HomeMy WebLinkAbout102 Holloway Ct; 17-3022; RE-ROOFCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
C, r
O ,9- 1 ( 0(Documented Construction Value: $ is Ida oo l (ae-y ciah ls. yu-9VAj
Job Address: 4 L Historic District: Yes No
Parcel ID: - -'3 J~ 51 `S - OODb -- 0O 'Lp Residential Commercial
Type of Work: New Addition Alteration Repair R1 Demo Change of Use Move
Description of Work: ES ii IT'Z v1_ ZlS - M_ Ora F
Plan Review Contact Person: lZtAw C>, S ea .i Title: C)(_D
Phone: VDz-3'ar b` Fax: LAO-7 .-'2 71 A4%'; 3 Email: ' VL rca\ ka liteS o '-i ta j tLr
Property Owner Information
Name MA-VULA 4-4•4 itpYLV""Z Phone: y0n - (:5,'1L
1 Street: W'A kxo\\Ow.14!: T ' _ Resident of property?
City, State Zip: S' a t^a' -!v rLf>
k L C-' -711
Contractor Information
Name -tS Phone:
Street: 1 I % KI, y` .r s-oK}w L' Fax:
City, State Zip: 3 ar1 S0 State License No.: L C' i 2a 06
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 INSPF,CTION. 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 1051 Shall be inscribed with the date of application and the code in effect as of that date: 5'h Edition (2014) k1orida 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 maybe 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: 1 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.
Sign rc or Ihvncr/Agent Date Sign. c of Contmctor/Agent Date
t yiG S co `.JiA m4
Print Owner/Agent's Name
Signature of Notary -State of Florida Dale
MARIA T. BUTCHER
MY COMMISSION # GG101540
at EXPIRES May 04, 2021
Own nt is Personally Known to Me o
Produced ID Type o
Print CCoontramrr/Agent's Name
Signature of Notary -State of Florida Date
MARIA T. BUTCHER
AMY COMMISSION # GGIO1540
5t, EXPIRES May 04, 2021
Contractor/Agent is Personalty Known to Me or
Produced Ill Type oft
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: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
Customer Info:
Job Address:
A
1182 N
Central
7- Homes
Ronald Reagan Rd. Longwood, FL 32750 office: 407.732.7262 centralhomesoffi55e@gmail.com
Date: 4t/Z./ /7
SERVICE AGREEMENT
WE PROPOSE THE FOLLOWING AT THE ABOVE LOCATION:
Tear off and haul away the existing shingle roof system (one layer). An additional $35/sq. for removal of each
unforeseen additional roof layer will be added.
Inspect the roof sheathing fastening system and supplement (re -nail).
Inspect the roof decking and repair as necessary on a per lineal or per piece basis as described below.
Supply and install one layer of Rhino Synthetic felt underlayment.
Supply and install new Shingle Over Ridge Vents andlor 4 ft. ORV Vents for proper ventilation.
Supply and install new 2 '/2" eave drip.
Supply and install Bullet Rubber boot flashing for plumbing stacks.
Supply and install a self -adhered peel & stick modified underlayment in all valleys.
Supply and install Certainteed Landmark Architectural Shingles.
We will obtain and pay for a permit and obtain all required inspections.
Upon completion, all roofing debris will be picked up and taken away.
Shingle color 51 y- r 61 r7+) Drip edge color i ; Vent color `
Deductible `'Sao ,
Insurance Proceeds
Please note: Central Homes LLC has the right to submit a supplemental invoice to the insurance company for
unpaid items which represents work performed by Central Homes LLC for which the insurance company did
not pay. Upon customer receiving the supplemental disbursement (if any), it is the responsibility of the
customer to remit said funds to Central Homes LLC in a timely manner.
Payment Terms: Deductible due upon completion of lob; First Check due upon completion of lob; All
insurance proceeds due upon arrival of checks after lob is complete.
A surcharge of 3.5% will be added to payment if paying with a credit card.
Any unforeseen decking repairs and/or wood rot repair will be replaced due to county codes which states that we
cannot nail into any soft or rotted wood; and which is covered under your policy under Ordinance and Law; and
will be invoiced via supplement invoice by Central Homes to the insurance company.
WARRANTY: Central Homes LLC, 7-year workmanship warranty.
ACCEPTED
ACCEPTED:
C1 I .Z - , I
Central Homes Roofing State of Florida License CCC1330609
r
J
THIS INSTRUMENT PREPARED BY:
Name: Kaajal Pate!
Address -
NOTICE OF COMMENCEMENT
Permit Number
Parcel ID Number: 3 - I Cl ' Jam— S'1 Op()Q- OUR D
N IJt IIIIt 1111t Itllt till Iltl
GRANT MALOYr SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLERBK9005Ps1161 (1P9s)
CLERK'S Y 2017102996
RECORDED 10/12/2017 03:08:03 F-11RECORDINGFEES $10.00
RECORDED BY hdevore
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, thefollowingInformationisprovidedinthisNoticeofCommencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the Qroperty and street address if available)
L, 0't- A drv1 A t_ r v a P u A 1 cc, c-> r- % c
T•
2. GENERAL DESCRIPTION OF IMPROVEMENT:
RESIDENTIAL RE -ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: i r t-'4Yta.1 j=jW w L- Q 7 Z - to'A kw%ciq CT, '3 -,-n "1
Interest in property: O W 1.i CU_ '
Fee Simple Title Holder Of other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: CENTRAL HOMES, LLC Phone Number. 407-732-7262
Address: 1226 BENNETT DR. #R111, LONGWOOD, FL 32750
5. SURETY (K applicable, a copy of the payment bond is attached): Name:
Address. Amount of Bond:
6, LENDER: Name: Phone Number.
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided by Section713.13(ixa)7., Florida Statutes.
Name: Phone Number.
Address:
8. In addition, Owner designates of
to receive a copy of the LieWs Notice as provided in Section 713.13(i)(b), Florida Statutes. Phone 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 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 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.
State of
14/LI. Lill
s oreer'sors wwfAmmager) Countyof
SC-Cn k hi.pLE. The foregoing Instrument
was acknowledged before me this a day of D C_ 0 eg by - lag:
L
4 H-y-Av'k . Who 1s personally known to me 0 OR NamnU e of
person nuking sbmrt // who has produced IdentiflcationA type
of identification prf_.. oduced: 3 2 tti D 7T Z , Print Name end Provide Signetary'e
TWed ce) T='-- C(Z,.0r,4- BUTCHER---— -
I MA. f MY COMMISSI0 #
GG101540 Naery
Signsmre i •=`
EXPIRES May 04.
2021 r
CITY OF
NFORDt Building & Fire Prevention Division
FIRE DEPARTMENT Re -Roof Permit Card
PERMIT NO. '7- 30 A x ISSUE DATE: 10. 1-To 17 VW11'
CONTRACTOR: '
Hymca JOB
ADDRESS: //0w TYPE
OF WORK:Ae. AM f*" 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 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
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)
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
y Of
Building & Fire Prevention DivisionT'SXNFORD RESIDEATIAL RE -ROOF POLICY& PROCEDURES
V IR UE PAR I MEN f
PERM rrruNC REQUIRENIEN-I'S - No PLAN REVIEW REQUIRED
THIS DOCUMENT (sicNrl)) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED -1.0 BE SU13MI'rrED AS PART OF YC)UR HRNI ITAPN ICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NumBERs FOR ALL ROOF
COMPONENTS THAT WILL BE INISTALLED ON THE PROJECT,
A PERMIT WILLNOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE J013 SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICTWILL REQUIRE PLAN REVIEWAND APPROVAL RYTIIE SANFORD
HISTORIC PRESERVATION BOARD INSPECTION
POLICY& PROCEDURES A
FINAL ROOF.fN'SPECT1ON IS THE ONLY INSPECTION REQUIRED FOR, IZESIDENTIAL (SINGLE FAMILY, TOWNHOUSE, MOBILE
HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS. THE
FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE: I
PERMIT
CARD, POSTED IN CONSPICUOUS AND WEATHERPROOF LOCATION COMPLETED
RESIDENTIAL RE -ROOF SCOPE OF WORK COMPLETE[)
AND NOTARIZED INSPECTION AFFIDAVIT 0
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS PRODUCT
APPROVAL SHALL MATCH WI IAT is ON Till' SCOPE OF WORK) DIGITAL
PI-IOTOGRAPI-IS(i\,IUSTIiXCLUDETIILPER\41TNUM13ERORADDRESS liNEACH PICTURE) EACH PLANT OF
THE ROOF, SHOWING THE UN'DERLAYNIE.N. I . INSTALLED ROOF .DECK NAILING
PATTERN & SPACING (INCLUDING ANIEASURING DEVICE OR RULER) ROOF DECK NAILS
USED (INCLUDING AMEASURING DEVICE OR RULER SHOWING SIZE OF NAILS) UNDERLAYMEN'T PATTERN, &
SPACING (INCLUDING ANICASURING DEVICE OR RULER) DRIP EDGE & VALLEY
ATTACHNIENT (INCLUDING A MEASURING DEVICE OR RULER) 0 SHINGLES INSTALLED.
NAIL PATTERN AND LOCATION OF NAILS SKYLIGHTS (IF APPLICABLE)
DIGITAL PHOTOGRAPHS SHOWING
ALL INSTALLATION CONIPONLNTS, PER FL PRODUCT APPROVAL DIGITAL PHOTOGRAPHS SHOWING
ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL FAII.URE-I-
OFOLLOW T"rsFSPECIFIC GUIDELINES WILL RESULT IN ANAFFIDAVIT PROVII)FF) OVA FI,OR.iDA DEsicN PROFESSIONAL. (ARC I I ITECT OR
ENGINEER), CERTIFYING NG F BC CODE CONURLIANCE BYPERSONAL INSPECTION. CO,.TRACTOR(OR OW,.E.,,,,.DER)
S,,,,A,U,E o DATE:
y Of
SANFORD
i iR( fAPAATMfN7
PER.M]T#
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE. OF WORK
JOB ADDRESS: k 0 L 0 Lo VQ_ C> -7 -11
STRUCTURE TYPE: 0 SING LF FA M I 1,.N' R FSil DENCEtTOWNHOLIS F, 0 "vionlix I-ION11, 0 wca\,DommumAPARTmm,,
Rr,-RooFTN,rE: 0 RrPI.ACEMIl-N-I-(TrAK OFF EXISTING ROOF AND REPLACE WITH NEW CO,\,IpONENTS)
0 RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY):
PLEASE A'OTI': 01%1)'100 SQUARE •I'LET 01THE I, !STING DECK IS Pl*R.IllrrED TORE REPLACED RooFVEN71LATION: *
OFF -RIDGE 0 RIDGE OSOFFIT OPOWFRED vr.\,rT 0TURMNEs SKYLICIrrs:
0 YES a No IF YES. PLEASE PROVIDE FLORIDA PRODuui- APPROVAL": MAIN
RoorAREA ROOF
SLOPE: 0 LESS THAN 2:12 0 2:12-4:12 19 4:12 OR GREATER TERTYPE
or ROOF NIANUFACNIZER FLORIDA PRODUCT APPROVAL 40
S H FNG L I. A-4 -V-cy FL# J y (A t-A L OWTAL
I. Lit 0
MODIFIED BITUNIEN FLP OTORCHDOW,,,
FL# 0
INSULATED FL# OTILr
FL# 0OTFIFR:
I- Ll" ROOF
ExTENSIONS (PORCIIES. PATIOS. ETC.) ROOF
SLOPE: 0 LESS TIIA,\, 2:12 0 2:12-4:12 0 4:12 OR GREATER TvpF
OF ROOF MANUFACTURER FLORIDA PRODUCTAPPROVAL oSI-lI.\
Gu FL# 0 M
FTAL FLI' 0 MODIFIED
j3ITLlN4EN' FL# OTORCH Doxv.\'
FLft' OINSULAM) It-'
OTILE F
LW 00THER: FI.
p
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 . . . . . 17-00003022 Date 10/16/17
Property Address . . . . . . 102 HOLLOWAY CT
Parcel Number . . 33.19.30.515-0000-0020
Application description . . . ROOFING APPLICATION
Subdivision Name . . . . . .
Property Zoning . . . . . . . PUD
Permit . . . . . . RESIDENTIAL ROOFING PERMIT
Additional desc .
Phone Access Code 1007111
Permit pin number 1007111
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 111 BL03 FINAL ROOF / /
SXNFORD
Y OF
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF AFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT#: -i "3Q - ADDRESS: \c)'a Lev LLpW"v C.T
S5 44-,\ eov-0 "3 D, -I -I I
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
FOREGO INFOR 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 #: C-X c( 3'5 O G p q
COMPANY / CONTRACTOR: &- hm--:'L `A-;:7DVol 3"- CONTRACTOR
SIGNATURE: - 4 k DATE: MUST
BE SIGNED BY LICENSE HOLD6 OR OWNER/BUILDER) 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 7!S15' 1 t'-L O LE Sworn
to and Subscribed before me this 910 day of 0 e `C— 20 V1 by: W
01`1 3- . Who isyPersonally Known to me or has 0 Produced (type of identification)
as identification. Signature
of Notary Public State
of Florida Print/
Type/Stamp Name of
Notary Public pAR1A
T. B11 R
GG101540
YA
1 •I M
V COMMISSION # ti
EXPIRES MaY04,2021