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Home My WebLink About1305 W 10 St 17-104 Int. repairsECEIVEh JAN052017 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1 —I— i ® I Documented Construction Value: $ r + Job Address: 07 W. [J J - sAX aY S; • Historic District: Yes [IN9K Parcel ID: 7 14-1 ,n i i i- a OQ .. a ZF o Residential Commercial Type of Work: New Addition AlterationX Repair Demo Change of Use Move Description of Work: Plan Review Contact Phone: iC_ Ili Title: 6!"L Email: Gpl\YpW ZOQq dlgi"'`yVL"CJCM'' Property Owner Information i1 _ Name' GY'1,G G :\ . Phone: `7 67— 7) Street: UO Resident of property.: N City, State Zip: C&S.6'y. Contractor Information Name' - a 1 /A Phone Street: S Nam" Fax: _ 4a7 BIZ-0713- City, State Zip ;/' . 2 State License No.: C_G Q15 15 140 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: 51' Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 4 ff. 00 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. ' a 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. Th •actual construction value will be figured based on the current ICC Valuation Table inheffect at the.tinle the permit is issued, in accordance with local ordinance. Should calculated charges fgufetl•off•the::executed*contractFezceet}'•-ihe`•.a4dual4 onstruction value, credit will be applied to your permit fees when the permit -is issued. ' d .,u OWNER'S AFFIDAVIT: I certify that all of the fore dpg information is accurate and that all work will be done irr compaliance with all licable laws regulating construction and zoning. Z. F 7 Wf r/Agent's Name Signature of NotijryyS..ttate of Florida Date Owner/Agent is'.,.. L'Perso1aa11y% Known to Me or e of Contractorfggi n \ Date ntractor/Agent's N e,K&Larw...•m. a Pau ANNETTE SUITT Notary"Public = State of Florida I My Comm. Eicplresr art 1.6;-2018 Commission # FF 071760 F h to ,Me or Produced ID Type -of fD , Produced ID T pe o1. f ID. UL- ' 1 {day .'f .•.1 .. • n iF \ e t 'tip`-.... .... _ t'F•-r t/ 'f -. wl .+', i BELOW IS FOR OFFICE USE ONLY Permits Required: Building ` Electricai Mechanical PlumbingPlumbing[]GasGas[]Roof Construction Type: ss _ 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: 111010 UTILITIES: ENGINEERING: r7V I It 0 FIRE: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: COMMENTS: OL Ty vKGI A-krZ a tr' re octI S . BUILDING: T— /-n-17 Revised: June 30, 2015 Permit Application BP# REQUIRED INSPECTION SEQUENCE l Address: ELECTRICAL :P.ERM`IT Min I Max BUILDING PERMIT Min Max Ins ection Descri tion Footer / Setback Stemwall Foundation / Form Board Survey Slab / Mono Slab Prepour Lintel / Tie Beam / Fill / Down Cell Sheathing — Walls Sheathing — Roof Roof Dry In Frame Insulation Rough In Firewall Screw Pattern Drywall / Sheetrock Lath Inspection Final Solar Final Firewall Final Roof Final Stucco / Siding Insulation Final Final Utility Building Final Door Final Window Final Screen Room Final Pool Screen Enclosure Final Single Family Residence Final Building (Other) ti. 1 o4- Electric Underground Footer / Slab Steel Bond Electric Rough T.U.G. Pre -Power Final Electric Final EG."rt a ' WriJWIN." ten f*+ Min Max Ins ectioffi Descrl tion Plumbing Underground Plumbing Sewer Plumbing Tub Set Plumbing Final MECHANICAL PERMIT Min Max Inspection Description Min I Max Mechanical Roug Mechanical Final Gas Unde Gas Roug Gas Final REVISEID: June 2014 SCPA Parcel View: 25-19-30-5AH-0000-0250 Page 1 of 2 DWd PAMPR GAR.IpU:00lMY, flOi/!L1 Parcel Information Property Record Card Parcel: 25-19-30-5AH-0000-0250 Owner: SMITH BERNETTE 0 Property Address: 1305 W 10TH ST SANFORD, FL 32771 Parcel 25-19-30-5AH-0000-0250 Owner SMITH BERNETTE O Property Address 1305 W 10TH ST SANFORD, FL 32771 Mailing 1900 W 18TH ST SANFORD, FL 32771 Subdivision Name ROBINSONS SURVEY OF AN ADD TO SANFORD Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions Legal Description N 135 FT OF E 49 1/2 FT OF W 1/2 OF LOT 25 ROBINSONS SURVEY OF AN ADD TO SANFORD PB 1 PG 92 Taxes Value Summary 2017 Working Values 2016 Certified Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 65,763 62,941 Depreciated EXFT Value Land Value (Market) 8,270 8,270 Land Value Ag Just/Market Value " 74,033 71.211 Portability Adj Save Our Homes Adj 0 0 Amendment 1 Adj 0 0 P&G Adj 0 0 Assessed Value 74,033 71,211 Tax Amount without SOH: $1,427.46 2016 Tax Bill Amount $1,427.46 Tax Estimator Save Our Homes Savings: $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value City Sanford 74.033 0 74,033 SJWM(Saint Johns Water Management) J $ 74,033 0 74,033 County Bonds 74,033 0 74,033 County General Fund 74.033 0 74,033 Schools 74,033 0 74.033 Sales Description Date Book Page Amount Qualified Vac/Imp QUIT CLAIM DEED 11/1/2006 06544 1118 100 No Vacant QUIT CLAIM DEED 7/1/2006 06313 0126 100 No Vacant WARRANTY DEED 11/1/2005 06015 0653 11,500 Yes Vacant CORRECTIVE DEED 11/1/2005 06015 0652 100 No Vacant QUIT CLAIM DEED 10/1/1999 03739 1549 100 No Improved Find Comparable Sales Land Method Frontage Depth Units Units Price Land Value FRONT FOOT & DEPTH I 49.001 135.00 I 0 174.00 8,270 Building Information Is Bed/Bath count incorrect? Click Here. http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=2519305AH00000250 1/5/2017 RECORD COPY City of Sanford Building and Fire Prevention PERMIT CONDITIONS Application #: 17-104 Address: 1305 W. 10" Street Description of Work: Drywall Repairs These comments are provided for the permit listed above only. This sheet must remain with the approved set of plans and be made available to the inspector at the time of inspection. All conditions must be met and strictly adhered to. Scope of Work 1 7 - 1 0 4 Repair Drywall in Master Bedroom and Bathroom Replace 2 Electric Receptacles aConditions: 1. No additional work permitted in the rest of the house. 2. No framing (structural or non-structural), insulation, mechanical duct work, plumbing or any additional electric wiring is permitted. 3. All drywall must be inspected prior to covering the fasteners with tape/mud. 4. Electric work to consist of replacing 2 receptacles, no additional wiring (per scope of work). 5. The entire house must be equipped with smoke detectors, located as required for new construction. 10-year battery backup detectors are permitted. REVIEWED POR CODE COMPLIANCE PLANS EXAMINER 7a - (7-- DATE SANFORD BUILDING DIVISION A PERMIT ISSUED SHALL BE CONSTRUED TO BE A LICENSE TO PROCEED WITH THE WORK AND NOT AS AUTHORITY TO VIOLATE, CANCEL, ALTER OR SET ASIDE ANY OF THE PROVISIONS OF THE TECHNICAL CODES, NOR SHALL ISSUANCE OF A PERMIT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING A CORRECTION OF ERRORS IN PLANS, CONSTRUCTION OR VIOLATIONS OF THIS CODE If you experience any difficulty, please call 407.688.5150 for assistance. CI- JAN 0 5 M7 jL pepr 17-104 J DING Sit` ,-0 i SPAR f3 VIP r. I City of Sanford Residential Alteration / Addition / Renovation F Permit Application Guidelines 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: PERMIT APPLICATION AND SUBMITTAL REQUIREMENTS Building Permit Application completed, signed and notarized. Floodplain development application completed and signed if any portion of the property is in a flood hazard area as identified on the most current flood insurance rate map. SG C!7% Copy of a contract, signed by the contractor and the property owner, indicating the documented V construction value t/ Application must include correct address and complete parcel I.D. number. Contractor information is required to be included on the permit application (if contractor is applicant). Applicant must include the name of the designated plan review contact person, their phone number and either a fax number or email address on the Building Permit Application form. y C Cif t e;O tractor's license issued by the State of Florida (if contractor is applicant). e specific notarized power of attorney shall be required from the licensed contractor ift/she appoints an employee of his/her company to sign the permit application as the contractor. Ce 4 Itge insurance indicating worker's compensation insurance coverage and naming the City of an ord 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). o I d and signed Owner Builder Statement / Affidavit (if owner is applicant). 7 Two 2) copies of all applicable plans and related documentation. n ate, signed and sealed, property survey which shows all improvements on the subject property h 10 feet on adjacent parcels. P t I owing location of proposed improvement(s) and setbacks to property line(s). May need to in i i lot requirements. Hand -drawn submittals must be submitted on plain white paper and include accurate dimensions, all details that apply to the project, and must be legible. Please see the following pages for construction document submittal guidelines ** Revised: February 2016 Page I of 5 Residential Alter/Add Permit Application Checklist THE CONSTRUCTION DOCUMENTS MUST INCLUDE, AT A MINIMUM, THE FOLLOWING, AS APPLICABLE: SITE PLAN / PLOT PLAN Must indicate the location o e pr Ksed addition. Two (2) copies are required BUILDING PLAN — Structural If any elements of the addition, alteration or renovation involve altering the structure or any structural elements, the following information must be included and must be signed and sealed by a registered design professional. Any alteration or change to an exterior wall is considered structural and requires signed and sealed engineered plans. Two (2) copies of construction documents are required. Construction documents shall indicate code edition being applied Construction pe Plans to minim m 1 c Designer inform tion: e, ddress, registration #, seal and signature on all signed/sealed pages Page size minimu 11' 7' All pages nu a and 1 eled Wind design d a r ired on drawings per FBC 1603.1.4 to meet 139 mph ultimate design wind speed for risk categor I buildings (residential) Ultimate sign wind speed (Vult) Nominal de ign wind speed (Vasd) Risk category Exposure category Enclosure classification Internal pressure coefficient Component and cladding design wind pressures in terms of psf Structural Calculations, if necessary FLOOR PLAN — ALL PERMITS (STRUCTURAL/NON-STRUCTURAL) Floor plan must include a layout of the entire home An e isting floor plan and a proposed floor plan must be provided, indicating any structural/non- str tural elements, electric, mechanical, plumbing, concrete slabs, and any other relevant details. ust indicate the area that will be altered/renovated ach room must be labeled (Kitchen, Bathroom, Bedroom, Living Room, ect.) r Must be legible and to minimum 1/4" scale Include all applicable span lengths and dimensions, including porches Revised: February 2016 Page 2 of 5 Residential Alter/Add Permit Application Checklist ELEVATION (if applicable) Attic ventilation Roof pitch Roofing material Exterior finish/stucco thickness Height/bearing elevations Window and door opening locations Chimney location/height ENERGY CALCULATIONS Required for Additions / Removing existing insulation and addmR new insulation Converting unconditioned space to conditioned s c . Form 402 or Form 405 FOUNDATION / SLAB Foundation plan Filled cells with reinforcement locations Footer denotation/details Footers minimum 12" below grade Interior bearing walls/pads Porch pads/footers Brick ledge detail Slab thickness/steel/fiber mesh Vapor barrier/termite treatment type Reinforcing steel over lap Relieving arch steel at pipe penetrations All wood minimum 6" above grade Crawl space ventilation rECTRIICAL if a licablePleasenote: any renovation, alteration or addition will require the entire home to be updated with oke detectors, located as required for new construction per FBCR R314 Level I Alterations will require 10 year, non -removable battery smoke detectors. Electrical existing floor plan and proposed floor plan for the work area. Location of receptacles, switches, lighting, fans, disconnecting, service panels, ect. Service riser diagram (for new service, service rebuilds or upgrades to service size) Bonding/Grounding Electrical load calculations Re -wire of 50% or more of home Additions, required on existing home to verify service size is sufficient' GFCI protection AFCI protection Tamper resistant outlets Smoke/CO alarm locations Revised: February 2016 Page 3 of 5 Residential Alter/Add Permit Application Checklist 9 MECHANICAL (if applicable) Equipment location Anchorage for condenser, engineered to meet wind loads Protection in garage locations Clearances at equipment Structural detail for air handler in attic Room ventilation Adding or modifying ductwork requires a duct layout. Duct layout must include a floor plan and indicate the duct sizes, R-value, register sizes Exhaust Bath exhausts size and termination Dryer exhaust discharge/make up air Energy calculations with equipment sizing calculations for new HVAC installations PLUMBING (if applicable) Plumbing drain, waste and vent schematic for new plumbing installations Bathroom or Kitchen existing floor plan and proposed floor plan. 0 FUEL GAS (if applicable) BTUs each outlet and total BTUs Pipe type and total length LP regulator and model type Combustion air vents Location of equipment Venting Gas Type Gas Pressure Gas piping riser ROOF TRUSS LAY OUT (for new engineered trusses) Truss I. D. #s 0 f Layout, required on plans and a copy included with truss p ckage Signed/Sealed truss engineering package Strapping/fasteners/truss tie -downs DETAIL SHEETS OR NOTES Footings Beam to wall and/or post attachments Post/column and beam construction Interior bearing walls Stairs section Chimney construction Dormer construction Floor framing Entry construction Arched windows Bay windows Frame to block connections Knee wall construction Sky light framing Top plate splicing requirements Revised: February 2016 Page 4 of 5 Residential Alter/Add Permit Application Checklist Steel. requirements (footer, lintel, vertical pour) Grade Over lap Veneer Shear wall locations and construction Connectors Fasteners Roof sheathing & diaphragms Fasteners Blocking Wall and gable sheathing fastening Gable end, frame and block, vaulted and flat Conventionally framed roof members Glass block Header schedule, including strapping/anchorage and frame supports (bearing walls) Bearing/non-bearing wall detail Typical wall section detail, one and two story, block and frame, for all scenarios Connectors Anchorage bolts Materials and assembly MANUFACTURER'S PRODUCT INSTALLATION INSTRUCTIONS Roofing components Underlayment Shingles / Tile / TPO / Rolled Off -ridge vents Window and mullion installation instruc Garage door, sliding glass door and swin door ins lat n instructions Siding installation instructions Soffit installation instructions Glass block installation instructions Engineered lumber products installation instructions PRODUCT APPROVAL Completed Sanford Product Approval specification sheet Florida Product Approval can be located at www.floridabuildi or . Product Approval must be approved under the current code edition FS 553.842, FAC 61 G20-3 These guidelines were compiled to assist the applicant in preparing a residential alteration / addition / renovation permit application submittal and may not be complete. The applicant is required to meet all city of Sanford, state, and federal requirements. Revised.• February 2016 Page 5 of 5 Residential Alter/Add Permit Application Checklist CEIV ., JAN 0 5 2017 36- 7 OPT _- COQ IV% t S.t'Paor t l r. ECEIVE JAN 0 5 2017 :! vr! - Gd Y' `C a.Sc. . L tT 1 arW Co n,Y`, e . A,c.L9!:fG_r— 05 J SCPA Parcel View: 25-19-30-5AH-0000-0250 Page 1 of 2 Property Record Card Z An fIPANUE6PCFAParcel: 25-19-30-5AH-0000-0250 Owner: SMITH BERNETTE O SC1." XJt COWIY, AX*tD11 Property Address: 1305 W 10TH ST SANFORD, FL 32771 Parcel Information Parcel 25-19-30-5AH-0000-0250 Owner SMITH BERNETTE O Property Address 1305 W 10TH ST SANFORD, FL 32771 Mailing 1900 W 18TH ST SANFORD, FL 32771 Subdivision Name ROBINSONS SURVEY OF AN ADD TO SANFORD Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions Legal Description N 135 FT OF E 49 1/2 FT OF W 1/2 OF LOT 25 ROBINSONS SURVEY OF AN ADD TO SANFORD PB 1 PG 92 Taxes Value Summary 2017 Working Values 2016 Certified Values Valuation Method Cost/Market Cost/Market Number of Buildings 1 1 Depreciated Bldg Value 65,763 62,941 Depreciated EXFT Value Land Value (Market) 8,270 8,270 Land Value Ag Just/ Market Value " 74,033 71,211 Portability Adj Save Our Homes Adj 0 0 Amendment 1 Adj 0 0 P& G Adj 0 0 Assessed Value 74,033 71,211 Tax Amount without SOH: $1,427.46 2016 Tax Bill Amount $1,427.46 Tax Estimator Save Our Homes Savings: $0.00 Does NOT INCLUDE Non Ad Valorem Assessments Taxing Authority Assessment Value Exempt Values Taxable Value City Sanford 74,033 0 74,033 SJWM( Saint Johns Water Management) 74,033 0 74.033 County Bonds 74,033 0 74,033 County General Fund 74,033 0 74,033 Schools 74,033 0 74,033 Sales Description Date Book Page Amount Qualified Vac/Imp QUIT CLAIM DEED 11/1/2006 06544 1118 100 No Vacant QUIT CLAIM DEED 7/1/2006 06313 0126 100 No Vacant WARRANTY DEED 11/1/2005 06015 0653 11,500 Yes Vacant CORRECTIVE DEED 11/1/2005 06015 0652 100 No Vacant QUIT CLAIM DEED 10/1/1999 03739 1549 100 No Improved Find Comparable Sales• Land Method Frontage Depth Units Units Price Land Value FRONT FOOT & DEPTH 49.00 135.00 1 0 174.00 8,270 Building Information Is Bed/Bath count incorrect? Click Here. http:// parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=2519305AH00000250 1/5/2017 c 1 FEB p 9 2017 r j CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION D • Application No: l Documented Construction Value: $ a Job Address: /,3(,!5;— ( ,/ `S -, .,Q Historic District: Yes No Parcel ID: Residential Commercial Type of Work: New Addition Alteration Repair emo El Change of Use Move Description of Work: 2; i i / L,r o o_- Plan Review Contact Person: Title: Phone: Name Fax: Email: Property Owner InformationSm //'</ Phone: 707 Street: 0/6 O pCity, State Zip:,, , C± 7, ,; ;,o: d; t.^3140 atc)^ .a, ts6 artt,;' 'St Name Name: Street: City, St, Zip: Bonding Company: Address: c P Resident of property? Pio'itra for Information Phone: yD7 y—%cam % Fax: State License No.: Z5;?;( Rey's 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 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: 51h Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application f) C S. Z 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-appYcable laws regulating construction and zoning. 4SignureoOwner/ v n Da a Signature ontractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date SigULure of ota z' II H Owner/Agent is Personally Known to Me or Produced ID Type of ID Produced ID s Name ANNETTE BLAND Notary Public . State of Florida Commission 0 GG ON623 My Comm. fsttpiras in 10.2011 Type of ID BELOW IS FOR OFFICE USE ONLY Z-cl,/7 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 # 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 Ir % Al"ql,l 7 S; f v 7Z /e 7Z- Ile ur lp loo— FEB 0 9 2017 LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: i—G-G7 40 I hereby name and appoint:. an agent of: 2 2 C Name of Company) to be my lawful 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): 911 The specific permit and application fo rwork located at: Address) Expiration Date for This Limited Power of Attorney: License Holder Name( State License Number:,f, Signature of License Holder: STATE OF FLORIDA COUNTY OF SS4-,,, rNAL The foregoing instrument was acknowledged before me this day of , 201+ , by L , C C- xb pg who is gpersonally nown to me or who has produced identification and who did (did not) take an oath. Notary Seal) NICOLE D. ANDERSON PY oV Notary Public - State of Florida My Comm. Expires Nov 15, 2017 Commission # FF 051599 OF 10 Bonded Through National Notary Assn. Rev. 08.12) Signature Print or type name Notary Public -State of c, Commission No. Fir S1'-79 My Commission Expires: (V(Q,\1S.Q\ as