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HomeMy WebLinkAbout1606 W 3 St; 17-2238; DEMO STRUCTUREf,TE E I V 77_- VA JUL 2 4 2017 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1)3 Y L p, Documented Construction Value: $ 7 A oo Py Job Address: pob o / ft Historic District: Yes No Parcel ID: Residential Commercial Type of Work: New Addition Alteration Repair Demo p Change of Use Move' Description of Work: Plan Review Contact Person: "/ V Phone: 027-,24 -C/1/1 Fax: e-11f T itl e:6"J Cbt 1 1r'C li Email f)I V j,— J A_/0Orel Property Owner Information c Name r l/ 1 ./hi^ Phone:7 ir Street: L Resident of property? City, State Zip: a&U .J271 Contractor Information 1-f'fName ucl& Phone: Y Street: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: 51" 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 the 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. VIA- t e of Owner/Agent I Da e r ik C Print er/Agent's Name ( % V / of Notary -State of gB1E6IAN}RteISSION # Fr 17P648COMA252019S. FebruaryEXPIRE na(iters 60ndedTw_13 Y1 Ub1cO Owner/Agent is Personally Known to Me or Produced ID Type of ID Signature of Contractor/Agent Print Contractor/Agent's Name Date Signature of Notary -State of Florida Date , Contractor/Agent is Personally Known to Me or Produced 1D Type of ID BELLOW 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: Revised: June 30, 2015 UTILITIES: FIRE: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Permit Application Addres !2iuA4e"cdav,1 crfa i f ut s stateop: Identify and describe surfacing material and other materials as applicable: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on -site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection duringnormalbusinesshours. DEP Form 62.257.900(1) eflecOva 10.12-04 Instructions The state asbestos removal program requirements of s. 376,60, F.S., and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257, F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required bylaw). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. If you checked renovation, is it an emergency renovation operation? if so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For "prior use' check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" isdefinedinRule62-257.200, F,A.C„ small business, as defined in s. 288.703(1), F.S.; or other. If "other° is checked, identify the use. Please follow the same instructions for "present use." 11. Complete the facility owner information. III. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section 61.145(3)(c)(i).) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriabie asbestos material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. Hack's Bobcat Service, Inc. 615 Archibald Ave Altamonte Springs, FL 32701 I NAME/ADDRESS I Habitat for Humanity Proposed Job Location 1606 W. 3rd Street Sanford, Florida Proposal DATE PROPOSAL N... 7/11/2017 121 QTY ITEM DESCRIPTION TOTAL t 24 House demolition and hauling 4,200.00 Thank you for your business. TOTAL $4,200.00 Da-'t —2b4L-- VIII. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. X. Provide the address where the Department is to send the invoice for any fee due. Do not send a fee with the notification. The fee will be calculated by the Department pursuant to Rule 62-257.400, F.A.C. Sign the form and mail the original to the district or local air program having jurisdiction in the county where the project is scheduled (DO NOT FAX). The correct address can be obtained by contacting the State Asbestos Coordinator at: Department of Environmental Protection, Division of Air Resources Management, 2600 Blair Stone Road, Tallahassee, FL 32399-2400. z FLORIDA March 2013 NOTICE OF DEMOLITION RENOVATION Florida Department of Environmental Protection Division of Air Resource Management DEP Form 62-257.900(1) Effective 10-12-08 Page 1 of 2 OR ASBESTOS TYPE OF NOTICE (CHECK ONE ONLY): 4erORIGINAL REVISED CANCELLATION COURTESY TYPE OF PROJECT (CHECK ONE ONLY): .$ DEMOLITION RENOVATION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? YES -0'NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? YES NO IS IT A PLANNED RENOVATION OPERATION? YES NO I. Facility Name r Cd '2S—!5-,7V - Address I WO (.If • Voyt- City Sty- Fv State_zip ,ja'7 7 / County .S?JV fn 6 <<-- Site Consultant Inspecting Site Building Size (Square Feet) # of Floors % Building Age in Years Prior Use: School/College/University Residence Small Business Other Present Use: School/College/University El Residence Small Business Other II. Facility Owner `hz ^v ' l?AfGLtzr G1 S l7 lTra (.v Phone (*7 (v - ' f-'pllo-5W A) 9 . Phone ( L fy —57f-s— zip J- / 01 9 NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: n A' Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. LtlJ4L4%CXjJi'7vqhLYrt11- .17u t p r13 Procedures to be Used (Check All That Apply): (/ Strip and Removal Glove Bag 1,121 Bulldozer I Wrecking Ball Wet Method I Dry Method I Explode I Bum Down OTHER: VI. Prc VII. As Address city Vill. Wa Address city IX. RA Zip 3 77 a2. M. Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type) square feet surfacing material linear feet pipe cubic feet of RACM off facility components square feet cementitious material square feet resilient flooring square feet asphalt roofing Name: LLi '-0 1 F 5 . D City of Sanford Demolition Permit Application Checklist All permit application packages must be complete prior to acceptance. You must check each box to the left or indicate n/a on this submittal. A complete application package shall include the following: E] Building Permit Application completed, signed and notarized. Application must include correct address and complete parcel I.D. number. Copy of a contract, signed by the contractor and the property owner, indicating the documented construction value C/ Copy of applicable contractor's license issued by the State of Florida A\\V A site specific notarized power of attorney shall be required from the licensed contractor if he/she appoints an employee of his/her company to sign the permit application as the contractor. Certificate of insurance indicating worker's compensation insurance coverage and naming the City of Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of Florida (must be submitted with each application if contractor is the applicant). A copy of an onsite sewage disposal system abandonment permit that has been issued by the Seminole County Health Department. ( if applicable) Please Note: A licensed General, Building or Residential Contractor is required for issuance of a Demolition Permit, as required by and limited under 489.105 Florida Statutes Partial Demolitions (Commercial & Residential) The partial interior or exterior demolition of existing commercial or residential spaces will not be issued as a Demolition Permit. This type of work will require an Alteration permit including at least an existing and proposedfloor plan indicating the extent and location of the demolition — in addition to required submittal documents for any alterations or renovations. Existing Floor Plan, indicating area of demolition (must specify structural or non-structural) Proposed Floor Plan These guidelines were compiled to assist the applicant in preparing a demolition permit application and may not be complete. The applicant is required to meet all City of Sanford, state, and federal code requirements. Revised: June 2016 acoR CERTIFICATE OF LIABILITY INSURANCE 104/27/2(M017d... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Lockton Affinity, LLC P. O. Box 873401 Kansas City, MO 64187-3401 INSURED Habitat for Humanity of Seminole County and Greater Apopka, Florida, Inc. PO Box 181010 T.. 1ri-r,,, Lffinit— T.T.0 AIrnvnco EM 888-553-9002 jZC No:913-652-3967CN E-MAILADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Ace American Insurance Co. 22667 INSURER B:ACE Property i Casualty Insurance Co. 20699 INSURER C : INSURER D : INSURER E : Casselberry, FL 32718-1010 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNan Ir,,,„,,,,,, ,,,,,,,, ADDL SUBRI r La.T crr rvLn.T tnr LIMITSLTR __.._........_ .------........- MMIDD/YW A X ---••• I Y I IGL1064585-17 104/01/2017 104/01/20181enunuLLumKtrNL.c $110001000 CLAIMS -MADE n OCCUR PREMISES (Ea occurrence) $ 1,000,000 GEHL AGGREGATE LIMIT APPLIES PER: X POLICY LOC AUTOMOBILE LIABILITY I ANY AUTO ALL OWNED AUTOS Auros I I I NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR I EXCESS LIAB CLAIMS -MADE DFD RETENTIONS B WORKERS COMPENSATION I C48740170 04/01/2017 04/01/2018 AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? C N I A Mandatory in NH) IDESCdibe under RIPesaTION OF OPERATIONS below MED EXP (Any one person) 0 PERSONAL 8 ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG I $ 2,000,000 f COMBINED SINGLE LIMIT I ( Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident EACH OCCURRENCE AGGREGATE x STATUTE I OERH I F. L FACH ACCI DFNT S1,000,000 I r E. L. DISEASE- EA EMPLOYEd $ 1,000,000 E. L DISEASE- POLICY LIMIT 1 $ 1 .000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD I Di, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER The City of Sanford 300 N. Park Ave Sanford, FL 32771 ACORD 25 (2014/01) 22847394 1064585 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH( RATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1064585 7/18/2017 DBPR - TRACEY, RICHARD J; Doing Business As: CAPITAL DEVELOPMENT GROUP INC, Certified General Contractor 4:06:53 PM 711 &2017 Licensee Details Licensee Information Name: TRACEY, RICHARD 3 (Primary Name) CAPITAL DEVELOPMENT GROUP INC (DBA Name) Main Address: 249 MAITLAND AVE STE 2000 ALTAMONTE SPRINGS Florida 32701 County: SEMINOLE License Mailing: 249 MAITLAND AVENUE #2000 ALTAMONTE SPRINGS FL 32701 County: SEMINOLE LicenseLocation: 249 MAITLAND AVE, STE 2000 ALTAMONTE SPRINGS FL 32701 County: SEMINOLE License Information License Type: Certified General Contractor Rank: Cert General License Number: CGCO21914 Status: Current,Active Licensure Date: 12/23/1992 Expires: 08/31/2018 Special Qualifications Qualification Effective Construction Business 02/20/2004 Alternate Names View Related License Information View License Complaint 2601 Blair Stone Road, Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007-2010 State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our Chapter 455 page to determine if you are affected by this change. https://www.myfloridalicense.com/LicenseDetail.asp?S ID=&id=OFA22DD3DADDE0087DBAC4D6341 A45E2 1 /1 Blanton Deborah From: Davis, Jeff Sent: Monday, July 24, 2017 11:26 AM To: Blanton, Deborah; Bland, Annette; Cash, Michael; Colbert, Sabreena; Dalton, Christine; Duncan, Hope; Gibson, Russell; Golloway, Jennifer; Grose, Quentin; Hinson, Eileen; Johnson, JoAnn; LOTEMPIO, CATHY; McCabe, Emily; Perkins, Trekelle; Presley, Darrel; SCOTT, DARREN; Smith, Chris; Smith, Jordan; Wagner, Cyndi; Hooks, Marlon Subject: RE: 1606 W 3rd St 17.2238 Public Works requests that the road and curb are photographed prior to demolition. Contractor will be liable for any damage not documented prior to work. Jeff YfC7 y Devv,, c M Project Manager City of Sanford Public Works P.407.688.5080 Jeff Aavis@sa nfordf I.gov M ENT From: Blanton, Deborah Sent: Monday, July 24, 2017 8:55 AM To: Bland, Annette; Cash, Michael; Colbert, Sabreena; Dalton, Christine; Davis, Jeff; Duncan, Hope; Gibson, Russell; Golloway, Jennifer; Grose, Quentin; Hinson, Eileen; Johnson, JoAnn; LOTEMPIO, CATHY; McCabe, Emily; Perkins, Trekelle; Presley, Darrel; SCOTT, DARREN; Smith, Chris; Smith, Jordan; Wagner, Cyndi Subject: 1606 W 3rd St 17.2238 Demo of the rest of the structures on this property Capital Construction Group 407.216.9111 Owner: Habitat for Humanity Debbie Blanton Building Permit Coordinator Building & Fire Prevention Division CITY OF i SANFORD, FIRE DERA-TMENT City of Sanford 300 N Park Ave Sanford FL 32771-1244 Phone # 407.688.5061 Fax # 407.688.5152 Debbie. BlantonPsanfordfl.eov www.sanfordfl.gov 1 Florida Limited (Special) Power of Attorney Form Pursuant to Chapter 709 - Power of Attorney and Similar Instruments I, Richard Tracey of Capital Development Group, City of Altamonte, County of Seminole, State of Florida ("Principal") hereby grant Mary Ellen Fernandez of Habitat for Humanity of Seminole Co. and Greater Apopka, City of Altamonte, County of Seminole, State of Florida ("Agent") a limited power of attorney. Under this Limited Power of Attorney, my Agent has my permission and authorization to act in my stead and on my behalf for the following specific acts: Picking up the Demo permit for 1606 W. 3rd Street, from the City of Sanford. My Agent also has my permission and authorization to perform any incidental acts necessary to accomplish the specific acts set forth above. I may revoke this Limited Power of Attorney at any time, however, a third party is entitled to rely on this Limited Power Attorney if such third party has not received a notice of revocation. IN WITNESS WHEREOF, I have executed this Limited Power of Attorney on this 261h day of July, 2017. 4 Signatur of rinci al My Agent hereby accepts and acknowledges this appointment as Agent under the terms set forth herein and agrees to accept the fiduciary responsibility to act in my best interest under the laws of the State of Florida. 6 IAA,h Pnraua Signature.jat Witness des Signature of Witness Nothing herein shall be considered legal advice. You are encouraged to seek legal advice from an attorney licensed to practice in yourlurisdiction before using this form. Copyright © 2015 Free Down loads. net. All Rights Reserved. THIS INSTRUMEIJT PREPARED B Name: C 407 iglus " :r'rtilh{ f°{i-01 t. SEMINOL{ GOUN Y Address: L' O1( ICfi C :..- r i r .. i (..(, _ 1lTzi l:P,w —' !.. E:n:r'. ,-sr I,R _ U1 1 0 )E: I -. f 01:1 'TRIOLLE_R, c c ? r c? { d {! rl 1.1 : 1.1 _= f ':l .t .,'.'.A (• y 1-` Lf s 1 t:L.ERK' S 2017077024. NOTICE OF COMMENCEMENT R{-t OR.DIE{_'i 07,'.";,1/ 21-11. ' 11. > -, Arl State of Florida { El.t_L.)E11;i_i.l r'," hdiSUr]i-•e County of Seminole Permit Number: ` / D Parcel ID Number: — / r D r ©6 13 I 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) 31S-Ale 35 77/ GE ERAL DESCRIPTION OF IMPROVEMENT: fU M n `1/ OWNER INFORMATION: /U, Name: l'YI ' C1 Address: 12,0• - / 10%D 3371F, Fee Simple Title Holder (if other than owner) Nahfe: Address: Address: ^ Z 14 7 494ffd' L AZA G-1< LGf/ GG7 lZ C[ S/J t (/Y` 1 F f' L— e Persons within the State of Florida Designated by Owner upon whom notice or otheY documents may be served as provided by Section 713.13(1)(b), Florida Statutes. Name: erri / Address: '. d, L5 U 80/0 2%/Y In addition to himself, Owner Designates of To receive a copy of 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, 1 declare that I have read the foregoing and that the facts stated in it are true two thebest of my knowledge and belief. Owner's Signat / Owner's Printed Name lorida Statute 713. 13(1)(g): " T wrier must sign the notice of commencement and no one else may be permitted to sign in his or her stead." rj ` I State of County of The foregoing instrument was acknowledged before me this day of 20 rJ _ by ' Who is personally known to m Name of person making statement OR who has produced identification type of identification proddeed. y DEBBIEBLANTON I' MY COMMISSION # FF 179648 EXPIRES: February 25, 2019 t+ F of c 0, Bonded Thru Notary Public Underwriters Notary Signature FA