HomeMy WebLinkAbout157 Wildwood DrRECEIVED
+•, , � `� OCT 12011
CITY OF SANFORD
BUILDING & FIRE PREVENTION
- �
PERMIT' APPLICATION
/ C �`
Application No: ! Documented Construction Value: $- V
Job Address: 151 W1 Id l,I ocxl Drive Historic District: Yes ❑ No ❑
Parcel ID: Zoning:
`/�
Description of Work: 1 tyl Imll(om S C-,' oor(l�
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
Property Owner Information nn
NameI 11"�"� Phone:
Street: 15.7 iA O W OOC� (Xc %ye Resident of property?
City, State Zip: SC nn1 (u FL 13
Contractor Information
Name Phone:
Street: Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address:
Building Permit O
Square Footage:
Address:
PERMIT INFORMATION '''"' 'rt 11
1
Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical O
New Service — No. of AMPS:
Mechanical 0 (Duct layout required for new systems)
x,18 d"
I'
t
Plumbing O '
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm O No. of heads:
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.
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.
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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Si tune o weer/Agent Date
Print Owner/Agent's Name
LCJCJQ�C&
i ature of No t
,Nrii'r''a'�e, DEBBIE BLANTON
Notary Public • State o1 Florida
My Comm. Expires Feb 25, 2015.
Commission # EE 60192
Bonded Through National Notary Assn.
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: *M to `6 UTILITIES:
ENGINEERING:
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
COMMENTS: ,t w; n,aows - 44, 4, Ogg I i
Rev 11.08
WASTE WATER:
y
BUILDING: o ,(
OWNER BUILDER STATEMENT/AFFID"IT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole Couhty, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
Rev. 9.14.2009
I understand that state law requires construction to be done by a licensed contractor and have applied for
an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of
I
the property listed, may act as my own contractor with certain restrictions even though I do not have a
v
license.
I understand that building permits are not required to be signed by a property owner unless he or she is
C�
responsible for the construction and is not hiring a licensed contractor to assume responsibility.
I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed
C
in his or her name instead of my own name. I also understand that a contractor is required by law to be
licensed in Florida and to list his or her license numbers on all permit and contracts.
I understand that I may build or improve a one -family or two-family residence or a farm outbuilding. I
may also build or improve a commercial building if the costs do not exceed $75,000. The building or
(�
residence must be for my own use or occupancy. It may not be built or substantially improved for sale or
C�(
lease. If a building or residence that I have built or substantially improved myself is sold or leased within
in I year after the construction is complete, the law will presume that I built or substantially improved it
for sale or lease, which violates this exemption.
I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed individual person to act as my contractor or to supervise
persons working on my building or residence. It is my responsibility to ensure that the persons whom 1
employ have the licenses required by law and by city ordinance.
I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an
owner -builder permit that erroneously implies that the property owner is providing his or her own labor
and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any
injuries sustained by an unlicensed person or his or her employees while working on my property. My
UV
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -
builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is
not licensed to perform the work being done. Any person working on my building who Is not licensed
must work under my direct supervision and must be employed by me, which means that I must
U
comply with laws requiring the withholding of federal income tax and social security contributions
under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation
for the employee. I understand that my failure to follow these laws may subject me to serious financial
risk.
Rev. 9.14.2009
Property Address: �� 'm 11C\ym( 1) r,
1, , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
Form of Identification
(Must be Photo ID)
ate
10-Z)- 1 I
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires Ucensure under
the permit issued.
Rev. 9.14.2009
I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern owner -builders as well as employers. 1 also
understand that the construction must comply with all applicable laws, ordinances, building codes, and
zoning regulations.
I am of aware of construction practices and I have accest to the Florida Building Codes.
I understand that I may obtain more information regarding my obligations as an employer from the Internal
Revenue Service, the United States Small Business Administration, the Florida Department of Financial
Services, and the Florida Department of Revenue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-850-487-1395 or at www.mvflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
I am aware of, and consent to, an owner -builder building permit applied for in my name and understand
that I am the party legally and financially responsible for the proposed construction activity at the address
(� L
v
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
�Jq
information that I have provided on this disclosure or in the permit application package.
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person
who does not have a license, the Construction Industry Licensing Board, the Department of Business and
Professional Regulation and the building department may be unable to assist you with any financial loss
that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in
civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an
individual or firm is injured while working on your property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying
whether the contractor is property licensed and the status of the contractor's workers' compensation
coverage.
Property Address: �� 'm 11C\ym( 1) r,
1, , do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
Form of Identification
(Must be Photo ID)
ate
10-Z)- 1 I
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed activity against the owner and any person performing work that requires Ucensure under
the permit issued.
Rev. 9.14.2009
Print Quote
\ More saving. More doing"
Home Depot Store tt 0264
4600 W LAKE MARY BLVD
LAKE MARY, FL 32746
4073339650
Page 1 of 3
r
CUSTOMER:
DATE: 10/03/2011
PETTIT, CASSIE
157 WILDWOOD DRIVE
SANFORD, FL 32773
3214398545
SALES ASSOCIATE: JUDITH
Thank you for shopping The Home Depot! We value your business!
ITEM FRAME SIZE
LOCATION PRODUCT CODE
DESCRIPTION
UNIT PRICE
QTY TOTAL PRICE
JELD-WEN
Windows &
0001
Doors -EX,
$1,090.80
1 $1,090.80
Millwork
Masters
RO Size = 72" W x 79 3/16" H
Plus Series Bundled
Savings of ($112)
$1,047.80
Handing = 28 RH O/S
have been applied to
this unit:
o Product Category: Patio Doors
o Manufacturer. JELD-WEN Windows & Doors -EX, Millwork Masters
o Plant: Wedowee
o Plant Contact: 1.877.880.3667
o Product Style: French
o Product: Fiberglass Plus
o Product Configuration: Double
o Handing and Swing: 28 RH O/S
o Retro or Full: Retro
o Florida Building Code: Yes
o Dade Notice of Acceptance: No
o Door Width: 69 13/16-
o Net Unit Width: 71 1/2"
o Rough Opening Width: 72"
o Door Height: 77"
o Net Unit Height: 78 11/16"
4 9/16" Primed
Aural-ast Jamb:
pf-
$0.00
http://vendorapps.homedepot.com/usp/PrintQuote.jspx 10/3/2011
Print Quote Page 2 of 3
http://vendorapps.homedepot.com/usp/PrintQuote.jspx 10/3/2011
Outswing Unit:
$24.00
o Rough Opening Height: 79 3/16"
o Door Finish Type: None
o Impact Glass Option: Standard Glass
o Quality for Stimulus Tax Credit Option: (All Products)
o Energy Star: No
o Door Bore: Double Bore
Ball Bearing Hinges:
$0.00
o Insert Design: Blinds Between Glass Tilt/Raise
o Glass Option: Low "E" IG Tempered
o Hinge Type: Ball Bearing
o Hinge Finish: Polished Brass
o Jamb Cladding: No
o Jamb Width: 4 9/16"
Polished Brass
$19.00
o Jamb Species: Primed AuraLast
Hinges:
o Jamb Finish Type: None
o Brickmold Specie: None
o Brickmold Type: None
o Sill Width: 4 9/16"
o Sill Type: Premium Sill
o Sill Finish: Aluminum
o Sillpan: No
o Lockset: None
o SKU: 302796 / SIO PLUS SERIES FIBERGLASS PD
Premium Sill:
$0.00
o "French drawn as seen from the exterior. -
13
"MAKE YOUR HOME MORE ENERGY EFFICIENT & RECEIVE UP TO
A $500 TAX CREDIT. Purchase and install ENERGY STAR qualified
doors from 1/1/11 - 12/31/11 and you may be eligible to receive a federal
o tax credit under the Tax Relief, Unemployment Insurance Reauthorization
and Job Creation Act of 2010'. VISIT HOMEDEPOT.COMIfAXCREDIT
AND CONSULT YOUR TAX ADVISOR FOR MORE INFORMATION."
http://vendorapps.homedepot.com/usp/PrintQuote.jspx 10/3/2011
Print Quote
QUOTE #:
Page 3 of 3
Quote Summary
ITEM DESCRIPTION UNIT PRICE QTY TOTAL PRICE
0001 MANUFACTURER:JELD•WEN Windows & Doors -EX, Millwork Masters $1,090.80 1 $1,090.80
PRETAX TOTAL PRICE: $1,090.80
http://vendorapps.homedepot.com/usp/PrintQuote.jspx 10/3/2011
BROWNELL 325300
----------------------------------------------------------------------------►----
NOT VALID FOR MERCHANDISE PICK-UP AFTER
DATE: 10/03/2011 TIME: 13:49:17
--------------------------------------------------------------------------------
svr020a HOME DEPOT, INC. PAGE: 1
CUSTOMER PICK-UP CONFIRMATION
DATE: 10/03/2011
STORE: 0264 LAKE MARY
TIME: 12:49:16
------------------------------------ CUSTOMER PICK-UP WILL -CALL NUMBER 325300W02
Customer : BROWNELL RICH
Company .
Phone : Home (407) 416-0402 Work ('407) 416-0402 Ext
Site : 156 SEMINOLE AVE
LAKE MARY, FL 32746
Reference: CASSIE
------ QUANTITY ------
REF # SKU ITEM DESCRIPTION PICKED UP REMAINING
SOl 64515591
SO101
875-314
<> FRAME = 73" X 49"
1.00
0.00
50102
875-314
(CONTINUED)
1.00
0.00
S0103
875-314
(CONTINUED)
1.00
0.00
50104
875-314
(CONTINUED)
1.00
0.00
50105
875-314
(CONTINUED)
1.00
0.00
50106
875-314
(CONTINUED)
1.00
0.00
50107
875-314
(CONTINUED)
1.00
0.00
50108
875-314
(CONTINUED)
1.00
0.00
50109
875-314
FRAME
1.00
0.00
SO110
875-314
INSULATED
1.00
0.00
SO111
875-314
<> FRAME = 24 1/2" X 24 1/2"
1.00
0.00
50112
875-314
(CONTINUED)
1.00
0.00
S0113
875-314
(CONTINUED)
1.00
0.00
50114
875-314
(CONTINUED)
1.00
0.00
50115
875-314
(CONTINUED)
1.00
0.00
50116
875-314
(CONTINUED)
1.00
0.00
S0117
875-314
(CONTINUED)
1.00
0.00
50118
875-314
(CONTINUED)
1.00
0.00
50119
875-314
FRAME
1.00
0.00
50120
875-314
OBSCURE
1.00
0.00
S0121
875-314
TEMPERED
1.00
0.00
S0122
875-314
INSULATED
1.00
0.00
50123
875-314
<> FRAME = 49" X 49"
1.00
0.00
50124
875-314
(CONTINUED)
1.00
0.00
50125
875-314
(CONTINUED)
1.00
0.00
50126
875-314
(CONTINUED)
1.00
0.00
50127
875-314
(CONTINUED)
1.00
0.00
S0128
875-314
(CONTINUED)
1.00
0.00
50129
875-314
(CONTINUED)
1.00
0.00
50130
875-314
(CONTINUED)
1.00
0.00
Balance Due : $0.00
I HEREBY ACKNOWLEDGE RECEIPT OF THE ABOVE
ITEMS IN THE QUANTITIES SHOWN IN THE
"PICKED -UP" COLUMN ABOVE:
----------------------------- END OF CUSTOMER PICK-UP WILL -CALL NUMBER 325300W02
CUSTOMER COPY
BROWNELL
325300
-----------------------------
----------------------------------------------
NOT VALID FOR MERCHANDISE PICK-UP AFTER
--------------------------------------------------------------------------------
DATE: 10/03/2011 TIME:
13:49:17
svr020a
HOME DEPOT, INC.
PAGE:
2
CUSTOMER PICK-UP CONFIRMATION
S0131
875-314
FRAME
1.00
0.0011
SS0132
875-314
INSULATED
1.00
0.00
50133
875-314
<> FRAME = 73" X 37"
1.00
0.0016
50134
875-314
(CONTINUED)
1.00
0.00
50135
875-314
(CONTINUED)
1.00
0.00
S0136
875-314
(CONTINUED)
1.00
0.00
S0137
875-314
(CONTINUED)
1.00
0.00
50138
875-314
(CONTINUED)
1.00
0.00
50139
875-314
(CONTINUED)
1.00
0.00
S0140
875-314
(CONTINUED)
1.00
0.00
50141
875-314
FRAME
1.00
0.00
S0142
875-314
INSULATED
1.00
0.00
50143
302-604
<> FRAME = 72" X 80"
1.00
0.00
50144
302-604
(CONTINUED)
1.00
0.00
50145
302-604
(CONTINUED)
1.00
0.00
50146
302-604
(CONTINUED)
1.00
0.00
50147
302-604
(CONTINUED)
1.00
0.00
50148
302-604
(CONTINUED)
1.00
0.00
50149
302-604
(CONTINUED)
1.00
0.00
50150
302-604
INSULATED
1.00
0.00
Balance Due : $0.00
I HEREBY ACKNOWLEDGE RECEIPT OF THE ABOVE
ITEMS IN THE QUANTITIES SHOWN IN THE
"PICKED -UP" COLUMN ABOVE:
----------------------------- END OF CUSTOMER PICK-UP WILL -CALL NUMBER 325300W02
CUSTOMER COPY
Feather River Door Company
Configuration
6'8' Opaque Premium Fiberglass Door
with Sidelite (BSL)
6'8' Opaque Premium Fiberglass Door
with Sidelites (CHS)
6'8' Opaque Premium Fiberglass Door
with Sidelites (BSL)
6'8' Double Opaque Premium Fiberglass Door
6'8' Double Opaque Premium Fiberglass Door
with Sidelites (BSL)
6'8' Glazed Premium Fiberglass Door
68' Glazed Premium Fiberglass Door
with Sidelite (CHS)
6'8' Glazed Premium Fiberglass Door
with Sidelite (BSL)
6'8' Glazed Premium Fiberglass Door
with Sidelites (CHS)
6'8' Glazed Premium Fiberglass Door
with Sidelites (BSL)
6'8' Double Glazed Premium Fiberglass Door
6'8' Double Glazed Premium Fiberglass Door
with Sidelites (BSL)
Evaluation of Equivalence of ASTM4W-05 to ASTM -84-04
Product Description'
8b' Opaque Premium Fiberglass Door
8b' Opaque Premium Fiberglass Door
with Sidelite (CHS)
8b' Opaque Premium Fiberglass Door
with Sidelites (CHS)
8b' Double Opaque Premium Fiberglass Door
Page 2 of 4
O Yes
55
55
55
55
Evaluation
Installation
4366_112.2
G No
47
47
47
G No
Report
Drawings
47
O Yes
50! 60'
50/70'
50 i 60*
50 i 60'
Evaluation
Installation
4366_R2.7
G No
47
47
47
70
Report
Drawings
i
O Yes
55
55
55
55
Evaluation
Installation
4366_R2.3
47
Evaluation
Installation
11165.6
Yes
Report
Drawings
r
O Yes
55
55
55
55
Evaluation
Installation
II
4366_R2.4
Evaluation
Report
Drawings
Report
Drawings
47
O Yes
55
55
55
55
Evaluation
Installation
4366_R2.5
Report
Report
Drawings
* Requires use
of sill anchors
G No
47
47
47
G No
47
47
47
G No
47
47
47
G No
47
47
47
G No
47
47
47
G No
47
47
47
G No
47
47
47
47
Evaluation
Installation
Report
Drawings
Q1165.1
47
Evaluation
Installation
11
Outswin g
Report
Drawings
.2
47
Evaluation
Installation
11165.3 i
+DP
Report
Drawings
47
Evaluation
Installation
11165.4 ,
70
Report
Drawings
Evaluation
47
Evaluation
Installation
11165.5 i
Report
Drawings
47
Evaluation
Installation
11165.6
Yes
Report
Drawings
47
47
Evaluation
Installation
11165.7
Report
Drawings
Evaluation
Report
Drawings
http://www.featherriverdoor.com/resources/testData.html 10/3/2011
Report
Glazing
Impact
Inswing
g
Outswin g
Approval
Documents
FL Product !
Type
+DP
-DP
+DP
-DP
Approval la
O
Yes
70
70
70
70
Evaluation
Installation
5750_R1.1
Report
Drawings
I
O
Yes
47
47
47
47
Evaluation
Installation
5750_R1.2
Report
Drawings
O
Yes
47
47
47
47
Evaluation
Installation
i
5750_R1.3 i
Report
Drawings
O
Yes
40
40
40
40
Evaluation
Installation
11174.13
Report
Drawings
http://www.featherriverdoor.com/resources/testData.html 10/3/2011
Permit No.
• Tax Folio No. 10- aQ -30'- '30-a- MOO -- OAC)
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
-• •••••awnMGM IN40M IRMOppppp�t1011IIII
NMRYW NIR%v CLERK OF CIRCUIT COW
SENINME CQUNTY
9K 071641 Pig 0615; (1pg)
CLERK'S 0 2()1 1 1()f,()09
RECORDED 10/04/2011 01:49t59 PN
RECORDING FEES 10.00
RECORM--D 8Y J Ecicenroth(all)
The undersigned hereby gives notice that improvement
will be made to certain real property, and in accordance
with Chapter 713, Florida Statutes, the following
information is provided in this Notice of Commencement. r� �` wood
1. Description of roperty: (legal des 12-17§'
ri tion of the roperty, and street address if available) 1 � o w t 1 i/�� VC. d N i
yl glcl . E(. , 2717 §3
2. General description of improvement: W d'
(ny 3. Owner information: Name: 011S3 i e e
LOD Address: 1N LI WOOC
b. Interest in property:
c. Name and address of fee simple titleholder (if other than owner): Name:
Address:
4. Contractor Name: Phone number:
c. Address:
5. Surety Name
Address:
b. Amount of bond: $
6. Lender: Name:
Address:
b. Lender's phone number:
7.a. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.130)(a)7., Florida Statutes: Name:
Address:
8.a. In addition to himself or herself, Owner designates of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement (the expiration date is 1 year from the 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
�O�RAAN� ATTORNEY BEFORE COMMENCING WORK OR RECORDING
yYOUR NOTICE OF
C� ECE
ME
�.%i ie
Signature of Owner or Owners Authorized Offcer/Director/Pariner/Manager Signatory's Title/Office
p kL-
The foregoing instrument was acknowledged before me this �{Q„ day of QcL, (year) , by ( 20 i 1 Crname y o� person�as (type of
authority.... e.g. officer, trustee, attorney in fact) for (name of patty on behalf of whom instrument was executed) . FL 0 L-
P
P 33o -It 9-0
(SEAL)
Signatureo4letery-Pablie Sud CA EeKenr-aty
Personally Known OR Produced Identification —Z Type of Identification Produced
Verification pursuant to Section 92.525, Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that
th facts stated in it 4M true to.ihe best of my kno Jedgd1tid-bejief. QX1ltltu burl
_X Cot -
-��t �-.- . �, .••'• . W ARYANNE MORSE
Signature of Natura Person Signing Above: V •. • , �, '. CLERK OF CIRCUIT COURT
Rev. date 3/2008 E SEMINOLE COUNTY. FLORID -4
• Y ` + i DEPUTY CLERt
ley
CF l.Ql)11�. .