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Home My WebLink About208 Conch Key WayCITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: Documented Construction Value: $ 14o 4C (dD 3) =�l Job Address: EaVA&_Historic District: Yes ❑ No ❑ Parcel ID: C1- ( - 3 - p(Residential Commercial ❑ Tvne of Work: NewtO Addition ❑ Alteration ❑ Renair ❑ Demo ❑ Chanae o``f'' Use ❑ Move ❑ Plan Review Contact Person: Phone: Fax: Email: Title: I Property Owner Information Name G ey-a 14 t A-e-, Phone: Street: '92-oz UJM Resident of property? City, State Zip: 5-K iLk" Contractor Information Name VD Phone: .1-( _ Street: �i �-j/� L�r g4c _ Fax: 2('PO 81 City, State Zip: MR VO )-e , FL State License No.: c� 3 3� S Architect/Engineer 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: 5'h 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 constrpction and zoning. Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Name h't ld Si e o Notary -State loride o"SYPue KRISTIN A. MORLEY Commission# GG 1b1894 r c� Expires November 20.2021 y�OFF�oQ� B=WThuMpoNot" Sm ices Contractor/Agent isqvype Personally Known to Me or Produced ID of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑ Construction Type: Occupancy Use: 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: Flood Zone: # of Stories: Plumbing - # of Fixtures, Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: Revised; June 30, 2015 Permit Application Product Approval Specification Form Permit # Project Location Address Cab As required by Florida Statute 553.842 and Florida Administrative 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.floridabuildin-g.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 U 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 r Underla ments Roofing Fasteners 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 Roofin E.P.S. Roof Panels Roof Vents Other June 2014 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 (Please Print) June 2014 3- THIS INSTRUMENT PREPARED BY: Name: Kevin Wilkinson (W dr;con Construction) Address: 305 North Drive Suite elboume, Florida 329M GRANT MALOYr SEMINOLE COUNTY CLERK OF CIRCUIT COURT & COMPTROLLER BK 9094 Ps 686 (iPss) CLERK'S : 2018030245 RECORDED 03/20/2018 12:12:35 PM RECORDING FEES 410.00 RECORDED BY Jeckenro Permit Number. Parcel ID Number .29-19 3/=5G(-Gc on—egOgO The undersigned hereby gives notice that improvement will be made to certain real properly, and in accordance with Chapter 713, Florlds Statutes, the following Information Is provided in this Notice of Commencement 1. DESCRIPTION OF, PROPERTY: (Legal description of, the property and street address N available) SAAraW, f-L. .3a77I , 2. GENERAL DESCRIPTION OF IMPROVEMENT: Shingle RE -ROOF 3. OWNER INFORMATION OR LESSEE INFORMATION iF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: &FA44D _ 5_.4.1,J7-F r1DO C000M y UA •1 S9AJFa['d FL . 3.2771 Interest in property: n JMI Fee Simple Title Holder (if other than owner listed above) Name: WA Address: WA 4. CONTRACTOR: Name: Weston Construction Inc Phone Number. 321-259-6789 Address: 305 North Drive Suite C Melbourne, Florida 32934 S. SURETY (U applicable, a copy of the payment bond is attached): Name: WA Address: N/A Amount of Bond:. S. LENDER: Name:"°N/A Phone NumberI Address: WA 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents mey be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name: N/A Phone Number,= Address: N/A 8. In addition, Owner designates N/A of WA to receive a copy of the Lienor's Notice as provided in Section 713.13(1 Kb), Florida Statutes. Phone number. N/A 9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a dliferent date Is specified) 2/22/20 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. (S of Owner or Lame, or Owners or teseee's 02m Nems and PMOU Signstarys TMNO01rs1 AutRwlzeA OfP oeADlreCOHPmtrterrMlensper) _ b State Of COuntyof S��\YV1� The foregoing Instrument was acknovAedged before me this day otdl ofy by [A I a J WYK Who Is personally known to me Nome of tfQ1san making i tww and who has produced identification)( type of identification produced>i1. � "•"• :; Md11EN NOVO * t MYCOWiS M#FF1731M EXI It1ES: November 3, 2018 NoWrySIgnat �?or ��1MabrY6enks 4696 305 North Drive Ste. C _SP / M &LG -Ro5Tc 6foAvz N Melbourne, FL 32934 H� N Tel:321-259-6789 Ale 1/0 CC>N5TIil C1'f>N. ,�< Fax:866-602-7933 lj�i /T-� CCC1330785/CGC1506914 WORK AUTHORIZATION I hereby authorize Wescon Construction, Inc. to perform repairs on my property located at: kley t, JAl SA,uFaeD Ft 3,:P77 I per the scope of repairs provided to my insurance company for claim # A 1411 o932 I further authorize my Insurance Company to release payment direct to Wescon Construction, Inc. for the services that are performed in conjunction with the above insurance claim. Should the Insurance Company require direct payment to me, I hereby request that the name, Wescon Construction, Inc. be added to the draft that will be sent to me in payment of said claim. This contract and any written agreement made pursuant thereto between Wescon Construction, Inc. (hereinafter "Co" or "Company") and the customers named herein on the reverses side. This contract and any written agreement will be subject to all appropriate laws, regulations and ordinances of the State of Florida and all parties agree that in any legal action arising out of the Contract and any written agreement the proper jurisdiction and venue shall be Brevard County, Florida courts. All parties hereby waive any jurisdiction or venue defense or arguments, which may be raised. In the event the Customer fails to pay Company any payment when due: interest on said amount at the rate of 2% per month or the highest rate permitted by law, whichever is lesser; and the Company's reasonable attorney's fees, expert witness fees, disposition, transcript fees and all costs associated with legal filling fees. The re-roof/repairs performed by Wescon Construction, Inc. are based on Wescon Construction Inc.'s visual inspection of the area of the reported problem. We cannot guarantee that no additional problems and damaged areas will be discovered once repairs begin. Customer acknowledges and understands that, after Wescon Construction Inc. commences its work, new or additional problems may be discovered and that the price and time of completion may be increased. Customer also acknowledges and agrees that Wescon Construction Inc. is not responsible for damages or leaks due to existing conditions or existing sources of leakage simply because work was started or performed. We understand that Contractor has no connection with our Insurance Company or its adjusters and that we alone have the authority to authorize Contractor to make repairs. Due to nature of work, no completion date is specified. No verbal agreements are binding. 35kEet's0i-/`-Y wOo6 0,-- PL^c'mer4'1,,1"o0"/ C-A`4 A0DJTkU,lAL_5,4ee—' Is 1%�-is��. Per final approved scope of r rk: c�u.. I / i r /�c _ i?rnc / <-fr.cV /,Gt—e 7b Br5 PAi8 r1T S7%{0_-1 &F ORK- The undersigned hereby assigns any and all insurance rights, benefits, proceeds and any causes of action under any applicable insurance policies to Wescon Construction, Inc, forservices rendered or to be rendered by Wescon Construction, Inc. In this regard, the undersigned waives his/hers privacy rights. The undersigned makes this assignmentin consideration of Wescon Construction, Inc. agreementto perform services and supply materials and otherwise perform its obligations under this contract, including, but not limited to, not requiring full payment at the time of service. The undersigned also hereby directs his/her insurance carriers) to release any and all information requested by Wescon Construction,lnc, its representatives, and/brits attorneys forthe direct purpose of obtaining actual benefits to be paid by his/hers insurance carrier(s) for services rendered or to be rendered. Insured is responsible for any amount not covered by insprance company. Company limited warranty Re -Roof 5 Years Compa; 1? warranty Repair 1 Year Owner's Name: �t a �ivir Signature: ` ' Date: Z �z /r� Z ZZSi�►atur:Wescon Representative: KEti, r�K�� Date: Wescon Officer: Signature: Date: ,.�CITY OF Building & Fire Prevention Division PERMIT NO. 2 ISSUE DATE: O. /®/ J? - CONTRACTOR: TYPE OF WORK: tet co zoo t PROTECT FROM WEATHER • 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..000NTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATEFeMANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. FBC 105.3.3 REVISED: 4-17 Inspection Line 407.792.6069 or 855.541.2112 TO SCHEDULE AN INSPECTION: • Dial 407.792.6069 or 855.541.2112 • Provide the items requested during the message • The type of inspection requested must be scheduled under the appropriate permit type • Follow the prompts PLEASE NOTE: Inspections scheduled by 5:00 p.m. will be conducted the next business day. If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am - 5:30 pm for assistance. AUTOMATED INSPECTION SYSTEM CODES Final Roof Inspection Code III 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) h `" 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 REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112 PERART # City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: STRUCTURE TYPE: SINGLE FAMILY RESIDENCE/TOWNHOUSE Q MOBILE HOME O APARTMENT/CONDOMINIUM WITH RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): "PLEASE NOTE: 0NLYI00 SQUARE FEET 04 THE EXISTING DECKISPERMITTED TO BE REPLACED" ROOF VENTILATION: 'FF-RIDGE p RIDGE QSOFFTT QPOWERED VENT SKYLIGHTS: O YES NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: ------------------------------------------------------------------- MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 0 2:12 -4:12 '04:12 OR GREATER QTURBINES TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL HINGLE FL# O METAL FL# O MODIFIED B FMMEN FL# Q TORCH DOWN FL# pINSULATED FL# 0 TILE FL# THER: bA4'JA&AkAh FL# N .� v OOF EXTENSIONS (PORCHES. PATIOS. ETC) "IF.APPLICABLE*" ROOF SLOPE: O LESS THAN 2:12 0 2:12 - 4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLE FL# Q METAL FL# p MODIFIED BITUMEN FL# p TORCH DOWN FL# 0INSULATED FL# O TILE FL# 0 OTHER: FL# City of Sanford Building Division Residential Re -hoof Inspection Policy & 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), certifyin C code compliance by personal inspection. CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: � -' � DATE:." FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 ---------------------------------------------------------------------------- Page 2 Application Number . . . . . 18-00002208 Date 5/10/18 Property Address . . . . . . 208 CONCH KEY WAY Parcel Number . . . . . . . . 29.19.31.501-0000-2090 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . SINGLE FAMILY Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 1050442 Permit pin number 1050442 ---------------------------------------------------------------------------- Required Inspections Phone Insp Seq Insp# Code Description Initials Date ---------------------------------------------------------------------------- 1000 111 BL03 FINAL ROOF _/_/_ RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: J 6? — 2 2C?R ADDRESS: I L. zz_ ►^ N mr) , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR OHNG CONT 0 GINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE FOREGO ATION 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/CONTRACTOR: CONTRACTOR SIGNATURE: _ (MUST BE SIGNED BY LICENSE 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 20z by: � Who is ersonally Known to me or has ❑ Produced (type of ident-fic ion) as identification. oK�Y P�eKRISTIN A. MORLEY Signat re of Notary Public e ' ° g ry Commission # GG 161894 State o orida toe Expires I��o1?*o[�20, 2021 to f��P\ gqded lhru Budget Notary Se,vims Print/Type/Stamp Name of Notary Public