Loading...
HomeMy WebLinkAbout333 Placid Lake Dr7 CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: / S;(p O Documented Construction Value: $ 6367.00 Job Address:, 333 Placid.Lake Dr. Historic District: Yes No Parcel ID:,. 02-20-30-520-0000-0170 Residential ® Commercial Type of Work: New Addition ® Alteration Repair Demo Change of Use Move Description of Work: Beroof Plan Review Contact Person: Jena Enfinaer_ Title: Office Admin Phone: 850-877-5516 Fax: _ Q_87,9_n989 _ Email: j II g tadlo kroofing om' Property Owner Information Name, Xaimara -Febo Rodriguez Phone: Street: 333 lacid-Lakp Dr. Resident of property? : Yes City, State Zip: Sanford , FI. 32771 Contractor Information Name _Dale Tadlock Roofing Phone: 850-877-5516 Street: '1408-3 Capital Cirble NF Fax:, 850-878-0289 City, State Zip: Tallahassee FI 08 State License No.: QQQ1398417 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 YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFCOMMENCEMENT. Application is hereby made to obtain a permit to do the work and installations as indicated. l 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. 1 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:'Ieaddition`ictIierd46iretiienfs-of'ihis-ppriitit IIieireinay' be -add itional-Je8trictions'applicable''td this`property1hat'may-b-6foundinthepublicrecordsofthiscounty, 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 of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID - 3 , .C) at rK)fContrnetor/A'gent Date T, Print Contractor/Agent's Name Si nature of Nottiry' -State of Flari a to r M', .t JESSICA RUTH SMITH i; s Commission # FF 917231 Expires September 10, 2019 7f ;, . WNL T[w Tro/ Frin Nw a U0.7A67011 Contractor/Agent is X Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY 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 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 m 02/12/2016 12:25 FAX 4076574007 ROBERTS SUPPLY Q 001 7T -A OLOCI R10FING When Trutt Cotewts! t rer:Ix4uelr Date: 10/26/14 I Olympus - Rodripez 333 Placid Lake Drive r r, rut lye 1.t.:: til.mflJ.tl r ny Il"glen AVir. .,ll lb rIOrn t)erk— e:1Y19-•y,.t In LJ r ,arr. In. YMMr.y.tlor NNnn.ur jWQ 6rnarrwewilleW IN . ll mt pm nn! I a• !1 nu me yIr 10 fa I,dT drtrchadWillrr.>rfarm the rallowtng crvrcrea when the Oen a mrrkt:d: acrnutec and 11LL•.,nJ UN_ Idyrr of ,ningle.a 11111 unrlurUrtinlcnl G Rollwt wood re lilt en at S i OIl PrtenAlp Anel M Mild dedkulq in 111rm Flotidd BWIOInQ COMr r.-quurinktnty Remove" L:gU(np ntf-Prnvn vnrlrn:llrrrttnrs and derle rnor he7lc4 Iuvluo A IM(311 nrv+ChurintcV flasnml• 9 'fOvida 4 nlylnn new h Ja 1'W v lu,n ]t d uives dole t V IovuJr 4 Insall rI PIpr; huols and kncnrn vl;ntu win squur0l ,pi.,1111 O Puwldr, S rrsrall 59 II ul Owerls Cornlnk VArisuru Rldke Vqm fl 'h;Ll •, n 1.d r+.mgvr,w Inll.1 Ated dehns ro 10PNluead landhlr ' I IIJ, Inoll-A, ne•r ,I or If what ap011Cr+bII;- wdl huIJeu;U on n mm -e .i( Iu1) lymph;pun U F deI W1'' IAii ntrnE of •wood W 01.1101' wnert cnecifen Il Inslell Ttanitirn UrldefWrrant on entire roof Q _ WE WILL PERFORM THIS SCOPE OF WORK PER LOCAL CODES AND MFG SPECNgfATION5 FOR YHEBASE PRICE OP Payment Terms; fgelance dug upon subrstUtlar completion fINANCriva QW0117CAMP OOMNS AyA1L4DLe UPON RgQULlT! V W w W'r W ADDITIONAL OPTIONS ........ yr W+ W W V W 0--UPORADE to OC DURA•T10N-TruDegnkior,-Arch."h gres:-,..,_..- — add --!/A__ LL UPGRADE to OC Weatnerlock Mat self -adhered underleyiirent...._._.. add _ y Cf OPTION - _ OPTION ---- add 0 OPTION - ado so add SO TOTAL WIIp ADDITIONAL OrYION3 AN macMel,y gwmnmrm 1'0 tet 4" ieNwlrllM. All want to 1'y oomplWed n a waremanutre winner accomhYr m atendrrd prectlern, AnyaltirauontindWlatlml from revue clw+:mradoln Invalwnt{ ra WX- WIII be tPteartrd uean Wllt9n Or.rer0el ardere, an1! d wee OW0en vetrs worse over and above tint adnYer. All wrycvnents aro a1' ranhn ertr upon icettlrrRe Of delnye heyona OuroOM091. fir, omoo at AlAII t in at.vllerprence ,mn 74 Para gnu Ju "Wd Un–Malice a1' m; nprl0n or rola Odic T wul'A RwmIA !r ACCPJTANCtt or Fleoeo5Al• Wlm my sednrlwe I)CAQW, I hereby JUl l thr, proDOWI and jVMOnle 0@%Tedloc4 RoOfirlp Ino 1.0 (10 0eu my101eSiNte prg 9rpprr, I hm,re mail and cr 29MO to ft Terms end Condloons On NmI! docuent or nhacned, 9houW oarmMI! N d2sOr Cnt not on rneipvmd upon suM Jnaa1 complerinn a1' the, IOM, 1heM Inlerert AFr111 VILS ( a a1' L5% 0urd t oleunt f0 tled to rmttorry "Or 00`16aINr 1 %V111 she rw. wvt)ke for their (MM. pee Monlh ana n a lic Ilan., - ...p.II-. • r - - Oere / 35C.964.75155 1 www I.NrIenTrustCounts Corrt Permn no.. Tax Folio No. 02-20-30-520-OW.017() NQU Q olti MINCEMENT To Whom It May Concern:--'^- 7` e-tn,dersigned-hereby informs=yba tharimpr'ovenients will ba'rna'de'tb-ceriain real prapetty; and in accordance-with`Si ecicFloridaStatutes, the following infbtm ulon is stated in this NOTICE OF COMMENCEMENT.,' t: Description of property: Single Family Residential - Built 1998 - Seminok County prepared by: LeanneLegalDescription: LOT 17 PLACID WOODS PH 1 PB 51 PGS 23 THRU 29 MurphyStrmtAddress: 333 PLACID LAKE DRIVE, SANFORD FLORIDA 32771 2. 'General dticxiption of improvements: Rooting Tadlock Roofing 3. Owner't Information.- 1408-3 Capital Circle NE Names: XAIMARA FEBO Tallahassee FL 32308 Address: 333 PLACID LAKE DRIVE, SANFORD FLORIDA 32T71 Interest in Pro": _- Name and Address of 4.(If Contractor rnfomtatloa: Name: Dale Tardloc Rooting, Tne. simple titleholder atfier than owner); Address: 1408-C Capital Clyde NE, TaIlabasue, Florida 32308 Telephone No.: (830) 877-5516 Fax No.: (850) 878.6289S. Surety Infarrrratiott: NIA Name: Address: Amount of Bmd: TeteP hone No"- - . Fax NoOpt.) t. 6. Lender Information: N/A Name: ( ) Telephone No. Fax No. (Opt.) - - .... _ _- 7. Identity of person within the State of Florida designated by ownerupon whom notices or other documentsmaybeserved- NIA Name: L Address: relephartc No. Fax No. (Opt.) g• In addition to himself, owner designates the following person to receivo a copy ofthe I.iaaor's Notices asPmvideiiinSection713.I3 (I) (b), FtoriGa Statutes: NIA Name: Address:"'" - 9. Expiration date ofNotice of ComrrtencemeTelephone c (the expiration dare is i year from the date pf recording unless differentdateisspecl$ed) N/A WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OFCOMMENCEMENTARECONSIDEREDIMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13. FLORIDASTATUTES, AND CAN RESULT IN YOUR PAYING TWICE FORL1IPROVEMENTS TO YOUR PROPERTY, A NOTICE OFCOMMENCEMENTMUSTBERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHETOOFIRSTLNSPECTION, IF YOU INTEND YOFINANCING, CONSULT YOU . a 1)ER OR AN 'A RNEY BEFORE COMMRNCENG WORK OR RECORDINGIRNOTICEOFCOMMENCEMEN'i. C' A- 1 U Zed: rarR irectorlParttitec ., State Of Florida PrintName County of Leon The r rctgng in u iirsicrit'r aes ckrita rla;ls ed before me this Iq day of _. 20 10, By lC t..11' who is per pnatl wn to ta e ii and who did/did not take an - pmcl p as identification Sig t :._:.:.. .. ,,,,w,. CCyy44jj / JESSICA RUTH SMITH ' Commltalon3FF917231 Printed Name t3y Exom Sepbmbw 10.2019Verification'04 uartt to Section 92.523, Florida Statutes Under pe dli' ti f "'tirv, [ deci mild the foregoing and that rhe facts stated in it are true to the best of my knowledge andbelief _ Signature ofNatural Person Signing Above MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL Pmvq a,)n1rn1anao RK;tAg7 Pro n7RA, f•ir,r.i F_pFrnpnRn nwnr)n1r, nz•in•na enn' City of Sanford Building & Fire Prevention Division Re -Roof Permit Card PERMIT NO. ISSUE DATE: A Gt.d /0 4 . CONTRACTOR: e% JOB ADDRESS: TYPE OF WORK e Post this Permit in a conspicuous place outside Approved plans must be posted with permit for inspection PROTECT FROM WEATHER Leave all work uncovered until inspected Permit expires six (6) months from date of issue or last approved inspection A R OOF DR Y -IN INSPECTION IS REQ UIRED For Inspection procedures, please refer to the re -roof inspection guidelines provided to you when the permit is issued. The Mitigation Affidavit will not suffice as an alternative to receiving a dry in inspection MISCELLANEOUS DRY -IN TION AFFIDAVIT ROOF WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OFCOMMENCEMENTMUSTBERECORDEDANDPOSTEDONTHEJOBSITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. NOTICE IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLICRECORDSOFTHISCOUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATEAGENCIES, OR FEDERAL AGENCIES. FBC 105.3.3 REVISED: October 2014 Inspection Line 855.541.2112 TO SCHEDULE AN INSPECTION: Dial 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 ig PLEASE NOTE: Inspections scheduled by 3:30 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 ROOF Roof Dry In 116 Mitigation Affadavit 129 Final Roof 111 Miscellaneous Notes: Miscellaneous Sheathing - Roof 106 Insulation - Roof 119 REVISED: OCTOBER 2014 Inspection Line: 855.541.2112 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 16-00000868 Date 3/21/16 Property Address . . . . . . 333 PLACID LAKE DR Parcel Number . . . . . . . . 02.20.30.520-0000-0170 Application description . . . ROOFING APPLICATION Subdivision Name . . . . . . Property Zoning . . . . . . . MULTIPLE FAMILY Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 932681 Permit pin number 932681 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 10-1000 129 BL29 MITIGATION AFFIDAVIT 10 116 BL15 ROOF DRY -IN —/—/- 1000 111 BL03 FINAL ROOF —/—/— CITY OF SANF©RD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: I — gl F I, Bne c1 KISS hereby acknowledge that I personally inspected Roof deck nailing and/orXsecondary water barrier work at ;jj, ) R''c-; r;' O?d /fp .1 "S'a-n Polg,, r` L and have determined that the work Job Site Address) was done according to the Hurricane Mitigation Retrofit Manual. (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 Sec 37.06 F.S. Signature of Contractor Date 14K- CCC 3 8 "% 9 Printed Name of Contr to License # License Type: General Building C ResidentialRoofing Contractor I or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF &L.AA worn to (or affirmed) and subscribed before me this 5-t day of Wk-Mbe-r 120 1p, by who is %Personally Known to me or has C Produced (type of i e tification). - as identification. SEAL) 81gdature of Notary Public St(a te1 of .F—l orida'' J ,t LAUREN PErns 1 r Nogry POW - Stfb o1 FWW& Print/Type/Stamp Name, Commission # FF 902097 of Notary Public 1;' RS`g`'` r omm. Espns Jul 21, 2019 ftU* BftW 1W1ry Assn. Permit no.: z Tax Faro No: di6`*520-000-0170 rrQ oi cQ Nc MErrr. ILP $ Y' Whurri I't May Concern: I'hc undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following Intbrmation is stated in this NOTICE OF COMMENCEMENT. 1. Description of property: Single Family Residential —Built 1995 —Seminole County prepared by: Leanne Legal Description: LOT 17 PLACED WOODS PH 1 PB 51 PGS 23 THRU 29 MurphyStmetAddress: 333 PLACID LAKE DRIVE, SANFORD FLORIDA 32771 Tadlock RoofingGeneraldaidiptioriofimprovements: Roofing 1408-3 Capital Circle NE3. Owner's Information: P Name: XAIMARA, FEBO Tallahassee FL 32308 Address: 333 PLACID LAKE DRIVE, SANFORD FLORIDA 32771 Interest in Property: Name and Address of fee simple titleholder (if other than owner): 4. Contractor Information: Name: Dale Tadlock Roofing, Inc. Address: 1408-C Capital Circle NE, Tallabassee, Florida 32308 Telephone No.: (830) 877-5516 Fax No.: (850) 8784284 5. Surety Infmnation: N/A Name: Address: Amount of Bond: 6. Telephone No. Fax No. (opt.) Lender Information: NIA h'amt Address: ..-_:-- • _................_....... Telephone No. Fax No. (Opt.) 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: N/A Name: Address - - . Telaphone No.- — Fax No. (Opt.) 8. In addition to himself, owner designates the following pmon to receive a copy bfthe Lienor's Notice as Provided in Section 713.13 (t) (b), Florida Statutes: N/A , Name: Address: Telephone No.- _ ,.. Fax No. (Opt.) _ 9. Expiration date -of Notice of Commencement (the exphurlondateisis I year from the date of recording unless differentdateisspecified) NIA WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMEN rS UNDER CHAPTER 713, PART 1, SECTION 113.13. FLORIDA S'fATUt'ES. AND CAN RESULT IN YOUR PAYTNO TWICE FOR N1PROVEMENTS TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTENDTOOBTAINFINANCING, CONSULT'YOU IIT)_ER OR AICA RNEY, BEFORE COMMF.NC(NG WORK OR RECORDINGYOUR, NOTICE OF COMMENCEMENT. rrp, 'ne. wn rx`s tl.udiorlaiti :csrr irectortPartrtcr `"" PrinName _ Stat of Florida _ County of Loon ( The F regain insttvment tvss c1 nriwlc i J before lne this day of :(I 2p, BY L[A,lr_ C L. who Es,personall knowfto Itis h..s rtufui ed as identificationandwhodid/did not take en oa "'"'-' JESSICA RUTH 917H Commission g FF 517231 Printed Name — 2R, ` . Explais September 10, 2019 t Verification pu dant to Section 92.525. Florida Statutes "t'' 0 0 T-TmF,o"""""'°°all,- ' Under Fe illi' .y f fire: ITutt 4 the foregoing and that the facts stated in it are true w the best of my [cnowledae andbelief. s Signature Of Natural Person Slgnino Above MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY FL r1 FPK'C 0?n1An1QnFZQ RK RFi17 Pn n7Fft- 11mril F.PFr.r)P i=n n?r'?'N7f ir, nz,l *nA PUA CONTRACTOR'S AFFIDAVIT AND CONDITIONAL RELEASE OF LIEN r__I.' li Before me, the undersigned authority, duly authorized to take acknowledgments and administer oaths, personallyappeared _bale.Tadlock . ("Contractor"), who, after being first duly sworn, deposes and says that: 1. I am a licensed contractor in the State of Florida doing business as. -Dale Tadlock Roofing_ , (name of business), located at 1409.1J, Capital Circle -NE Tal[aha`ssce-E1.,.32308 (mailing address). r 2. Contractor has heretofore furnished, or caused to be furnished, labor, materials, and/ or other service for the repair or replacement of a property (collectively, the "Services") insured by Olympus Insurance Company OIC") located at '333 Placid Lake Dr. ,Sanford FI. 32773- (property address) and owned by Ruddy 116ari, iiez ("Owner"). 3. Contractor represents that all work performed with respect to the Services for the aforementioned property has been fully completed. Contractor further represents that, conditioned upon Contractor's receipt of a final payment for the Services in the amount of $00.00 (the "Final Payment"), that all subcontractors, materialmen, lienors, and potential lienors, who have furnished labor, materials, and/or other services with respect to the Services have been or will be paid in full and have properly executed or will execute waivers and releases of liens. 4. In consideration of the Final Payment to the Contractor, and all other previous payments paid by Olympus MGA Corporation or its designated agent ("OMC"), OIC or the Owner to the Contractor, the undersigned, conditioned upon receipt of the Final Payment, does hereby, for and on behalf of the Contractor, waive, release and relinquish the Contractor's right to any claim or demand or right to impose a lien or liens for work done or materials for Services furnished or any other class of lien whatsoever, on any of the property owned byOwner, on which Services have been completed. 5. Conditioned upon Contractor's receipt of the Final Payment, Contractor agrees to indemnify and hold harmless Owner, OMC and OIC from and against all liability and costs, including reasonable attorneys' fees, arising from any claim or lien that may be asserted at any time in the future against Owner by Contractor or any other party by virtue of the work performed on the aforementioned property. 6. The undersigned represents that he has authority to execute this Affidavit and Conditional Release of Lien for and on behalf of the Contractor. Under penalties of perjury, I declare that I have read the foregoing Affidavifand the facts stated in it are true. A Sig ature Q. Printed Name STATE Florida COUNTY Leon On this 5 day of JLAtW 2016,_before me, the undersigned notary, personally appeared ho is personally known to me or [ ] proved to me through identification documents allowed by law, which were -- _., to be the person who signed the preceding document in my presence and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. Notary Seal My Commission Expires: SX5 o ary Public 1!:Lj skg c- s PrintedName IETKWSHEAT3 n y Commlrtan! FF 1M E** May20;2020 onewltwhgw,Uwirwioieo4,tlsioti CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit#:' 1I —00000868 I, hereby acknowledge that I personally inspected V Roof deck nailing and/or;vSecondary water barrier work at 33 Y I0 I U LUN 6 tyl Uo r -1 J 277land have determined that the work Job 5ite Address) was done according to the Hurricane Mitigation Retrofit Manual. (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 toSection837.06 F.S. gnature of Contracto Printed Name of Contractor Date r 1-32-R] License # License Type: General Building Residential Roofing Contractor or any individual certified in accordance with F.S. 468 to make such an inspection. STATE OF FLORIDA COUNTY OF iSw rn o (or affir ggd and subscribed before me this --2 day of —,20 Ax—, byl? `it ,who is OPersonally Known tom or has Produced (type of ode ionOq as identification. SEAL) Sign ture of otaryPublic .'ti l4 s JESSICA RUTH SMITHStat $f( rjd S `1 :` Commission # FF 917231VUrt ( • 1 r I 1 Expires September 10, 2019 Print/Type/Stamp Name a° •'°0J 101 of Notary Public