2306 Palmetto Ave - BR17-002762 - SCREEN INSERTiyw.iG.n i3'qy plyCITOF
BUILDING FIRE PREVENTION
s PERMIT APPLICATIONIz
Application No:
Documented Con truetioit .-Av. $
F.r
1
fob Address: r {1/11111: " _. / t 1storic District: 'es E No arrel
It}: .'' _dG ., uXJ Residential Commercial LJ T11peofWork: NeR, El Addition Alteration Re air El DexnoEl Change of fuse Move Description
of Work: T9 i'1 Z t W i , i^t, -, t, -mot .., i Plan
Revieav Contact person: Title: Phone: L -i'-IF
J.
2f i9l:
1x. A' 5.1 iProperty Owner
Information Name Inane:
Resident
of
property? . City; State
Zip: Contractor Information
Name f° ; —_
v
City,
State
Zip: State License o.: Arch itect/
En ineer Information - Street:C. « <. `
Fax: r . y W
city, :
st,
Zip: ' t E-mail: Bonding Company;
Mortgage ender: Address: Address: ,
WARNINGTO
OWNER: YOUR FAILURE TO RECORD ANOTICk OF Ct)14IMENCF NIENT MAY RESULT IN YOUR PAYING 'TWICEFORIMPROVEMENTSToFOURPROPERTY. A NOTICE, OF COMMENCEMENT ` MUST BI RECORDED AND (POSTED ON THE joi3 SITE BEFORE. THE FIRST INSPECTION. IF.YOCI INTEND TO OBTAIN FINANCING, CONSULTWITHYOURLENDERORANAT`FORNEY BEFORE RECORDING YOIJIi NOTICE OFCOMMENCEMENT. Application is,
iiereby made to obtain a permit to do ttc work and installations as indicated. -I certify that no work or installation liar commenced priertotheissuanceofapermitandthatallworkwillbeperformedtomeetstandardsof°all laws regulating can Fr;cton / in thisjurisdiction, bles, &understand
that a separate permit must fie seem for electrical work, plumbing, sic;ras, e ellc, pools, k_7
furnaces. boilers, heaters, tanks, and airconditioners, etc. FBC 105.
3 Shall he inscribed ;with the date aq application and the code ifl affect as cif that date: gear Editia)n (2014) Florida ftili ingCode , itesistAhlne 30,
20'15 f rrsnt #.:;.ict?
tiun
Ni'-3MF" -: In addition to the requirements ofthis permit, there may be additional restrictions applicable to this PrOPerty that may befoundinthepublicrecordsOfthiscounty, and there may be additional. permits required fi`om other governmental- entities such as watermanagementdistricts,; state agencies;, or federal agencies, - I
Acceptance ofpermit -is -verification that I will notify the owner of the property of the requirements r_-if.florida lien Law, F5 713.
The City of Sanford requires payment o€ a plan review tee at the time of permit submittaL A copy of the executed contract is tequircdinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionValueofthejobatthethroeofsubmittal. The actual construction value evill be figured based on the current ICC Valuation T le in eftect at the time the permit is issued, inaccordancewithlocalordinance. Sbould calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your Hermit fees'When the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of_the foregoing information is accurate .and that III work willbedoneipliancewithallapplicablelawsregulatingconstructionand7oniaig,
i t atx3re iE°ani aedtrr,r nr t a rs:
Pant t.3wtt i t_ r is Name
S gztat re of (- orida c due re«f cat rizite 'iloric:t DaCe
JOSEPH J OIMfNICK
P KARRIE KRELLA%'• M' COIMIMISS/ON N FF131103NotaryPublic -State of Florida
Mv ices Mar 4, 201B
C3arr;r, •i l'
COMMExp . FJcpIRES;hmeE7,201a114a3
Produce T x tl National Notary :> Contrac or riown toProducedID
w1e_tar o
I ylne of III _
E
BELOW IS FOR OFFICET
Permits Required: uIred`: BuildingEl Electrical [l MechanicalMechanicalEjPitim i Gay , c f Construction
Type: Occupancy Use: F)(oaa Matte' Total
Sq Ft of Ilkio tV.Iitt. Occupancy caztaartcyLoad: # of Stories: New
canstr ctioaa. Electric - # of Am v_ —. —.
Plum bing - # of Fi hares Fire
Sprinkler Permit: Yes E] NoEl r# of HeadsFire Mar°eat Permit: Yes No APPROVALS:
ZONING:2S L?t iii ti, __.. %T STi-a. p'.3`i~F;...__., ENGINEERING:
FIRE: BUILDING: 4r 17 COMMENTS:
1 j'aTLi I C l' I'P P 1_—Q.. (b l ' ` e4
Ol ('L,C U n i A 11/1 YeVsed
June. 30,2W5 Peim
it App l icjtjc ti
Thanlk,You-Your Businessis'Appreciated
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: — t(K'jej
I hereby name and appoint:
an agent of:
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 only one option):
Th pecific permit and pi icat n for wo located a :
20td' z ryn
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number: .'*") CC 05__&(D _( x
Signature of License Holder: e-
STATE OF FLORID
COUNTY OF
zK
The foregoing instrument was acknowledged before me this day of (! r(1)q0eK
20V-7 , by _ YM, c 17 , L° , J e who isA persona nown
to me or who has produced as
id nti lckion and who did (did not a oath.
Notary Seal ' 4411 ra 0 weed
CMRISTINAANNCOLUCC10 Print or type name
x' Notary Fub c-Stele of1" Commission,# GG083082
Mycamm.xa'0GG089'2021 Notary Public -State of Ft,6
Commission No.
My Commission Expires: 9J o-d Rev.
08.12)
RECORD COPY
UMINUI' SCREEN DESIGN
E`ASD m ,M
General Notes & Design Standards
Screen Patio Room Enclosure)
The following are general design standards. More stringent design standards may be noted on the plans. In the event
of a conflict in plans and/or design standard dimensions and/or member sizes, the contractor must utilize the more
stringent dimensions and/or member sizes prior to ordering materials, fabrication and/or construction.
Design Codes:
Florida Building Code 2014 (51 Edition)
Aluminum Design Manual 2010
ASCE 7-10
Design Loads:
Pursuant to FBC Chapters 16 & 20
Ultimate Wind: -130 MPH (FBC Table 2002.4) (35 psi
Risk Category: -See attach site specific plan sheet (FBC Table 1604.5)
Exposure Category: -See attach site specific plan sheet (FBC 1609.4.3)
PM
SANFQQn BUILDING DIVISION
A PERMIT ISSUED SHALL BE CONSTRUED TO BE ALICENSETOPROCEEDWITHTHEWORKANDNOTASAUTHORITYTOVIOLATE, CANCEL, ALTER OR SETASIDEANYOFTHEPROVISIONSOFTHETECHNICALCODES, NOR SHALL ISSUANCE OF A PERMIT PREVENTfHEBUILDINGOFFICIALFROMTHEREAFTER
AICOSIN PLANS, NSTRUCTIONTISTRUCTION08VIOLATIONSOFTHISCODEAdditional
Load requirements: Structural
members supporting screened enclosures are designed for wind in both of two orthogonal directions using the
pressures given in Table 2002.4. Each primary member is also designed for a 300 pound load applied vertically downward
along any 1 foot of any member, not occurring simultaneously with wind load. In addition to wind pressures,
purlins is also be designed for a 200 pound load applied vertically downward along any I foot of any member,
not occurring simultaneously with wind load. REVIEWED POR CODE COMPLIANCE Design
Basis: Allowable
Stress Design (ASD) =Allowable Strength Design (ASD) divide by safety factor PLAINS EXAMINER Ia•
q•11 General
Requirements: DATE Reproductions
of contract drawings by contractor in lieu of preparation of shop drawings signifies acceptance of information
shown as correct and obligates himself to any expense, real or implied, arising from their use. A
change to the structural drawings due to the acceptance of alternates and/or substitutes is the responsibility of the contractor
and must be submitted to the engineer for approval. The
general contractor and each subcontractor shall review the approve construction plans in its entirety and verify all
existing conditions prior to the start of any work. All inconsistencies shall be reported to the designer and/or structural
engineer, if needed. Should contractor construct the premises in a fashion not consistent with the plans prepared
by the designer and/or structural engineer, or in any fashion, change the plans and drawing without the review
and approval from the designer and/or structural engineer. Then designer and/or structural engineer shall bear
no responsibility or liability for the construction of premises and accuracy of thedrawings. Foundation
and Earthwork: Applicable
only when unsuitable soils are encountered. When
unsuitable soils are encountered as specified bearing strata, notify owner's representative/engineer. Soil
bearing capacity — 2,000 psf Minimum Provide
neat excavation for footing and place concrete immediately after excavation and inspection. Pump
water from footing excavation if greater than one inch. Compact
all fill to 95% ASTM D698 density. Unit
soil weight = 105 pcf 7 Internalangleoffriction = 30 degrees tt p_
DI/VG Coeff.
Of friction between footing and soil = 0.5 Michael
Thompson, P.E. #47509/CA#30930 SANFORD 4401
Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790 www.
aluminumscreendesign.comj,
AS DA...rnmurr. N Consiruc:i.,n
D=G
Structural Aluminum:
Conform to latest edition of Florida Building Code and Aluminum Design Manual standard practice for aluminum
design.
All aluminum shall be 6005-T5 (E= 10,000 ksi; Fy = 35 ksi) with a minimum wall thickness of 0.046"
Splicing prohibited without prior approval as to location and type.
Burning of holes in aluminum members is prohibited. Any member with burned holes must be replaced.
Aluminum Protection:
Shall be pursuant FBC 2003.8.4. Aluminum surfaces in contact with dissimilar materials, lime -mortar, concrete, or
other masonry materials, shall be protected with powder coated or ESP paint or alkali -resistant coatings, such as
heavy -bodied bituminous paint or water -white methacrylate lacquer.
Screws:
Aluminum self -tapping screws shall conform to ASME B 18.6.4 specification.
Self —tapping screws shall meet the requirements of ADM J.5
Maximum fastener spacing shall not exceed (3+20t) where "t" is the member thickness in inches.
For roofing and siding connection, use minimum #12 screws for end and side laps spaced at 12" max for side lap
and end lap fasteners shall be no more than 2" from the end of overlapping sheets.
Bolts:
Bolts and other fasteners shall be aluminum, stainless steel, hot -dip or electro-galvanized steel. Double cadmium
plated steel bolts may also be used. Bolt holes diameter shall not exceed 1/16" larger than the bolt diameter and shall
be spaced at a minimum of 2.5 times the bolt diameter with minimum edge distance of 1.5 times the bolt diameter.
Bolts shall meet the requirements of ADM J.3
Chair Rails, Purlins & Wind Brace:
Chair rails, purlins and wind brace shall conform with the below maximum span length. If the event contractor's
specific site plan conflict with the below recommended length, the contractor shall utilize the more stringent
dimensions and member sizes prior to ordering materials, fabrication and/or construction.
Wind Speed =130 MPH
2 x 2 Chair Rail = 6'-0" 2 x 2 Purlins = 6'-6" 2 x 2 Wind Brace = 4'-3" 2 x 3 (0.125) Wind Brace = 9'-0"
2 x 3 Chair Rail = 8'-0" 2 x 3 Purlins = 8'-0" 2 x 3 Wind Brace = 8'-0" 2 x 4 Wind Brace = 9'-0"
Concrete
Conform to ACI 318, latest edition and ACI 301
Compressive Ultimate Strength (Minimum at 28 days) shall be 3000 psi
Exposed chamfer edges shall be'/4"
Reinforcing Steel:
Conform to ACI 318 and 315, Latest edition
All reinforcement steel shall be ASTM A615 Grade 60.
Smooth dowels & ties shall be ASTM A 185
Welded Wire Fabric shall be ASTM A185 or A82 (Flat sheet).
Deformed bar anchors shall be ASTM A496, Grade 70
Cover: Footing 3"
Washer:
Washers shall be used under bolt heads and under nuts.
Hole Alignment:
Poor matching holes must be rejected. Contractor shall prevent holes from drifting and distort the metal. All chips
and foreign matter between contacting surfaces shall be removed before assembly.
Michael Thompson, P.E. #47509/CA#30930
4401 Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790
www.aluminumscreendesign.com
IA DA-iMir)UM 'a
01 M
F n g i r g
Beams & UDHEhts:
In the event of a conflict with the values in this table and the site specific plan, the contractor must utilize the more
stringent dimensions and/or member sizes between the site specific plan and the below applicable span limitations
prior to ordering materials, fabrication and/or construction.
130 MPH
PRIMARY BEAMS & COLUMNS -SCREEN & PATIO ROOM ENCLOSURES ROOF PANELS
Beam -Size
Max Beam
Span & Max
Column
Spacing Column -Size Max Column -Height Pan Roof Span
Insulated Roof
Span
2 X 3 6'-0" 2 X 3 8'-0"
3" Spans 13'-
6" 3" Spans 15'-0"
6" Spans 20'-0" 2 X 4 8'-6" 2 X 4 8'-0"
2 x 5 10'-0" 2 x 5 9'-01,
2 X 6 12'-0" 2 X 6 10'-0"
Knee Bracing:
Contractor shall provide knee bracing on 45 degree angle pursuant the attach detail sheet that specified size and
length requirements. Knee bracing on upright above super gutter intersection shall be connected to upright no more
than 6" above the super gutter. Knee brace size shall be a minimum of 2 x 2 for beam span of 15' max; 2 x 3 for 30'
max; 2 x 4 for beam span greater than 30'.
Purlin•
Contractor is required to install purlins spaced to align with column spacing; however, spacing between purlins shall
not exceed 7'-2".
Intermediate/Header Beam:
Contractor is required to install a minimum 2 x 7 intermediate header beam supported with 3 x 3 column spaced at
10 feet (max) when insulated roof span exceeds 15 feet.
Patio Cover:
Contractor is required to install insulated roof covering pursuant to the Florida product approval specification.
Overhang shall be a maximum of 1'-0" along the side, 3'-0" along the front and 1/2" along the front interface
between the super gutter and the attached pool cage knee riser wall.
Edge Distance:
Contractor is required to install uprights to provide a 2" minimum clearance from edge of slab and/or footer.
Michael Thompson, P.E. #47509/CA#30930
4401 Vineland Road., Suite A6, Orlando, FL 32811. (P) 407-734-1470 (F) 407-734-1790
www.aluminumscreendesign.com
Fl
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ALUMINUM SCREEN DESIGN
FILL IN DETAIL
2X2 POST .046 OR GREATER
P4251 1m
HINGE LOCATIONS
SCREEN DOOR FULL Z OR
DOOR JAM STANDARD DETAIL
EACH DOOR IS SCREWED INTO UPRIGHTS WITH #10 1" 6" FROM ENDS 24" O.C.
BOTTOM PLATE IS ATTACHED TO
OCONCRETE WITH 2-1/4" X 1/4" TAPCON
5" X 2-1/4" IF THRU PAVERS)
6" FROM ENDS 24" O.C.
ALUMINUM FRAME IS ATTACHEDOTOBLOCKWITH2-1/4" X 1/4"
10 2" IF TO WOOD STRUCTURE)
6" FROM ENDS 24" O.C.
2X2 ANGLE IS ATTACHED TO
CO ALUMINUM FRAME WITH 2 #10 1" &
1 2-1/4" X 1/4" TAPCON PER SIDE
CHAIR RAIL & UPRIGHTS ARE ATTACHED
WITH EITHER:
@ BLIND SCREWED WITH (3) #10 3
CAPRI CLIPPED WITH (4) #10 1" PER CLIP
BLIND CLIPPED WITH (4) #10 1" PER CLIP
O KICK PLATE IS ATTACHED TO STRUCTURE
WITH #10 1" 6" FROM ENDS 18" O.C.
ALUMINUMSCREENDESIGN.COM DESIGN STATEMENT MICHAEL THOMPSON
METAL IS.046 SS ORALUMINUMSCREENDESIGNALLTAPCONSSHALLPROVIDEMINIMUMOFR1 ,
ALLOY IS 6005-T5
1/8" EMBEDMENT DEPTH
4401 VINELAND ROAD
SUITE A6@YAHOO.COM THIS STRUCTURE HAS BEEN DESIGNED IN ACCORDANCE TO MEET THE REQUIREMENTS OF THE 2014 (5TH EDITION) ORLANDO FL 32811OFTHEFLORIDABUILDINGCODEFOROPENANDSEMI -OPEN STRUCTURES AND SHALL WITH STAND ULTIMATE WINDPHONE: 407-734-1470 SPEEDS OF 130 MPH (FOR 3 SECOND GUSTS) NOMINAL SPEED 101.4 MPH UP TO A 15FT ROOF HEIGHT, FACTOR OF 1.0, AND EXPOSURE C, RISK CATEGORY 1. .9 47509
FAX: 407-734-1790 CONTRACTOR SHALL FIELD VERIFY ALL PLANS DIMENSIONS PRIOR TO MATERIAL PURCHASE, FABRICATION AND CONSTRUCTION
A#30930CONTRACTORSHALLNOTIFYTHEENGINEERIMMEDIATELYSHOULDSITECONDITIONSDIFFERFROMCONSTRUCTIONPLANS
a,
PLAT OF SURVEY
DESCRIPTION
LOT 24, LANE'S ADDITION TO CITY OF SANFORD, AS RECORDED IN PLAT BOOK 3, PAGES 9 & 10, PUBLIC
RECORDS OF SEMINOLE COUNTY, FLORIDA.
I i
LOT 25 LOT 23 I LOT 21
L---------------I—----------
O
DIRTDW FND 1/2" IRFND1/2" IR e ¢ (WIDTH LB #4475
PSM #3382 ¢ VARIES)
av OW OW —
56' PLAT 4' WF o
909'v 55.72' MEA S
U.
c 9+ C'
i C
LP i-
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LOT 24
a 20.5•
0 0 0
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ti o
LOT 26 T 35.0, 10.4
FND 5/8" IR
NO #
SE CORNER, LOT 30
FND 5/8" IR
PLS #4200
168' P&M
inN
FORMBOARDS ONLY
I
a 11- w 4 ADDRESS #2306
a
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C:2r
o
10.5' O^ 13.0'
2' CURB &
9
soot
55.97' MEAS
56' PLAT `9s
5' CW
PALMETTO AVENUE
50' R/W
CENTRAL FLORIDA CONTRACTING, LLC
ryryryryjjTn1 tLqq{{=.
ams
ACCURIGHT SURVEYS
OF ORLANDO INC., LB 4475
2012 E. Robinson Street Orlando. Florida 32803
WWWAccurightSurveys.net
ACCU u tccuright5urveys.net
PHONE: (407) 894-6314
FRANK A. MYMOIfD III PLSV25
NOT VALIDWITHOUT THESIGNATUREAND THE ORIGINAL RAISED
SEALOFTHS FLORIDA LICENSED SURVEYORANDMAPPER.-
1. BEARING STRUCTURE IS BASED ON THE MONUMENTED SOUTH
RAW LINE OF PALMETTO AVENUE. BEING NORTH (ASSUMED}
2. THISBUILDINGILOTLIES INZONE'X'. BASED ONFLOOD
ISURANCE RATE MAP NO. 1211700070F. COMMUNITY NO-
120291 (CITY OF SANFORD) ORANGE COUNTY, FLORIDA,
EFFECTIVE SEPTEMBER 25.2009.
3. THIS SURVEY REFLECTS ONLY MATTERS OF RECORD AS
PROVIDED BY CLIENT.
4. UNOERGROUNDIMPROVEMENTS HAVE NOT BEEN LOCATED.
S. BUILDING TIES SHOWN ON THIS SURVEY SHOULD NOT BE USED
TO RECONSTRUCT PROPERTY LINES.
6, THIS SURVEY IS VALID ONLY FOR THE PARTIES TO WHOM IT IS
CERTIFIED.
7. THIS SURVEY EXCEEDS THE ACCURACY REQUIREMENTS SET
FORTH IN FLORIDA STATUTES.
B. ELEVATIONS BASED ON ASSUMED SITE BENCHMARK HAVING
ELEVATION OF 100.00 FEET, (NAVD BB).
WF `\
LOT 22
4' WF
s
ca
M
ZriNiN C4__
O* A-C,
nSef S
FND 1/2" IR
LB #4475
aP t'1-p(0'z
cj
n S a\ 5c YYe 4 Y1
LEGEND
CABLENRISER 4-LIGHTPOLECENTERLINELS . LICENSED SURVEYOR
CLEAN OUT LSA-LANDSCAPEAREA
CONCRETE BLOCK WALL MEAS-MEASURED
COWERED CONCRETE
CHAIN LINK FENCE
MF -METAL PENCE
MS-METALSHED
CONCRETE MONUMENT NAVD-NORTHAMERICAN
CONCRETE VERTICAL DATUM
COVEREDCONCRETE PAD NGVD- NATIONAL GEODETIC
VERTICAL DATUM
CONCRETE WALKWAY N&D -NAILS DISK
CENTRAL ANGLE OW -OVERHEAD WIREDESCRIBED&MEASURED B - OFFICIAL RECORDS BOOK
DRAINAGE EASEMENT Pam -PLAT&MEASURED
DESCRIPTION
DOT MANHOLE
Pa -PLAT BOOK
PC - POINT OF CURVATURE
DRIVEWAY PG -PAGE
EOCEOFPAVEMENT PF -PLASTIC FENCE
ELECTRIC BOX Poe -POINT OF BEGINNING
ELECTRIC METER POC -POINT OF COMMENCE&fENf
ELEVATIONEASEMENT ' R -RADIUS
RAv-RIGHTOFWAY
FINISHED FLOOR ELEVATION TR . TELEPHONE RISER
FIRE HYDRANT T -TRANSFORMER
FLOOD INSURANCE RATE MAP TYP -TYPICAL
FOUND UE-UnLITY EASEMENT
GUY WARE ANCHOR
IRON PIPE
IRON Roo
OUP-LMURYPOLE
WATER METERIt: - WATER VALVENGTH -ARCLELICENSED BUSINESS WF -WOODFENCE
WS .WOOD SHFn
REQl[TM EIID INSPECTION SEQUENCE
BP# l - ?_'lro - Address:
B-UILDING (PERMIT
min Max . Inspection Description
Footer / Setback
Stemwall
Foundation / Form Board Survey
Slab / Mono Slab Pre our
Lintel / Tie Beam / Fill / Down Cell
Sheathing — Walls
Sheathing — Roof
Roof Dry In
Frame
Insulation Rough In
Firewall Screw Pattern
Drywall / Sheetrock
Lath Inspection
Final Solar
Final Firewall
Final Roof
Final Stucco / Siding
Insulation Final
Final Utility Building
Final Door
Final Window
Final Screen Room
Final Pool Screen Enclosure
Final Single Family Residence
Final Building (Other)
71
II min I Max I Inspection Description '
Electric Underground
Footer / Slab Steel Bond
Electric Rough
T.U.G.
Pre -Power Final
Electric Final
min Max Ins ection Descri tion
Plumbing Underground
Plumbing Sewer
Plumbing Tub Set
Plumbing Final
i k o.
i 111 3 1 .I \ Inspection Description
Mechanical Rough
ONTO mm,
n ll'y,`4,TL f•.sr.1:=`rr7-a'S(r.,i!(I:ii .7.c ccC :.} }o'.,....7 9?icSY".nk.. !L:U a l<{
III 331 ..I \ Inspection Description _
Gas Underground
REVISED: June 2014
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: October 10, 2017
I hereby name and appoint: Christina Coluccio
an agent of: CJS Aluminum, Inc.
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:
2306 S. Palmetto Ave. Sanford, FL 32771
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: Charles L
State License Number: SCC056698
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instru"nstrruu
20_J_, by
was acknowledged before me this day of 00r-
who is impersonally known
to me or who has produced 3
identification and who did (did not) take an oath.
41
Signature
Notary Seal) &&( t-
Print or type name
Notary Public - State of Fc.Oti i) A
Commission No. FP 13 Y -70'5
My Commission Expires: J ii(yi
ja RIEKNBLLRev. 08.]2) ASSION / FF 134703
e-J=22,2018
1