, as stated on insurer's loss sheet, UNLESS teplacement/iepair of
deteriorated decking is required and/or Owner requests optional upgrades. Heritage CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or
any part of the insurance deductible applicable to the insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on
the insurer's Loss Sheet shall overrule deductible listed below,
Deductible: — MUST BE PAID IN FULL, PLUS ANY APPLICABLE SALES TAX
MORTGAGE —AUTHORIZATION: 1, Owner / Mortgagor, grant authorization for Initials)
Heritage Construction & Roofing, on matters including, but not limited to, the claim and payment status. ortgage Co. to speak with
PAYMENT SCHEDULE: Owner agrees to pay Heritage based on the following pay schedule: (i) Deposit in the amount of $
due upon signing this contract; (ii) the Contract Price, less the Deposit and any applicable depreciation retained by Owner's insurer(s),
plus Upgrade
Costs, due and payable to Heritage upon completion of work being performed; and, (iii) the remaining Contract Price (equal to any applicable
depreciation and/or change orders) due and payable to Heritage upon completion of work performed In the event of a pending inspection, no more than
2% of Contract Price may be withheld until inspection' p tional: UPGRADE ITEM: I -
PRICE: $ QTY:-,
TOTAL: $ Replacemedt Work and Price* Upon
insurer's approval and subject to the terms and conditions herein, Heritage agrees to furnish all materials and provide the labor necessary to perform e
full roof replacement which shall take place following Owner's insurarice company's approval, approximately within 30 days, conditions permitting.
th
ting.
Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance company for a full roof replacement, Heritage shall
perform the roof replacement upon receipt of funds from Owner's insurance company. CANCELLATION: If Owner elects to terminate the services of
Heritage, Owner may do so before midnight on the third business day after Contract is executed. Owner shall receive a full refund of all deposits. Owner
may also rescind Contract before midnight on the third business day after the contract is executed after notification from insurer(s) that the claim for
payment on roof contract has been denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered
to Heritages corporate office: 1544 Seminola Blvd., Suite 1,36, Casselberr), Florida 32707. CANCELLATION EXCEPTIONS: The three (3) day right
of cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence. L Owner, have read and understand all statements,
terms and conditions of the "Roof Replacement Contracti. and agree that all details are acceptable and satisfactory. I fta-ther understand that this contract
constitutes the entire agreement between the parties and that any further changes or alterations to this contract must be made in writing and agreed upon
by both parties. Each party represents and warrants to the other that it has the full power and authority to enter into the contract and that it is binding and
enforceable in cordance with its terms.
Au ze Heritage Representative 7
1 Date Owner Date
Print.Name Print Name
TERMS AND CONDITIONS: Acceptance of Terms: L Owner, hereby agree to retain Heritage -for a full roof replacement on the terms and conditions
stated herein. I further agree to provide Heritage with the Scope of Loss Report generated by my insurer and authorize and grant full access to the
property for the purpose of staging and completing all agreed upon work. Supplemental Claims:.Heritage reserves the right to file a supplemental claim
with Owner's insurance in the event that the estimate is incorrect and/or additional damage is discovered after commencement. The supplemental claim
amount(s), in addition to any depreciated amounts held back by the insurer, are immediately due to Heritage upon receipt. Commencement of Work:
Work shall commence at Heritage's discretion. Heritage shall not be liable for delay in, or failure to perform due to: labor controversies, strikes, fire,
weather, Acts of God, war, governmental actions, inability to obtain materials from usual sources, delays caused by and/or as a direct result of Owner's
insurer or other circumstances not listed which are beyond the control.of Heritage, Noise Pollution and Vibrations; Prior to installation, it is the sole
responsibility of Owner to remove any and all items which are not secured to walls including, but not limited to, items on mantles, shelves or other areas
susceptible to vibrations, as these may fall. Heritage shall not be liable for noise pollution and/or vibrations due to the performance of work contracted
herein, or damages resulting to person(s) or property.
I
THIS INSTRUMENT PREPARED BY: .,,ny t� i7Z
Name: Heritage Construction & Roofing �a-L,
Address: 1544 Seminole Blvd. Suite'.'
Casselber y- FL 32707
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit Number:
��F:a�ha'I" 11ALOY? `Ei'l:tNOLE COUhi-l'Y
CLERK OF
CIRCUIT C OUF: i f., :" i.)rIP1'ROL.L.E (
CLERK J C ;
2t_i18025y.g2
RECORDED
;r=C:ORDTr,G
03-'/07 '^i i " 12.33 _ ..,,, , ,p
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FEES f11}, iil
RECORDED
B
Parcel ID Number: ' Lam' LI `mot 3l 1 �0q r)MC)%.0'-? o
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.
OF PROPERTY_ (Legal description of the property and street address if available)
Z
GENERAL DESCRIPTION OF IMPROVEMENT:
OWNER I
Address: I � C_�\ i
Fee Simple Title Holder (if other than
Address:
32? b 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)(b), Florida Statutes.
Name:
Address:
In addition to himself, Owner Designates of
To receive a copyof the Lienor's Notice as Provided in
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement (The expiration date 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.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the best of my knowledge and belief.
a a ¢
1 rl l��ti,!I 1119
G
tz
r Owner's gignature Owner's Printed Name
Florida Statute 713.13(1)(g): "The owner must sign the notice of commencement and no one else maybe permitted to sign in his or her stead "
l7 V 1 u
p UJ CC
State Of � County of fey-)t h C;1 e
W O P b
J —
The foregoing instrument was acknowledged before me this 25 day of 1-/C/y 2017
cc cc uj q
r
by \,t-� \91[--4'5 Who is personally known to
Name of person making statement
OR who has produced identification type of identification produced:
O
O
N
Ne I'uoltc Stale of rionud
Lest ey G Gaiza
7 r Notary Signature
r� My Commission GU iu.i6+ `y
oIIF Expires O/U//2020
Product Approval Specification Form
Permit #
Project Location Address
As required by Florida Statute 553.842 and Florida Administlative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuilding.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category/Subcategory
Manufacturer
Product
Description
Florida Approval #
(include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll Up
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Category/,Subcategory
Manufacturer
Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
C
S
Underla ments
t
Roofing Fasteners
R t
Nonstructural
Metal Roofing
Wood Shakes and
Shingles
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofing slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
T
Category/Subcategory
Manufacturer
Product
Description
Florida Approval #
include decimal)
5. Shutters
Accordion
Bahama
Colonial
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name J ��
(Please Print)
June 2014 3
CITY OF
kNFORD
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE OEPARTMENT
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: 3 // (
:+
a
r
CITY OF
SkN'FO
FIREOEPARTMEN
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: 1�1� ln/ II`C1 W �41l/ 1�a P S�
STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLEDOVEREXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): � p 0 A JkCIh I r C�
**PLEASE NOTE: ONLY 100 SQUARE FEET OFT E EXISTING DECK IS PER ED TO BE REPLACED
ROOF VENTILATION: OOFF-RIDGE RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES �No IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 �:12 — 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
MC.(
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
O INSULATED
FL#
O TILE
FL#
(� 1
OTHER: U Y\ l Vh
MAC,
^ C
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#
OTILE
FL#
0 OTHER:
FL#
City of Sanford
Building and Fire Prevention
RESIDENTIAL RE-RoOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: l _ �2-1 ADDRESS:
I n7 �v, e_s �a%h (7,% AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT-, QeF.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 #: VC.. C S 32 A 977V
COMPANY/CONTRA
CONTRACTOR SIGNA
(MUST BE SIGNED BY
'TOR: eC'
TURE: DATE:
LI NS HOLDER OR OWNER/BUIL R)
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 ��1plQ
Sworn to and Subscribed before me this ay of 20LV _ by:
ersonally Known to me or has ❑ Produced (type of
as identification.
Lesley G<^C?:!?�
Print/Type/Stamp Name
of Notary Public
aY a�B4 i otar! ley G PublicState of Florida
Pub
Garza 009517
°�� ar My Co mission GG
oF EApres071�712020