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HomeMy WebLinkAbout118 McKay BlvdC. jar , CITY OF SANFORD OCT 5 2016 BUILDING & FIRE PREVENTION PERMIT APPLICATION r M / vApplicationNo:. ljG ' j, Documented Construction Value: $ Job Address: 0. Ind Historic District: Yes No Parcel ID• 3- 9 3 2 0 Q O O Residential Commercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Desc1 riptionofWork: 9-Vri 0-1 6 1 5 t 0e ) t s (t U'' 2 TO L vc - C Q SS s 41 to P 1-e Plan Review Contact Person: Phone: e- Fax: Title: Email: j Property Owner Information Name Y b U uv\' i tM; t L L C Street: 114 0 \1 S ' Aio L.A., r - City, State Zip: iGAyz6e43 TL 34R3 Phone: Resident of property? : 0 Contractor Information A v-71a - 4) Ufa Name `° y Phone: Street: 3S d ( mma, -r- Fax: City, State Zip: t` M-1 ey 0V ,p a_x, State License No.: C__(LC IT2 Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: Bonding Company: Address: 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 CQMMFNCFMFNT. 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, beaters, tanks, and air conditioners, etc. FBC 1053 Shall be inscribed with the date of application and the code in effect as of that date: 51 Edition (2014) Florida Building Code 6D Revised: June 30, 2015 Permit Application 1 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 foi egoing information is accurate and that all work will be done in compliance with all applicable laws gulating construction and zoning. S t a........od ' ign re of Owner/Agent Date Sign ure of ontr t r/Agent Dat Print Own genrs Name v 0 i6 Signat of ' o IRYNA S. AF DategfFlorida 2 ;"= Notary Public - State of Florida Commission # FF 906792 My Comm. Expires Jul 26, 2018 a E"'o /g2.loin Print Contractor/Agent's Name Notary Public - State of Florida Commission # FF 906792 My Comm. Expires Jul 26, 2018 Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID Type of ID 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 t 2-(') Altamonte Springs, Casselberry, Lake'Mary, Longwood, Sanford, Seminole County, Winter Springs Date: JD )511 L I hereby name and appoint: 6 I-., Qu..0 v 2a u an agent of: %- A CE-p-11` yt'b k" 9 " 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): The specific permit and application for work located at: Street Address) Expiration Date for This Limited Power of Attorney: 10 5' 1 : License Holder Name:_ v,,3 State License Number: L rc \3Mq q Signature of License Holder: STATE OF FLORIDA COUNTY OF _0_&My b"E The foregoing instrument was acknowledged before me this day of F3-C- - , 201-6 , by }1 , ,t p t,._ who is rsonally known to me or o who has pr 't uced as identification and who did (did not) taA an oath. io» v fi Qtary S 1 A S. AFONG r K\/Nk A A ( Notary Public Stag of Florida print or type name Commission # FF 906792 F o?•' My Comm Expires Jul 26, 2018 Notary Public - State of r—j-og, Commission No_ My Commission Expires: LIE Rev. 08.12) THIS INSTRUMENT PREPARED BY: Name: Carlos A Marrero Address: Permit Number: Parcel ID Number: 31-19-31-521-01300-0100 1111111111111111111111111111111111111111 tlfahYr NIC 1101:tSE; SE11i:1,401-E COIJITF C:LI=RK OF CIIZC:L1IT COIJI0. & C011F'1'ROLLER BK 8777 1' 1tti t1F'ss) CLERK'S u 201L102701 RECOI;I)ED 09/30/` f).l. ii;,:20;; J.0 111 RECORDING FEE $10.0o I EC00ED BY t -se. i th The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following inforlmlattiioon iis provided in this) Notice of Commencement. 1. DES fPBLK BFV a110 gTon(UaVS geCp1 qp, the R pe&y and street address if available) Sanford, I'ti 1 I Ci t5 2. GENERAL DESCRIPTION OF IMPROVEMENT: Tear -off old shingle roof install new fiberglass shingle roof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: PDV Unlimited LLC 16017 Citrus Knoll Dr. Winter Garden FL 34787 Interest in property: owner Fee Simple Title Holder (if other than owner listed above) 4. CONTRACTOR: Name: k o- 1 Phone Number. (4 0 AA ,' Address: 3l a o !- pp t oL A kt/e, i ,?-y gak . 1"' r L 32191 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 whom notice or other documents may be served as provided by Sectio r 713.13(1)(a)7., Florida Statutes, g z N Name- Phone Number. " '' , A 8. In addition, Owner designates 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 CON(1C1 EN TARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN f21:S' . IN OUR 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. 0•-v1 Ci, 45 0- V J 2 Signature of Owner4zldsseb, or Owner's or Lessee's (Print Name and Provide Signatorys Title/Office) j Authorized Officer/Director/Partner/Manager) State of County of 5 e v.ni 1&0 (G, The foregoing instrument was acknowledged before me this day of S C,12 Z. -" l l .Z , 20 by Name of person making statement who has produced identification b type of'iddntification 1 produced: CARLOS A. NotarA ublic =_ My Gomm. E0 CommiBslori Who is personally known to me TOR Notary S' n ure F City of Sanford Building and Fire Prevention Product Approval Specification Form Permit # Project Location Address / l (o I"I C K3,4o 4V"'0 - PL 3DIg1 As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the information and product approval number(s) on the building components listed below if they are to be utilized on the construction project for which you are applying for a building permit. We recommend that you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product Approval can be obtained at www.floridabuildinq.org. The following information must be available on the jobsite for inspections: 1. This entire product approval form 2. A copy of the manufacturer's installation details and requirements for each product. Category / Subcategory Manufacturer Product Description Florida Approval # include decimal 1. Exterior Doors Swinging Sliding Sectional Roll U Automatic Other 2. Windows Single Hun Horizontal Slider Casement Double Hun Fixed Awning Pass Through Projected Mullions Wind Breaker Dual Action Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # including.decimal) 3. Panel Walls Siding Soffits Storefronts Curtain Walls Wall Louver Glass block Membrane Greenhouse E.P.S Composite Panels Other 4. Roofing Products Asphalt Shingles e,1 0, pr,/ F L $ < Underla ments Roofing Fasteners Nonstructural Metal Roofing Wood Shakes and Shingles Roofing tiles Roofing Insulation Waterproofing Built up roofing System Modified Bitumen Single Ply Roof Systems Roofing slate Cements/ Adhesives / Coating Liquid Applied Roofing Systems Roof Tile adhesive Spray Applied Polyurethane Roofing E.P.S. Roof Panels Roof Vents Other June 2014 Category / Subcategory Manufacturer Product Description Florida Approval # include decimal 5. Shutters Accordion Bahama Colonial Roil u Equipment Other 6. Skylights Skylights Other i. Structural Components Wood Connectors Anchors Truss Plates Engineered Lumber Railing" Coolers/Freezers Concrete Admixtures Precast Lintels Insulation Forms Plastics Deck 1 Roof Wall Prefab Sheds Other 3. New Exterior Envelope Products Applicant's Signature Applicant's Name , Please Print) June 2014 9/22/2016 SCPA Parcel View: 31-19-31-521-OG00-0100 Parcel Information Property Record Card Parcel: 31-19-31-521-OG00-0100 Owner: PDV UNLIMITED LLC Property Address: 118 MCKAY BLVD SAN FORD, FL 32171 1.._...._............. _________....................._______.._............................. _______................................___.._..,.....,,_______.......................... Parcel31-19-31-521-OG00-0100 Owner PDV UNLIMITED LLC Property Address 118 MCKAY BLVD SANFORD, FL 32771 Mailing 16017 CITRUS KNOLL DR WINTER GARDEN, FL 34787- Subdivision Name I WASHINGTON OAKS SEC 1 Tax District S1-SANFORD DOR Use Code 01-SINGLE FAMILY Exemptions Value Summary j I........... 2016 Working Values 2015 Certified Values Valuation Method s CostlMarket 1 Cost/Market NumberofBuildings I........................ r......_ 1 ................_..__...,.._.,,............ 1 i Depreciated Bldg Value j..._.._.._......................................,,,,.,,...j,,........................_.__................_...__..., j $50,982 51,326 Depreciated EXFT Value Land Value (Market) i $13,500 13,500 Land Value Ag t..........................._......... _. Just/Market Value ** i $64,482 a........................................................................................................................ 64,826 1 Portability Adj I Save Our Homes Adj 0 t..................................._... _- Amendment 1 Adj 0..........._ ._. _.....__._,,,.,,,,,,,,,,.,,,,,,..,.,,,,........................... 0 0 p.......................................__..._......_............................................ P&G Adj y___..................... _......._.... .................I....,..................__....._.._._....,.. 0 0 Assessed Value 64,482 64,826 Tax Amount without SOH: $1,319.00 2015 Tax Bill Amount $1,319.00 Tax Estimator Save Our Homes Savings: $0.00 TRIM Notice Help Does NOT INCLUDE Non Ad Valorem Assessments Detail by Entity Name Page 1 of 2 Detail by Entity Name Florida Limited Liability Company PDV UNLIMITED LLC Filing Information Document Number FEI/EIN Number Date Filed Effective Date State Status Principal Address 16017 CITRUS KNOLL DR WINTER GARDEN, FL 34787 Mailing Address 16017 CITRUS KNOLL DR WINTER GARDEN, FL 34787 L16000100094 NONE 05/23/2016 05/17/2016 FL ACTIVE Registered Agent Name & Address BARRETO JUNIOR, EMERSON DE SA 16017 CITRUS KNOLL DR WINTER GARDEN, FL 34787 Authorized Person(s) Detail Name & Address Title MGR BARRETO JUNIOR, EMERSON DE SA 16017 CITRUS KNOLL DR WINTER GARDEN, FL 34787 Title MGR DOMES DE SA BARRETO, ROSANA 16017 CITRUS KNOLL DR .___..e WftTER-GARDEN, FL 34787 Annual Reports No Annual Reports Filed http://search. sunbiz. org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 10/5/2016 Detail by Entity Name Page 2 of 2 Document Images 05/23/2016 -- Florida Limited Liability I View image in PDF format Copyright © and Privacy Policies State of Florida, Department of State http://search. sunbiz. org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 10/5 /2016 G I A. I C e °t.fied Rodin() lrlC. Your Roo jinn; ompany. South s HOUSTON • ORLANDO • PALM COAST • MIAMI • Date: 09/ 20/ 2016 G&A hereby proposes to perform and furnish the labor, materials, insurance, supervision, equipment, and warranty in accordance with the specifications described below for: Client: Rosana Gomes De Sa Barreto Address:116 Mckay Blvd. Telephone: 407-462-1239 Lic#CCC1329699 Roofing Proposal/Contract G&A Certified roofing is pleased to submit this proposal to Mrs. Barreto and we thank you for the opportunity to bid on your upcoming project. G&A Certified Roofing is a licensed and insured roofing contractor in the state of Florida and is uniquely positioned to handle a Turnkey Project of this magnitude. Upon signing a contract, G&A will provide all supervision, labor, material, equipment and tools to meet your specification. The Site Supervisor will have authority to make decisions on behalf of G&A Certified Roofing as it relates to the above referenced project. G&A Certified Roofing has the proper combination of resources, skills and experience required to successfully integrate, procure the materials required for installation and technically supervise the installation of the specified roofing material in a clean and professional manner. We base this on a long history of successful projects. G&A Certified Roofing Inc. pulls all permits and files a Notice of Commencement. a f1or IGioli !., La•. South Corporate Office a 3500 Aloma Ave suite W-3 • Winter park. FL 32792 • Phone (407) 772-4242 9 Fax (407) 678-4242 NEW ROOFINSTALLATION G& A hereby proposes to perform labor and materials for the Fiat Roof. Remove all existing roofing and flashing and properly dispose all debris Furnish and install eave metal around perimeter of the house. Furnish and install lead flashing, kitchens vents. Furnish and install shingle over ridge vent: Install Certainteed Landmark Shingles. Payment Terms; 40% at delivery of material 60% upon completion of the project. Contract Sum Slope Roof: $5,000.00 (Five Thousand Dollars). Conditions: 1. PUNCH OUT 48 HOURS AFTER JOB COMPLETION. DAMAGE AFTER PUNCH OUT IS NOT UNDER. WARRANTY. 2. G&A WILL PROVIDE A 2-YEAR WORKMANSHIP WARRANTY FROM THE COMPLETION DATE 3. SHOULD YOU HAVE ANY QUESTIONS OR COMMENTS, PLEASE CALL US. 4. PLYWOOD REPLACEMENT (PRICE INCLUDES 2 SHEETS) AT AN ADDITIONAL CHARGE OF $45.00 PER SHEET (4X8). ALL NAILS AND NAIL PATTERNS TO MEET CODES. PLYWOOD CLIPS SHALL BE USED AS PER CODES. 5. REPLACEMENT OF DAMAGED OR ROTTEN 6" FASCIA $3.40 PER LF. SUB FASCIA AND RAFTERS ARE AN ADDITIONAL $5.25 PER LF. 6. ESTIMATED TIME OF COMPLETION WILL BE 14 DAYS UPON RECEIPT OF PERMIT, EXCLUDING SUNDAY AND WEATHER DAYS. Summary: A review of our overall bid and experience will demonstrate the overall value of working with G&A Certified Roofing on your project. G&A possesses extensive experience in roofing options which enables us to recommend the most appropriate application for your specific project tohelpachieve your end goal. G&A Certified roofing appreciates the opportunity to continue working with you. If you have any questions regarding the information presented here please feel free to call us at the contact number below. This agreement is subject to revision or withdrawal by G&A, until signed and accepted by Client and executed by an Officer of G&A Certified Roofing Inc. This is the complete agreement between the'two parties. No prior of contemporaneous oral agreements, and no other written agreements, except as listed above, shall be binding. The undersigned hereby accepts this Agreement and agrees to be legally bound by all the terms and conditions set forth on the terms and conditions page. This Agreement shall be governed in accordance with the, laws of the state of Florida. Any action arising under this Agreement shall be brought in the County where G&A's principle office is located. Client Signature Date President Signature Date Deerfield Office Palm Coast Office Certified Roorhl;, hw South Corporate Office « 3500 !Noma Ave suite R%-3 0 Winter park. FL. 32792 • Phone (407) 772-4242 • Fax (407) 678-4242 PROJECT PROVISIONS I. PROJECT PROVISIONS a. Guideline: The project will be constructed in strict conformance to the plans and specifications, which have been examined by the Owner. b. Compliance: The project will be completed in strict compliance with all laws, ordinances, rules,. and regulations of the applicable government authorities. c. Control: The agreement, plans, and specifications are intended to supplement each other. In case of conflict, the plans will control the specifications and the agreement provisions will control both. d. Change Orders: As directed by Owner, construction lender, public body or inspector, any alteration or deviation from the specifications that involves extra cost (subcontract, labor, and materials) will be executed only upon the parties entering into a written change order. The owner will pay for expense occurred because of unusual or unanticipated conditions. c. Allowances: If the agreement price allowances, and the cost of performing the work is greater or less than this allowance, then the agreement price will be adjusted accordingly. 11. FINANCIAL RIGHTS AND RESPONSIBILITIES a. Labor and Material: Contractor will provide and pay for all labor and material necessary to complete the Project. Contractor is released from this obligation for expenses incurred when the Owner is in arrears in making progress payments. b. Permits: Contractor will obtain and pay for all required permits and licenses. c. Taxes, Assessments, and Charges: Owner will pay taxes, special assessments of all descriptions and charges required by public bodies and utilities. d. Bankruptcy: If either party becomes bankrupt, the other party has the right to cancel this agreement. III. OWNERS RIGHTS AND RESPONSIBILITIES a. Cancellation: Owner has the unconditional right to cancel the agreement, without penalty or obligation, until midnight of the third business day after the agreement was signed. Cancellation must be done in writing. Upon cancellation, any property traded in, any payments made under this agreement, and the contractor will return any negotiable instrument executed 10 business days following the receipt of cancellation. b. Property Lines: Owner shall locate and point out any property lines to the contractor. Contractor may, at his opinion, require the owner to provide a licensed land surveyor's map of the property. C. Liens: Failure to pay persons supplying materials or services according to the terms of this agreement may result in the filing of mechanic' liens on the affected property. Owner has the right to ask the contractor for lien waivers from all persons supplying these materials or services. In the event any mechanics is filled through no fault of the owner, then the contractor agrees to take all steps necessary for the release and discharge of such lien. d. Insurance: Owner will maintain property damage insurance at least equal to the Agreement price. e. Damage to Project: Contractor will not be responsible for any damage caused by the owner, or other cases beyond the control of the contractor. Owner will pay for any restoration work. IV. CONTRACTORS RIGHTS AND RESPONSIBILITIES a. Delay: Contractor will be excused for any delay beyond his reasonable control. These delays may include but are not limited to act of god, labor disputes, inclement weather, acts of public authority, acts of the owner, or other unforeseen contingencies. b. Right to Stop Work: If any payment under this Agreement is not made when due, the contractor may suspend work until such time as all payments due have been made. Any failure to make payments is subject to a claim enforced against the property in accordance with the applicable lien laws. c. Substitution of Materials: Contractor may substitute materials without notice to the owner in order to allow work to proceed, provided that the substituted materials are no lesser quality than those listed in the -specifications. d. Salvage: All salvage resulting from work under this Agreement is to be retained by the contractor unless other Agreements are contained in the written specifications. e. Insurance: Contractor will maintain workers' disability compensation insurance for his employees and comprehensive public liability insurance policies. V. COMPLETION OF PROJECTS G I A 1 t ertiriol lioofin!, Im. South Corporate Office 9 3500 Aloma Ave suite W-3 r Winter park. FL 32792 • Phone (407) 772-4242 • Fax (407) 678-4242 a. Notice: Owner agrees to sign a Notice of Completion within 5 days of completion of the project. If the project passes final inspection and the owner does not sign the Notice, the contractor may act as the Owner'sagent and sign the Notice. b. Clean-up: Contractor is responsible for removing debris and surplus material from the property and leaving the property in a neat and orderly condition. VI. CONFLICT RESOLUTION a. Arbitration: Any controversy or claim arising out of this Agreement that cannot be resolved is subject to arbitration, with an arbitrator of mutual agreement, and all parties (including Owner, Contractor, Architect, and Sub -contractors) are bound to this arbitration. If any party does not appear at arbitration proceedings, the arbitrator is empowered to decide the controversy in accordance with whatever evidence is presented by the party (ies) that do not participate. b. Attorney Fees: If either party becomes involved in litigation arising out of this Agreement; the court shall award costs/ expenses including attorney fees to the prevailing party. c. Limitations: No action related to this Project may be made by either party against the other more than 2 years after completion of work. VII. GENERAL PROVISIONS a. Notice: Any notice required or permitted under this Agreement may be given by certified or registered mail at the addresses contained in the Agreement. b. Prohibition of Assignment: Neither party may assign this Agreement or payment due under this Agreement without the written consent of the other party. C. Qualifications: This document constitutes the entire Agreement of the parties. No other Agreements exist. This Agreement can be modified only by written Agreement signed by both parties. d. Governance: This. Agreement shall be construed in accordance with and governed by the laws of the state in which the project is located. We will use caution during installation and will not be responsible for damages to interior or interior contents, landscaping, pool, patios, driveways, sidewalks, underground tines, except for proven negligence. It is recommended that accessible iterns around the exterior be placed inside furnishings in rooms with "open seam" ceilings be covered, items which might be damaged from vibration be removed or secured. Items such as screen/patio enclosure, solar system, air conditioning system, guttering which may require removal and reinstallation are not included in this contract unless specified therein. It is agreed that the Contract price is based upon the belief that the structure is sound and built in accordance with the local building codes. Additional costs to correct any of these situations will be customer's responsibility. Customer Cam'--'--' Date G Cer ifivd M),, ring, low. South Corporate Office * 3500 Aloma Ave suite W-3 • Winter park. FL, 32792 + Phone (407) 772-4242 • Fax (407) 678-4242 CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: ' 2-6 hereby acknowledge that I personally inspected of deck nailing and/or Secondary water barrier work r at and have determined that the work JW-Site AddressT _ 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 , uty shall constitute a misdemeanor of the second degree pursuant to Section 837.06 F.S. JLo Signature of Contractor Date n` ,M v, r,,, C--c-s— ) Printed of Contractor 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 ex) d Sworn to (or affirmed) and subscribed before me this day of D , 20 L40._, by who is Personally Known to me or has Produced (type of identificatio>< SEAL) Signature Io o ry PublicdState of FlA--, o, T,,_y i Print/Type/ Stamp Name of Notary Public IRYNA S. AFON Notary Public - State of Florida Commission # FF 906792 e N;; ocF dP My Comm. Expires Jul 26, 2018 Revised: February 2015 as identification.