HomeMy WebLinkAbout103 Balboa Ct - BR17-002778 - REROOFRevised: June 30, 2015 Pennit Application
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: l l-a9q/
Docu nted Construction Value: $ , ow
Job Address: ,/)3,o6,q " 377 istoric District: Yes No
Parcel ID: 10. 503. (j -W • U()U Residentialio/Commercial
Type of Work: New Addition Alteration Re_pair Demo Change of Use Move
Description of Work: (fire p F — S KJ-/,K4r(0_S
Plan Review Contact Person: — Lw Title:
Phone: 32 . y C6" Fax: UC •2(o j _ g-S-S-2 Email:C6Y 1 ir 1. (m 1z00P&QMq ). corn
Property Owner Information
Named Phone:. 37 _ 7 1d^
Street: 0- Reside of property?
City, State Zip: 3 2- 7 23
Contractor Information
Name (Irj Wean vad-i ag a 061COr- 1 Oh, 1 roc • Phone: 3 21 , 9 (0 ) . Z. l U Co
Street: l6 F1 (Qr)g 'it W f 5t) i } -* 100 y Fax: Y U-'. z& '1 • S"oZ
City, State Zip: IOCc t F 1 -3 2`-t-E-0 State License No.: Cam, 1329Silo
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 constructioninthisjurisdiction. 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 ofapplication and the code in effect as of that date: 5` Edition (2014) Florida Building Code
11-1
qcz>
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 ofthe 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.
A-1 2
Signature o wner/Agent Date afine o ontractor/Agent 16ate
Print Owner/A n' Name (
Signatur of Notary- tate of F ida r5ate
t i CAROLINACRUZ
s My COMMISSION # GG OWIaEXPIRES: June , 20rPCFf P••tnnMpl ,tyu blicU rs
Owner/Agent is Personally Known to Me or
Produced ID---Tvt)e of ID
Print
lZi 1'YI. y kw S
of Florida
CAROLINACRUZ
MY COMMISSION # GG 094001
EXPIRES: June 17,2020
Date
Contractor/Agent is " Personally Known to Me or
Produced ID Type of ID _
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas[] Roo
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:
UTILITIES:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: L _ '_f lF Etn- i h Ue) b
r
an agent of: 1,0, a c3, 3 .PP r m i k-N 1 n C i S, r V `CSZ.S.
Nake of Comoanv)
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):
p The specific permit and application for work located at:
lI l b 3 C
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number: ((-(-
Signature of License Holder: 'A Z2
STATE OF FLORIDA
COUNTY OF
The foregoing i strume t was ac wledged before me this day of ,
200_a, by A who is ersonally known
to me or o who has produced
identification and who did (di
Notary Seal)
NAB
z My #00094001
s 'o` EXf :..;e:_ 17, 2020
Rev. 08.12)
Print or type name
Notary Public - State of Y i J'a
Commission No. G 6 09 4 CO)
My Commission Expires:=T,.) nQ V )_0
as
d- *
I Property Record Card
CFA Parcel: 10-20-30-503-0200-0060
Owner: FARIAS ELBA M L
sr cX7ueytiv c4Hx n Property Address: 103 BALBOA CT SANFORD, FL 32771
Parcel Information
Parcel 10-20-30-503-0200-0060
Owner FARIAS ELBA M L
Property Address 103 BALBOA CT SANFORD, FL 32771
Mailing 103 BALBOA CT SANFORD, FL 32773-5544
Subdivision Name HIDDEN LAKE PH 2 UNIT 1
Tax Distri` S1-SANAN -FORD
DOR Use Code 01-SINGLE FAMILY
Exemptions 00-HOMESTEAD(1995)
Value Summary
2017 Working
Values
2016 Certified
Values
Valuation Method Cost/Market Cost/Market
Number of Buildings 11 1
Depreciated Bldg Value 83,148 72,832
Depreciated EXFT Value
Land Value (Market) 25,000 21,000
Land Value Ag
Just/Market Value " 108,148 j $93,832
Portability Adj
Save Our Homes Adj 38,702 25,814
Amendment 1 Adj
P&G Adj 0 0
Assessed Value 69,446 68,018
Tax Amount without SOH: $1,067.57
2016 Tax Bill Amount $637.31
Tax Estimator
Save Our Homes Savings: $430.26
TRIM Notice Help
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 6 BLK 2
HIDDEN LAKE PHASE II UNIT I
PB 24 PGS 15 TO 17
Taxes
T
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund 69,446 44,446 25,000
Schools 69,446 25,000 44,446
City Sanford 69,446 44,446 25,000
SJWM(Saint Johns Water Management) 69,446 44,446 3 25,000
County Bonds 69,446 44,446 25,000
Sales
Description Date Book Page Amount Qualified Vac/Imp
QUIT CLAIM DEED 4/1/2001 04097 i 0860 100 No E Improved
hImprovedWARRANTYDEED7/1/1981 01349 1868 41,400 ` Yes
Find Comparable Sales
Land
Method Frontage Depth Units Units Price Land Value
LOT 0.00 0.00 1 25,000.00 ' 25,000
Building Information
Is Bed/Bath count incorrect? Click Here.
Year BuiltDescription Fixtures Bed Bath Base Area Total SF Living SF Ext Wall Adj Value Repl Value Appendages
Actual/Effective
1 SINGLE ( 1981 6 2 2_0 1 1,040 1,672 1,274 CONC 83,148 100,178 Description I Area
FAMILY BLOCK OPEN I
j PORCH 60.00
FINISHED i
BASE SEMI I
FINISHED 234.00
I
GARAGE
338.00I
f
FINISHED
Permits
Permit # Description Agency Amount CO Date Permit Date
01357 REROOF SANFORD i $1,200 3/1/2003
03055 MECHANICAL SANFORD i $01 7/1/2000
03054 ELECTRICAL SANFORD 0 7/1/2000
02606 FLORIDA ROOM 160 SO FT SANFORD 3,000 5/26/2000
01570 ERECT SHED; 120 SO FT I SANFORD 1,350h 13/1/1999
02361 PARTIAL WOOD FENCING SANFORD 625 j 17/1/1997
Extra Features
Description Year Built Units Value New Cost
No Extra Features
NO. 566740FloridaCentralParkway, Suite 1004
Longwood, FL 32750
Email: caribbeanroof@gmail.com
www.caribbeanroofinginc.com
CMISSEM Office: 407-269-8552 Cell: 321-961-2106
CCC 1329576
CONSTRUCTION INC.
Name: a s Date:
Street: tO.3 i C Proposal prepared by:
Address: p" { { I ` 2 —— 3 Home PhonePL40 7 •
Cell Phone:
Email:
DESCRIPTION AMOUNT
ROOF Due Care taken to protect home exterior, shrubs and landscaping.
Includes Dumpster. Roll off dumpster for paver driveways.
Includes inspecting deck for damage and renailing to code with 8D ring shank nails.
Includes replacing new ridge vents, O.R.V., shingle over R.V.
Includes saving gutters, soffit, fascia on existing home (some damage may occur in construction).
Includes replacing existing drip edge in choice of color.
Includes 1-1/4" roofing collated nails.
Includes installing new shingles in choice of color.
Includes replacing all lead boots and goose vents (does not include gas -related vents).
Includes new galvanized metal in all valleys.
Includes starter shingles and ridge cap per code.
Includes obtaining and posting permit with local jurisdiction.
Includes magnetically sweeping job site, cleaning out gutters and hauling away debris.
SHINGLES 130mph
UNDERLAYMENT Peel and stick UPGRADE
301b. Felt
Synthetic
MISC INCLUDES LABOR AND DUMPSTER TO REMOVE LAYER(S) OF SHINGLES
ADDITIONAL LAYERS WILL COST $ PER LAYER INITIAL
Deteriorated existing decking replaced at $ per sheet ofplywood INITIAL
Deteriorated existing decking replaced at $ per linear ft. (lx-2x)
Does not include painting to match.
Does not include any stucco repairs where deteriorated flashing had to be replaced.
WARRANTIES WORRY -FREE 5 yr. non -prorated WORKMANSHIP INCLUDED
WIND MITIGATION INSPECTION: UPON REQUEST / Additional Fee Will Apply TOTAL:
NOTES:
L
Name: Date: Name: Date:
I HAVE READ AND UNDERSTAND THIS PROPOSAL, THE TERMS AND CONDITIONS AND ALL DOCUMENTS
REFERENCED THEREIN AND AGREE TO BE BOUND BY THEIR TERMS.
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are Satisfactory and hereby accepted.
Contractor is authorized to do the work as specified. By signing Customer acknowledges that Customer is the owner of the
property where the work is to be performed.
ALL PAYMENTS ARE DUE UPON COMPLETION OF THE ROOK Any delay in payments may result in a 1.5% interest per 30 days.
Wind mitigations are not considered part of the project but offered as a service to our customers through a third party
certified licensed inspection company and shall not be used as reason for any delay offinal payment.
This agreement constitutes the entire contract by and between contractor and owner and parties are not bound by oral expressions
or representations by any party or agent of either party.
CITY OF
S,ORD Building &Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT
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/OIt 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.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE:
i
CITY OF
SrUuroldr
PERMIT # (
77k Building &
Fire Prevention Division RESIDENTIAL
RE -ROOF SCOPE OF WORK JOB
ADDRESS -I () 3 BU 1 boU C}-• cSck Y)fC)r d 1 f 1 3 2 3-_)- 3 STRUCTURE
TYPE: MINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -
ROOF TYPE: laEPLACEMENT (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: ODFF-RIDGE RIDGE OSOFFIT OPOWERED VENT SKYLIGHTS:
O YES (kO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA ROOF
SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 IV CA4:12 OR GREATER O
TURBINESTYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL SHINGLE
Yl e_G FL# SL1 L4 1 O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# OINSULATED
FL# O
TILE FL# O
OTHER: FL# ROOF
EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE** 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# 0INSULATED
FL# O
TILE FL# O
OTHER: FL#
IHIS1Name TRUM NT PREP ED Bar:
IUC ff ff ff llAddress:'i'
I
Iona t ovd l 37_' SU
GRANT HALOYr SEI` INOLE COUNT`{
NOTICE OF COMMENCEMENT ; ( R)t fJFFCIRCUIT C3)URT f. C:OhiFTROLLER
CLERK'S v 2017094772
Permit Number: RECORDED O9f 20/21-1:{. 7 11 ::1ti o ` All
Parcel ID Number 16 , 2n, W. 5-03--Q2-)Q-WSp0 RI:::CORDING FEES $10.01-_I The
undersigned hereby gives notice that improvement will be made to certain real property, and i l e i h iwi}t &.401,0713, Florida Statutes, the following
information is provided in t its Notice of Commencement. 1.
LSC)
T rONOF L 2RTY.(
IDDSal tion /Y of
the
L p
F
perty
a
address aQNlr i BB ZL4 F>6s 2. GENERAL
DESCRI TION OF IMPROVEMENT: 3. OWNER
INFORMATION OR LESSEE INFORMATOOI/y IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and
address: c I % Q /6-y ri as / to 2 JC0 a C+ - Interest in
property: 6turiL Y. _- Fee Simple
Title Holder (if other than owner listed above) Name: 1 Address:
103f6a) %O (;, _V C 4 SC ryfo r t T- j 3Z 1 4. CONTRACTOR:
Name: If rA r i bLVA11 (AC/f nG 1 68YiSff UCi I OW Whone Number: 3 Z 1 . e10) • 210 Address: -4uO
FI Co-nbra, PLWN SV 1- -0100U 10n0. Ua0oG . F 1 R2, ? S-rJ 5. SURETY (
If 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 whore notice or other documents maybe served as provided by Section 713.13(
1)(a)7., Florida Statutes. 8. In
addition, Owner designates Phone Number:
of to
receive
a copy of the Lienor's Notice as provided in Section 713.13(1)(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 COMMENDING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. E,C13a
ra r- i a nor Lessee,
or Owners or Lessee's (Print Name and Provide Signatory's Title/Office) State of
lW r1 "-- Countyof mi Yl Q The foregoing
Instrument was acknowledged before me this _ _ day of r 1'Y) b , 20 1 4 bY_S/
r ( Nameofperson making
statement Who is personally
known to me4'0Ir— who has produced
identification 0 type of identification produced:
CITY OF
S,kNFORD Building & Fire Prevention Division
RESIDENTIAL RE-ROOFAFFIDAVIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I T r' 2 —4 " S" ADDRESS:
32 3 3-1.
I A 1eKQnC r0S / jutzi /I r- 6cc' '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 #:C CC 13 2—cl G —+- Co
COMPANY / CONTRACTOR: &D,XQI KA(-c)S a 1G) ffl , -V S
CONTRACTOR SIGNATURE: / DATE: / 7
MUST BE SIGNED BY LICENSE HOLDER OR OWNEWBUILDER)
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 TILE 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 ROOFI.NG COMPONENTS.
STATE OF FLORIDA COUNTY OF
Sworn to and Subscribed before me this 215 day of .C. 20 R by:
Who is Personally Known to me or has 0 Produced (type of
identific i n as identification.
Sign+ re f N tary lie' YM CAROLINACRUZ
State o Florid MYC0MMISSI0k#GG094W1
r
1 U
P EXPIRES: June 17, 2020
rw1l (Banded Thru Wory Public Underiters
Print/Type/Stamp Name
v
of Notary Public