HomeMy WebLinkAbout159 London Fog WayCITY OF SANFORD
BUILDING & FIRE PREVENTION
D
PERMIT APPLICATION
Application No: '6-6 N
Documented Construction Value: $ &/I) t), 00
Job Address: 15-q L-ohdt)() RQ Akl Historic District: Yes El No El
Parcel ID:3 3 -1 q-,3() _51:, "N - e)n 6 Residentialp Commercial 11
Type of Work: NewEl Addition 1-1 AlterationZ RepairEl DemoEl Change of Use 0 Move El
Description of Work: 1ze_—"C(-, ncPamo3t-41 -o'hiviom (0
Plan Review Contact Perso'n:sarnarftcl MLX
I __
Title:
Phone:46 7.0 7X.7):tT.Fax:-.331-3(01 F ail- M
Property Owner Information
Name Qmev- Phone:
Street: 1fl Unclon EM \NU Resident of property? :
City, State Zip-Sanffird
Contractor Information
Name )OLS O-e-Y 6cw+fku!)n Phone: (-toi - a I rL.
Fax:
City, State Zip: onay\cw RL w cr?- State License No.: Ca19C')q(VrJ
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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: 5'h 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 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 applicable laws regulating construction and zoning.
Signature ofON,.,ner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
I MA
JA I !KA
M. nature of Contractor/Agent
s Name
a 3-?) 1 . C"'
EAN13RIANAMCCLE,
M ISS*N # PF942988
S = '1 019
P-4Y C ZMD Zb, 3 2EXP45ip2988MyCOMMISSION0PF94
EXPIRES Dece-bel 13 2019
t4101'32a-01b3 FW OWYSOrM4 CW'
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building n Electrical [] MechanicaIE] PlurnbingF] Gas [] RoofE]
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes [] No n
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes [] No []
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
Jasper Contractors, Inc.
5380 E. Colonial Dr.
Orlando,'FL 32807 k(o_ 06daL
407) 278-7788 qa- 'S
800) 337-3361 Fax JASPERlasperRoof.com ;
parRoof.com
info(@iast)erinc.o L9V_1 76-`_770 ontractor's License # CCC 132965100C
H-sHEMI
ROOF REPLACEMENT CONTRACT
Account Mi!ager A UA/ OAAL-0
Contact#
CompanyL,1 UW:1a1_XY__A&LAU.A(_
Policy # A S14 _,&&_ 415 -3 2e% - la
Cl ai in # e7)77, -7, -7 _q 0/2-5 q I
Mortgage Company Information
Company C) ctA_14 ju
LoanNumber- -WA SC36AWD
Owner(s):
Apmc t<AAACP,
Phohe: qO7- b 32--:5 3 --7&
Address:
t 5CA Lg) P tak) RQ LJ
Alt Phone:
City:
a: P -t-i % g_,
State:
Pc_
Zijgode:
1-7-7-1
Shingle Color:
D(Z Prujc os
Email-
t")v (,ANG 2_ 0 e CEL, AS , co /VA
Roof RCV amount:
11400.00
Drip Edge Color:
1 k&)I-
If Owner's Insurance Company does not agree to pay for a full roof replacement, this contract shall be voidable.
Assignment of Insurance Benefits for the Full Roof Replacement Only: I hereby assign any and all insurance rights, benefits and proceeds
under any applicable insurance policies to Jasper Contractors, Inc. ("Jasper"), the scope of which shall be limited to a Full Roof Replacement. I
make this assignment and authorization in consideration of Jasper's agreement to perform services, supply materials and otherwise perform its
obligations under this contract, including not requiring full payment at the time of service. I also hereby direct my insurer(s) to release any and
all information requested by Jasper, its representative, or its attorney for the direct purpose of obtaining actual benefits to be paid by my
insurer(s) for services rendered. In this regard, I waive my privacy rights. If payment is made directly. to the Owner/Agent/insured(s), it shall be
endorsed over to Jasper inunediately upon receipt. I agree that any por ion of work, deductibles, betterment or additional work requested by the
undersigned, not covered by insurance, must be paid by the undersigned on (he day of installation.
Deductible: It is the Owner's responsibili y to om all Insurance Deductibles. Owner's out-of-pocket expense will not exceed the deductible
amount, as stated on insurer's loss sheet, UNLESS replacement/repair of deteriorated decking is required and/or Owner requests optional
upgrades. Jasper CANNOT pay, waive, rebate, or promise to pay, waive or rebate all or any part of the insurance deductible applicable
to the insurance claim for payment of work. In the event of a discrepancy, the deductible amount stated on the insurer's Loss Sheet shall
overrule Deductible listed above.
Deductible: $ Q_5o(:) MUST BE PAID IN FULL, PLUS APPLICABLE SALES TAX (initial)
MORTGAGE AUTHORIZATION: 1, Owner/Mortgagor, grant authorization for QCCJ(7ju MortgageoCo. t speak with
Jasper on matters including, but not limited to, the claim and draw status. J (initial)
of S PA"IENT SCHE DULE: Owncr agrees to pay Jasper based on the following pay schedule: (i) Deposit in the amount of S 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 upon cornpletion of work being performed; and, (iii) the remaining Contract Price (equal to any
applicable depreciation and/or change orders) due and payable to Jasper upon completion of work performed. In the event of a pending
inspection, no more than 2% of Contract Price may be withheld Lmtil inspe.-tion has passed.
Optional: UPGRADF ITFIA: QTY: __ — PRICE: $ TOTAL:
Replacement Work and Price: Upon insurer's approval and subject to the terms and conditions herein, Jasper agrees to furnish all materials
and provide the labor necessary to perform the full roof replacement which 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 Rinds from Owner's insurance company.
CANCELLATION: If Owner elects to terminate the services of Jasper, Owner may do so before midnight on the third business day
after Contract is executed. Owner shall receive a full refund of alt deposits. Owner may also rescind Contract before midnight on the
third business day after the contract is executed after notification from insurer(s) that the claim for payment on roof contract has been
denied, in whole or in part. All written notices of cancellation, regardless of reason, shall be postmarked or delivered to Jasper's
corporate office: 1955 Vaughn Road, Suite 209, Kennesaw, GA 30144. CANCELLATION EXCEPTIONS: The three (3) day right of
cancellation DOES NOT APPLY to contracts for emergency home repairs as time is of the essence.
r, Owner, have read and understand all statements, terims and conditions of the "Roof Replacement Contract" and agree that an
details are acceptable and satisfactory. I further understand that this contract constitutes the entire agreement between the parties and
that any further changes or alterations to this contract must be made in writing and agreed upon by both parties. Each part),
represents and warrants to the other that it has the full power and authority to enter into the contract and that it is binding and
acc(r/dnec with its terms. ae ; -
o Ze-n
Audyrrz ed Jasper ReprrsentEtive Date Owner
TEAMS AND CONDMONS: Acceptance,3f Terms: L Owner, hereby agree to retain Jasper for a full roof replacement on the terms and
conditions stated herein. I furtthei agm to pro -,,id-- Ja.per with die Scope T Loss Report generated by my insurer and authorize and grant full
accessto the propertyfor the pwTose uf staging and comple'.ing all a&-,ed upon work. Supplemental Claims: Jasper reserves the right to file a
supplemental claim with :Yiner's imwrance in die evert ibat the esth-nate is incorrect and/or additional damage is discovered after
Prope :ord Card
P Rki "'E Parcel: 33-19-30-513-0000-0030
tpp Owner: KRAMER DEBORAH C & DAVID A
s"'
Property Address., 159 LONDON FOG WAY SANFORD, FL 32771
Parcel: 33-19-30-513-0000-0030
Property Address: 159 LONDON FOG WAY
Owner: KRAMER DEBORAH C &DAVID A
Mailing: 159 LONDON FOGWAY
SANFORD, FL 32771-7761
Subdivision Name: MAYFAIR OAKS 331930513
Tax District: Sl-SANFORD
Exemptions; 00-HOMESTEAD (2004)
DOR. Use Code: 01-SINGLE FAMILY
T't
rA
in
Value Summary
2016 Working 2015 Cerbfied
Values Values
Valuation Method Cost/Market Cost/market
Number of Buildings I I
Depreciated Bldg Value 137,141 132,465
Depreciated EXFT Value 2,730 2,844
Land Value (Market) 32,000 28,000
Land Value Ag
Just/Market Value
171,371 t 163,309
Portability Adj
Save Our Homes Adj 41,261 33,607
Amendment 1 Adj
Assessed Value 130,610 129,702
Tax Amount withoutSOH: $2,502.22
2015 Tax Bill Amount $1,818.28
Tax Estimator
Save Our Homes Savings: $683.94
Does NOT INCLUDE Non Ad Valorem Assessments
Legal Description
LOT 3
MAYFAIROAKS
PB 50 PGS 38 THRU 41
Taxes
Taxing Authority AssessmentValue Exempt Values Taxable Value
County General Fund 130,610 50,000 80,610
Schools 130,610 25,000 105,610
City Sanford 130,610 50,000 80,610
SJW M(Saint Johns Water Management) 130,610 50,000 80,610
County Bonds 130,610 50,000 80,610
Sales
Description Date Book Page Amount Qualified Vac/Imp
WARRANTY DEED 5/1/2003 04847 0998 171,300 Yes Improved
WARRANTY DEED 1/1/1997 03189 1890 118,500 Yes Improved
r,nd Comparabk, Sek s with n tl i, Subdivision
Land
Method Frontage Depth Units Units Price Land Value
LOT 1 32,000.00 32,000
Building Information
Description
Year Built Fixtures Base Area Total SF Living SF Ext Wall Adj Value Rep I Value Appendages
Actival/Effective
1 SINGLE 1997 8 1,935 2,375 1,935 CB/STUCCO $137,141 147,463
Description Area
FAMILY FINISH
I - IN 'I -, U I ,
Permits
Permit # Type
02326 Miscellaneous
01165 Miscellaneous
02448 Addition - Residential
00944 Addition - Residential
00913 Addition - Residential
00169 New - Residential
Extra Features
Description
ALUM GLASS PORCH
GARAGE 404
FINISHED
OPEN
PORCH 36
FINISHED
Agency Amount CO Date Permit Date
Sanford 3,224 8/27/2012
Sanford 5,563 V9/2007
Sanford 7,600 5/10/2000
Sanford 1,500 1/1/1997
Sanford 821 1/1/1997
Sanford 86,044 1/9/1997 10/1/1996
Year Built Units Value New Cost
1/1/2000 325 2,730 $4,550
LEWTED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: \A
I hereby name and appoint: Samantha Murray
an agent of.- Jasper Contractors
Name ofCompany)
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 o* one option):
0 The specific pe it and application for work located at:
Expiration Date for This Limited Power of Attorney:
License Holder Name:- M I G14 A f t- 5-ryp t ejo
State License Number:
IN
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acWwledc!ed before me this A-i day of A2--Pn20(p -,by 'VVCkNaej who is o personally known
to me orXwho has produced as
identification and who did (did not) take an oath.
Notary Seal)
999AMCCLEAN
My C ISSjot4 # FF9429"
2019ExPIRESDec8mber0
k40j)3Q&01b3
Rev. 09.12)
Signatuie
Print or type name
Notary Public - State of
Comn-&sion No.
My Commission Expires:
THtS INIIYI
A PNRMRPTOR
32807 417960
NOTICE OF COMMENCEMENT
Permit Number
Parcsw io Number 33-19-30-513-OGOO-0030
The undarsIgned hereby gives notice thst Improvement will be made to certain real property, and In acm ance with Chapter 713, Florkla Statutes, the
following Information Is prcr-lded In this Notice of commenoement
1. DESCRIPTION OF PROPERTY. (Legal description ofthe property and &beet addran if "lable)
2. GENERAL DESCRIPTION OF FMPROVEIIIIENT.,
RE -ROOF
3. OWNER INFORMKnON OR LESSEE INFOFMIATION IF THE LESSEE COWMACTED FOR THE VAPROVEMENT.
Name and address: DAVID KRAMER, 159 LONDON FOG WAY, SANFORD FL 32771
Interest In property. OWNER
Fee Slmpla Title Holder (if ollhar Um owner listed above) Name:
Address.*
4. CONTRACTOR: Name: J A S PER CONTR ACTOR Ph.Numb., 407-278-7788
Address: 5380 E COLONIAL DR ORLANDO FL.12807
SURETY (If applicable, a copy of the payment bond Is -- cled):
Address: Amount of Bond:
LENDER: Name: Phone Number
Address:
7. Persons within the State of Florida DesIgnaW by0wroaruponwhom notice orother documents maybe smved *a provided by"on
713.13(1)(s)7., Florida Statutes. (r 0
Name: Phone Number 51 z
LU t:
Address* :: :)
In addition, Owner designates Of fn
0
to receive a copy or the UeWs Notice as provided in Section 713A3(1)(b). Florida Statutes. Phone number:
Eixplrallon 0rla of Nobce of Commencement (The expIration is 1 year from date ofrecording unless a dtiferent data Is
WAgNM To OWNEp- ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713. PART 1. SECTION 713A3, FLORIDA STATUTES. AND CAN RESULT IPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTEDJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AT
BEFORE COMMENCING WORK CR RECORDING YOUR NOTICE OF COMMENCEMENT.
DAVrD KRAMER
or 0mvers or Lwow's
owwr,xro==?srtw-AsnmPd
state of
FL countyof SEMINOLE
FEB 16
The foregoing Instrument was acknowledged befix methis
23
day of
by DAVID KPAMER Who is pemnally known to me 0 OR
No=orpas6nrrsW*NtNtNff"9 DL
who ha3 produced (dentli1cation EXtYPO of identification produced:
SAMANTHA MURRAY
Wary EWW%- my COMMISSION 0 FF9"322
EXPIRES December 16. 2019
MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL
CLERKS # 2016019223 SK 8637 Pg 1617; (1 pg) E-RECORDED 02/23/2016 09:07:41 AM
CIO
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MWE9192 :- Appli.ticin
FL #
FL3794-R4
Application Type
Affirmation
Code Version
2010
Application Status
Approved
Comments
Archived
Product Manufacturer
Address/Phone/Emalf
Authorized Signature
Technical Representative
Address/Phone/Emall
Quality Assurance Representative
Address/ Phone/Emall
Category
Subcategory
Compliance Method
Certification Agency
Validated By
Referenced Standard and Year (of Standard)
Equivalence of Product Standards
Certlfied By
Lomanco, Tnc
2101 West Main
Jacksonville, AR 72076
501) 982-6511
acarter@lomanco.com
Andrew Carter
acarter@lomanco.com
Andrew Carter
2101 West Main Street
Jacksonville, AR 72076
501) 982-6511 Ext 361
acarter@lomanco.com
Andrew Carter
2101 West Main Street
Jacksonville, AR 72078
501) 982-6511 Ext 361
acarter@lomanco.com
Roofing
Roofing Accessories that are an Integral Part of theRoofingSystem
Certification Mark or USLIng
Miami -Dade BCCO - CER
Miami -Dade BCCO - VAL
Standard
Miami -Dade TAS 100 (A)
Year
1995
ht'p://Www.floridabuilding-Org/Pr/pi-app_ dtl.aspx?param=wCTi-,,V3((-)ixlnn.p"l),,,V-..--.ny I 1_. — - -
MIAM EOMER - . ON - I
AILAMI-DADECOUNTY
BUILDING AND NJCIGHBORIJOOD COMPLIANCE Dr-,PART-NUNT (BNC) PRODUCT CONTROL SECTION
BOARD AND CODEADMINISTRA31ON DIVISION H 805 SW 26 Slrvc(, Room 208
Minini. Florida 33171-2474
1'(786)315-2590 F(786).'315-2599NOTICE )F ACCEPTANCE (NOA) lv%vw.lni-intidst(I't,.Lyol'/I)iiiidinr)/ Lomanco, Inc.
2101 West Mill Street
JaCkSonville, AR 72076
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction materials. The documentation submitted has been reviewed and accepted by Miami-Dadc County BNC - Product Control
AHJ). CSectiontobeusedinMiamiDadeCountyandotherareaswhereallowedbyth Authority Having Jurisdiction
This NOA shall not be valid after tile expiration date stated below. The Miami -Dade County Product Control
reserve the right to
or quality assurance purposes. If t is product or material fails to performhavethisproductormaterialtestedftSection (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade Coun y)
in the accepted manner, the manufacturer will incur the expense
11
of such testing and the AHJ mayimmediatelyrevoke, modify, or suspend the use Of such product or material within their BNC
ails to meet the requirements of the applicable building code.
Section that this product or material f -Dadc County Product Controlreservestherighttorevokethisacceptance, if it is determined by Miami Jurisdiction.
This product is approved as described herein, and has been designed to COMPlY will, the Florida Building CodeincludingtheHighVelocityHurricaneZoneoftheFloridaBuildingCode.
DESCRIPTION: 135 Roof Vent, Lomancool 2000 Power Vent
LA13ELING: Each unit shall bear a permanent label with the manufacturer's name or logo, city, state andfollowingstatement: "Miami -Dade County Product Control Approved", unless Otherwise noted herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has been nochangeintheapplicablebuildingcodenegativelyaffecting (he performance of this product.
TERMINATION of Ellis NOA will occur after the expiration date or if there has been a revision or change in thematerials, use, and/or manufacture of the product or process. Misuse of this NOA as an endorsement of anyproduct, for sales, advertising or any other purposes shall automatically terminate this NOA. Failure to complywithanysectionofthisNOAshallbecauseforterrilinationandremovalofNOA.
ADVERTISEN11C, NT: The NOA number preceded by tile words Miami -Dade County, Florida, and followed bytheexpirationdatemaybedisplayedinadvertisingliterature. Ifanyportion of die NOA is displayed, then it shallbedoneinitsentirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by tile manufacturer or its distributorsandshallbeavailableforinspectionatthejobsiteattherequestoftheBuildingofficial.
This renews NOA# 06-050 1.11 and consists of pages I through 4. The submitted documentation was reviewed by Alex Tigera.
P 0F0 NOA No.: 11-0602.02
Expiration Date: 08/17/16
Approval Date: 08/17/11
page I of 4
1A
ROOFING COMPONE NT APPROVAL
Ca RoofingSub-Catelzory: Ventilation
Lb-teriah Aluminum
TRADE NAMES OF PRODUCTS MANUFACTURED OR LABELED BY APPLICANT:
kroduct Dimension
Test Product
135 Roof Vent, 9" x 28.5" TAS 100Lornancool2000Power Powered Roof Vent, with fan and
Vent thermostat with a aluininurn hood.
MANUFACTURING LOCATION
I . Jacksonville, AR
EVIDENCE SUBMITTED:
Test k9encyadentifier Name Re
PRI Aspbalt Technologies, inc.
j)ort Date
TAS 100(A) LOM-01 1-02-01 04105106
lnmnmh
ML4141-DADE- I q OUNTy NOA No.: 11-0602.02W&UNWr Expiration Date: OS117/16
Approval Date: ()s/17/1,
PUL-le 2 of 4
CITY OF SANFORD BUILDING SERVICES
Residential Re -Roof
Hurricane Mitigation Inspection Affidavit
Permit #: 5-9g
1, Mkp,- hereby acknowledge that I personally inspected
9 Roof deck nailing and/or F1 Secondary water barrier work
at
Job Site Address)
was done according to the Hurricane
and have determined that the work
based on 553.844 F.S.)
I certify that my statements herein are true and accurate to the best of my belief and that I fully
understand that making any false statements in writing with the intent to mislead a public servant in the
performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to
Section 837 06 17 8
WrK - -z- )
el of Contractor
1'.
Date
CIC C
Printed Name of Contractor License #
License Type: F1 General F] Building 0 Residential 0 Roofing Contractor
LJ or any individual certified in accordance with F.S. 468 to make such an inspection.
STATE OF FLORIDA COUNTY OF S7 I -,n o) U
Sworn to (or affirmed) and subscribed before me this c90 day of 20 1 b, by
c>,a,, os Ve j who is 0 Personally Known to me or has 19 Produced (type of
i entificat on as identification. ti'
WrA A A _M"A6&LJ) (SEAL)
ii2gnature of Notary Public
State of Florida
amww ff- 0--, /
Print/Type/Stamp Name
of Notary Public -
SAMANTHA MURRAY
My COMMISWON # FF9"322
EXPRES Dewmber 16.2019
40f) 398-0'53 FWxW40taryservice com
Revised: February 2015
j# 5qg,
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: Jimmy Allen, Scott Meixsell, Luis Rios
an agent of.- Jasper Contractors
NameofCornpany)
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):
0 The fic ermit and application for work located at: 1TV r () n /gin in rf) q VQ J
Expiration Date for This Limited Power of Attorney:
License Holder Name: Kjf44jAV,, 3TV-Poe;Nj
State License Number:
I
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this c9(.Oda-Y of b
20§A.2_,by VVJ((-f agj who is ci personally known
to me o,a who has produced as
identiffiation and who did (did no take an oath. 0 take an
ignature
Notary Seal) gai-na hl-l-w /&—/2-av
SAMA H; NT MURRAY
My COMMISSION # FF944322
December 16. 2019EXPIRES
00;) 398-O'b3 Fjo rySeryice.COM
Rev. 08. 12)
Print or type name
Notary Public - State of F-(-
Commission No. Et- /-/'-/
My Commission Expires: , c)