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HomeMy WebLinkAbout316 Appaloosa Ct; 17-2155; ROOF426930 i3 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION F JUL 17 2017 Application No: ' — i Documented Construction Value: $ 11,200 Job Address: 316 APPALOOSA CT SANFORD, FL 32773 Historic District: Yes No El 18-20-31-506-0000-0860 Parcel ID: ResidentialFA Commercial Type of Work: New Addition Alteration RepairEl Demo Change of Use Move Description of Work: RE -ROOF OWENS CORNING FL10674 TECHWRAP FL17194 33 SQ'S 7/12 PITCH OAKRIDGE DESERT TAN LIFETIME WARRANTY Plan Review Contact Person: KARLA ALMODOVOAR Phone: 407- 278-7788 Fax: 800-337-3361 Name GUENTHER DONALD J Street: 316 APPALOOSA CT City, State Zip: SANFORD, FL 32773 Title: ADMIN Email: PERMIT@JASPERiNC. COM Property Owner Information Phone: Resident of property.. YES Contractor Information Name JASPER CONTRACTORS--DONALD BOUCHARD Phone: 407-278-7788 Street: 3203 S CONWAY ROAD SUITE 201 City, State Zip: ORLANDO, FL 32812 Name: Street:, City, St, Zip: Bonding Company: Address: Fax: 800- 337-3361 State License No.: CCC1331153 Architect/ Engineer Information 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 yin 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 10. 5.3 Shall be inscribed with the date of application and the code in effect as of that date: 5` Edition (2014) Florida Building Code Revised: June 30, 2015 Pemit 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 inay be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance of permit is verification that 1 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 1CC 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 Print Owner/Agent's Name KW MWAAt,9-- (71-2V4-717 Signature of Contractor/Agent Date K o :L -A), mD [Yftt,- Print Contractor/Affekt's Name 7 Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Signature 11 SKYLAR 8 AMKRAUT Commission Ji FF 127890 My Commission Expires June 01, 2018 Produced ID X Type of ID DL BELOW IS FOR OFFICE USE ONLY to Me or Permits Required: Building Electrical Mechanical Plumbing Gas Roof Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 20'15 Permit Application 5380 E, Colonial Dr. Orlando, FL 32807 Account manager:%2 3203 Conwayx Rd., Ste.202Orlando, FL 32812 Contact 407) 278-7788- JAS Company: 800) - bispe 61 Fax info a'ttiUcri tt org JasperRoot.00m Policy #: Claim F.L. Contractor's License: M4urais CCC1329651 & CCC1331153 Company: Owner's):; ROOF REPLACEMENTCONTRACT Loan Number: Addr ess Phone: 07 - 7/,;Z City; GL c2C SQ-4 AlfPhone: I State:, 7.in_r_m_ ccl1 $ 11,200 -- - G ti-7C Assignment of insurance Benefits for the 14 rn Roof Replacement Qnly: I hereby assign any and all insurance rights, benefits and any"applicable insu, e,Policies to Jasper Contractors, Inc. {"Jas andauthorizationinconsiderationofJasper's agreement to perform services; supply materials and otherwise Proceeds under per"), the scope of which shall be limited to a Full, Roof Replacement. I make'this assignment includingnotrequiringfullaperformits, obligations under this Contract, representative(s); for the direct Payment o time of service: I also hereby direct my, Y my tfor releasefor services, ny" and-all information requested b Jasper, rights. If payment is made direct) to the Ownerin g actual s , it shall a paid b Y per; or its Y purpose of obtaining actual benefits to be aid b ia rendered. In this regard, I waive p privacy OedovertoJasperimmediate) u work, deductibles, betterment or .additional Work requestedbyby the undersigned, not covered by insurance, must be paidby the undersigned on the day of receipt,agreethatanyporttonofinstallation. Deductible: It is the Owner's res nsibilit to a all. insurance deductibles. Owner's out -of -"pocket expense will not exceed the deductible amount, asstatedoninsurer's loss sheet (the "Loss Sheet"), UNLESS replacement/repair of deteriorated decking is required by code and/or Owner requests optional upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate any ;or all of the insurance dec uc le applicable to the insurance claimforpaymentofworkIntheventofadiscrepancy, the ' cable a sslpated on the insurer's Loss She amount disclosed. Deductible: $_ r'pF/r e deductible MORTGAGE AUTHORIZATION; i, Owner/Mort a or, MUSTBEPAI F[ J 4 PLICABLE SALES TAX g g " grant authorizati 2pC (initial) Jasper on matters including but not limited to, the claim and draw status. rtgage Co. to speak with pay Jasper based on the following schedule: (i) Deposit in the amount of $ (initial) PAYMENT SCHEDULE: Owner agrees to 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 Jasper on of work beingperformed; and, (iii) the remaining Contract Price (equal to any applicable -depreciation and/or change orders) due and ayable to Jaspper upon completion ofworkperformed. In the evef a din inspection, no,more than 2% of Contract Price y be withheld until inspection has passed. Optional: UPGRADE ITEM: Qir / / QTy: PRICE: TOT AL Replacement Work andPrice: Upon insurer's appfoval and subject to the Terms and Conditions herein, Jasper agrees to, furnish all materials and provide the tabornecessarytoperformthefullroofreplacementwhich- shall take place following Owner's "insurance company's approval, approximately within 30 days, conditions permitting. Owner's Declaration of Intent: Owner acknowledges and agrees that, upon approval by insurance. company for a full roof replacement, Jasper shall perform the roof replacement upon receipt of funds from Owner's insurance company, FLORIDA HOMEOWNERS' CONSTUCTION RECOVERY FUND PAYMENT, UP TO A LIMITED AMOUNT, MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUNDIFYOULOSEMONEYONAPROJECTPERFORMEDUNDERCONTRACT, WHERE THE LOSSRESULTSFROMSPECIFIEDVIOLATIONSOFFLORIDALAWBYALICENSEDCONTRACTOR. FOR INFORMATION ABOUTTHERECOVERYFUNDANDFILINGACLAIM, CONTACT, THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: Construction Industry Licensing Board: 2601 Blairstone Road, Tallahassee, FL'3239911039, (850) 487=I395 ANCELLATION: If Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business lay after Contractisexecuted. Owner shall receive a Full .refund of all deposits. Owner may also rescind Contract before midnight on he third business day after the contract is executed after notification from insurer(s) that the"claim for payment on roof contract has een denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's rrporate office: 1690 Roberts Boulevard, Suite 112, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day ght of cancellationDOESNOTAPPLYtocontractsforemergencyhome'repairs'as time is of the essence. 1, Owner, have read "and understand all statements, Terms and Conditions of the "Roof Replacement Contract" and agree at all details are acceptable and satisfactory. I further understand that: this Contract constitutes the entire agreement between the rties and that any further changes or alterations to this Contract must be made in writing and agreed upon by both parties. ch party represents and warrants to the other that 'it has the full powe nd authority 'to enter into the contract and that it is ding and enforceable in accordance with its terms. Z1'1 uthorized Jasp .r Representative Date fl.irnar natP City of Sanford Building & Fire Prevention Division Re -Roof Permit Card PERMIT NO. + 076• QL A 4 ISSUE DATE: 1 P7s CONTRACTOR: JOB ADDRESS: A loo TYPE OF WORK: S t PROTECT FROM W ATHER 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 rNSPECTION 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 City of Sanford Building. Division Residential Re -Roof 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 pennit 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) DigitalPhotographs (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 OWNEWBUILDER) SIGNATURE:' DATE: 7/14/17 426930 JOB ADDRESS: 316 APPALOOSA COURT SANFORD, FL 32773 STRUCTURE TYPE: XO SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME PERMIT # al 55 City of Sanford Building Division Residential Re -Roof Scope of Work O APARTMENT/CONDOMINIUM RE -ROOF TYPE: © REPLACEMENT (TEAR 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 DECK IS PERMITTED TO BE REPLACED" ROOF VENTILATION: Q OFF -RIDGE O RIDGE O SOFFIT OPOWERED VENT SKYLIGHTS: O YES ® 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 O TURBINES TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE OWENS CORNING FL# 10674 O METAL FL# O MODIFIED BITUMEN FL# O TORCH DOWN FL# 0INSULATED FL# O TILE FL# O OTHER: FL# ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IF APPLICABLE** 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# LMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: 7-14-17 l hereby name and appoint: Rachel Holcomb, Skylar Amkraut, Karla Almodovar Ana Chavez an agent of: Jaswconuaaol5 lame orcompany) to be my la'%ful 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 located at: 316 APPALOOSA COURT SANFORD, FL 32773 sager A&Irm) Expiration Date for This Limited Power of Attorney: 1-1-18 License Holder Name: Donald Bouchard State License Number.. CCC1331153 Signature of License Holder. STATE OF FLORIDA COUNTY OF se14i The foregoing instrument was acknowledged before me this 14 day of JULY , 200 17 , by o«Eda t3«,ad who is o personally known to me or m who has produced a as identification and who did (did not) take an oath. Signature Notary Sea]) Slar Amkraut SK f3-AMKRAIJT Commission N FF 127890 s a ° My Commission Expires , OFF,' June 01 , 2018 Rev. 08.12) Print or type name Notary Public - State of FL Commission No. 127890 My Commission Expires° 6/1/2018 I;(- gnnpd by C;amgrannP.r 1 11111111111 IIlII!(Ill Lill( III(I lit! III{ GRANT NALOYr SEMir:i BF, RY 8933FFCIRr,UIT CS0U -T & 6111`TROLLUCLERK'S 4 2017071446RECOROEP07/14/2017 11:20 i(;IMR[t:rtl, NG FEEL s16.00 Themt, N T R£rOFtOEO BY ht) w per; ` I follo'undefr'41cd 1. D Cnf°rmationr shproitl nohce (1at in; r CEO TION OF PROpERn this NogCe o vComnntew{11 be made to certain real >ruTl : (Legal d mont, t {rorty, and in "cc -dance with Chapter 713escdptlonoftheP , Florida Statutes, thePr°por1Y and street address If available) 2• GENE I 7D SCRIPTION 3, OWNER INF _ property VE ENT: -- Name and ORMATI IN OR LESSEE — address: FORtdATipN IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT. Interest in1 4 Properly: nj Fee Simple Title HolderAddress: (°firer than o weer listed above 4- CONT ) Name: RACTOR: Name: Jasper ContractorsAddress: 5380 E Colonial Drive Orlando, FL 32807S, SURETY if a Phone Number. 407-27g_7788 PPllcable, a copy of the payment bond is attached): Name: Address 6, LENDER: Address: Nais INSTRme. UMFAddre$S. 'ns er PREPDnirac oFp pY: NoTi Permit Numb COm' YImp cr, ENcEParcelIDNu y 1Y Amount of Bond: Phone Number: ---- 7. Persons within the State of Florida Designated by Owner u713,13(1)(a)7,. Florida Statutes. Pon whom notice or other documents may be served as provided by SectionName: Phone Number. B. In addition, Owner designates Io receive a copy of the Lienor s NOGce as prov ded in Section 713.13(1)(b), Florida StatutestPhone 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 ARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713,13, FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THEJOBSITE € FORE THE FIRST INSPECT N'' IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFOMENCINGWORKORRERDINGYOURNOTICEOPCOMMENCEMENT. i S pneN dt Own rnles,ce, or Ovine/ea leseecL "J' \v'-` 1P i'1 n ,rFuttwr(zed °RkedeirecrorRertnerrManaperJ (Pool I'W" end Pr V ovWe 6lpnaloye 71Uo1prlree) State of D of thGl County of The foregoing Instrument was acknowledged before me this day of by 1 11711 lr l Ii ({jALL 20Neme or pe ,an maunp,raremem Who is personally known to me OR who hasproducedIdentification ^ a", type oridentificationproduced; t y...... KARL A M AI.MODOVAR' I F-State of Florida -Notary Public 9e Commission # GG 111330 MY Commission Expires J une W ,a Zozi I81i UN zt'd LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: l l b V I hereby name and appoint: Scott Meixsell, James Allen, Michael Watts, Jacob Horst, Ricardo Prito, Paul Padgett an agent of Jaspar oo"tractors d:amt of Company) to be my lawful attomey-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 located a 7 k t n /'t• 1/A.nr>I -r^"•f -fe rrn n -" .'. ^ r— I r (Strut Address) Expiration Date for This Limited Power o Attomey: License Holder Name: flaw - State License Number. ccc1331153 Signature of License Holder. STATE OF FLORIDA COUNTY OF s The foregoing instrument was acknowledged before me this _ )Sday of l 200by otx,a a Bo who is o personally Down to m who has produced a- identii3cation and who did (did not) *e/an path. 1 Notary Sea]) Rev. 08. I2) Mnt or type name Notary Public - State of Commission No. 1'Qnn My Commission Expires--A-a-- j - i SKYLAR B MKRAUT ion N FF 127890 conXIrEsMYcommissionEPneJU Ol , 2018 as Scanned by CamScanner Du City of Sanford Building and Fire Prevention RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT #: U /`S ADDRESS: I c G'"- V 1 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 #: COMPANY / CONTRACTOR: CONTRACTOR SIGNATURE: MUST BE SIGNED BY LICENSE HOLDER A FINAL ROOF INSPECTION IS REQUIRED: DATE: I It, I 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 1 20 _Iby: IIVA4 ho is Personally Known to me or ha F'oduced (type of identification) / as identification. 6 MKR AUKp -VL R 0 F 12 g90 Signature o tary Public .;/"' ^9, cnl asp }5.0. EX 8ceStateofFlori / y,,'', ,«:N.G:4n 0 201 Jun Print/ I ypMSh mp ;me - of Notary Public