324 Conch Key Way - BR18-004337 - REROOFrv` i CITY OF SANFORD
OCT Z $ COI$ BUILDING & FIRE PREVENTION
PERMIT APPLICATION
b, 1 1 Application No:
Documented Construction Value: $ 10,573.51
Job Address: 324 Conch Key Way, Sanford, FL 32771 Historic District: Yes No
Parcel ID: 29-19-31-501-0000-1230 Residential ® Commercial
Type of Work: New Addition Alteration Repair ® Demo Change of Use Move
Description of Work: Complete Re -Roof, GAF 30 year asphalt shingle, 28 sq, 6/12 pitch
Plan Review Contact Person: Peter Arcomone
Phone: 407-677-7663 Fax: 407-677-7664
Title: Production Manager
Email: pete@jaeofamerica.com
Property Owner Information
Name LaLisa Harris Phone: 407-221-2855
Street: 324 Conch Key Way
City, State Zip: Sanford, FL 32771
Name JA Edwards of America, Inc.
Street: 220 Weber St
City, State Zip: Orlando, FL 32803
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Resident of property?: Yes
Contractor Information
Phone: 407-677-7663
Fax: 407-677-7664
State License No.: CCC057521
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: 51 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 befoundinthepublicrecordsofthiscounty, and there may be additional permits required from other governmental entities such as watermanagementdistricts, state agencies, or federal agencies.
Acceptance ofpermit 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 requiredinordertocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal. The actual construction value will be figured based on the current ICC Valuatior. Table in effect at the time the permit is issued, inaccordancewithlocalordinance. 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.
i.
3,
OWNER'S AFFIDAVIT: I certify that all of the foregoing infoimation is accurate and that all work will
be done incompliance with all applicable laws regulating construction and zoning.
Signature of Owkr/Agent ate
Print Owner/Agent's Name
bL-1 GAC Jb/Yn brN
Signature of Notary -State of Florida Date
6y?3 puss
c
LONI ANN ARCOMGNE
Commission # GG 187137
1 B, 2022
a Expires February
Bonded Thra budget Notary Services
Owner/Agent is Personally KnoLlvn to or
Produced ID —$::7 Type of ID
Signature of ontractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of 11Date LORI-
ANNARCOMONE 2otaRYptl'jc
Commission #
GG 187137 o=
Expires February 18, 2022 1rFOFFuoP'` Contractor/
Agent Bonded
ThruBudget Notary Services is < Personally
Known to Me or Produced ID
Type of ID BELOW IS
FOR OFFICE USE ONLY s Permits
Required:
Building Construction Type:
Total Sq
Ft of Bldg:_ Electrical Mechanical
Plumbing Occupancy Use:
I' Min. Occupancy
Load: New Construction:
Electric - # of Amps, Fire Sprinkler
Permit: Yes No APPROVALLS: ZONING:
ENGINEERING: COMMENTS:
of
Heads
UTILITIES: FIRE:
Gas
Roof
Flood Zone:
of Stories:
Plumbing - # of
Fixtures Fite Alarm
Permit: Yes No WASTE WATER:
BUILDING: Revised:
January
1, 2018 Permit Application
10/3/2018 SCPA Parcel View: 29-19-31-501-0000-1230
cc Property Record Card
Parcel: 29-19-31-501-0000-1230
i Property Address: 324 CONCH KEY WAY SANFORD, FL 32771
http://parceldetail.scpafl.org/Parcel Detail Info.aspx?PI D=29193150100001230 1 /2
Product Approval Specification Form
Permit #
Project Location Address 324 Conch Key Way, Sanford, FL 32771
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.floridabuildinci.ora.
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 Up
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 GAF Timberline FL10124-R20
Underla ments Interwrap RhinoRoof FL15216-R4
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
Roll u
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name Gerald Laschober
Please Print)
June 2014
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eSignLiveTM Electronic Evidence Summary
Signing Ceremony ID:
ID:
Name:
Created:
Completed:
Summary document generated:
Sender:
Name:
esign@acculynx.com
TIwQYtywAV7Z_h EtP B2v-Lrbn k8=
JA Edwards of America - Orlando FL - Final Contract
3 pages)
2018-Oct-0917:48:03 GMT
2018-Oct-0919:02:54 GMT
2018-Oct-0919:02:57 GMT
AccuLynx Software
Documents:
Electronic Disclosures and Signatures Consent 2 pages
final—contract-3—pages 3 pages
eSignLive Electronic Evidence Summary 2 pages
Recipients:
Name:
Email:
Role:
ID:
Name:
Email:
Role:
ID:
Electronic Disclosures and Signatures Consent
final—contract-3—pages
Name:
Email:
Role:
ID:
Electronic Disclosures and Signatures Consent
final—contract-3—pages
Accu Lynx Software
esign@acculynx.com
Owner
vtd9fpMcjB89
LaLisa Harris
recruiter@orlandoseniorhealth.org
b06687ecl7d6449aa2960900c5b4a204
b06687ecl7d6449aa2960900c5b4a204
1 accept
3 signatures, 1 initial
Brent Young
brent@jaeofamerica.com
cb48804f61264875blc68403b247e265
cb48804f61264875blc68403b247e265
1 accept
1 signature
Audit Trail:
Date and Time Recipient ' Action Document IP Other
2018-Oct-0918:53:17 GMT LaLisa Harris Login N/A 99.77.77.230
2018-Oct-0918:53:17 GMT LaLisa Harris Signing Session N/A 99.77.77.230 Signing session
For Recipient for recipient:
recruiter@
orlandoseniorhea
Ith.org(LaLisa
Harris)
2018-Oct-0918:53:21 GMT LaLisa Harris View Electronic 99.77.77.230
Disclosures and
Signatures
Consent
2018-Oct-09 18:53:34 GMT LaLisa Harris Accept Electronic 99.77.77.230 Approval:
Disclosures and 3e6e04e8-eadd-
Signatures 4740-9c8a-
Consent 382d594cb913
2018-Oct-09 18:53:34 GMT LaLisa Harris Confirm Electronic 99.77.77.230
Disclosures and
Signatures
Consent
2018-Oct-0918:53:39 GMT LaLisa Harris View final contract 3 99.77.77.230
pages
2018-Oct-0918:53:58 GMT LaLisa Harris Click To Initial final—contract-3— 99.77.77.230 Approval:
pages s5ccyiav9iMS
2018-Oct-09 18:54:02 GMT LaLisa Harris Click To Sign final_contract_3_ 99.77.77.230 Approval:
pages ediyUihEg2o5
2018-Oct-09 18:54:12 GMT LaLisa Harris Click To Sign final—contract-3— 99.77.77.230 Approval:
pages yTFOGnKRewMB
2018-Oct-09 18:54:15 GMT LaLisa Harris Click To Sign final—contract-3— 99.77.77.230 Approval:
pages zQYXf8i RzBU R
2018-Oct-09 18:54:19 GMT LaLisa Harris Confirm final—contract-3— 99.77.77.230
pages
2018-Oct-0918:54:24 GMT LaLisa Harris View final—contract-3— 99.77.77.230
pages
2018-Oct-09 19:02:37 GMT Brent Young Login N/A 172.58.175.63
2018-Oct-09 19:02:37 GMT Brent Young Signing Session N/A 172.58.175.63 Signing session
For Recipient for recipient:
brent@
jaeofamerica.
com(Brent Young)
2018-Oct-0919:02:40 GMT Brent Young View Electronic 172.58.175.63
Disclosures and
Signatures
Consent
2018-Oct-09 19:02:44 GMT Brent Young Accept Electronic 172.58.175.63 Approval:
Disclosures and 41f8adc7-5f2a-
Signatures 4308-bdea-
Consent 4dafac4fdad0
2018-Oct-09 19:02:44 GMT Brent Young Confirm Electronic 172.58.175.63
Disclosures and
Signatures
Consent
2018-Oct-09 19:02:45 GMT Brent Young View final—contract-3— 172.58.175.63
pages
2018-Oct-09 19:02:51 GMT Brent Young Click To Sign final—contract-3— 172.58.175.63 Approval:
pages ZMQNdGd2J1Y1
2018-Oct-09 19:02:54 GMT Brent Young Confirm final—contract-3— 172.58.175.63
pages
Grant Maloyy, Clerk Of The Circuit Court & Comptroller Seminole Countyy, FLInst #2018'f20656 Book:9235 Page:536; (1 PAGES) RCD: 10/19/2018 8:10:16 AM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY: PMat. k%ea%,,,Coe C& NaIII e:.1A Eww tscs oa Address.
st>
L ra.a coo . 32803 r
1( ..1 i ) _ i, I• I i '. it 'l ' i ` i_ 1' n, a Permit
Number. Parcel
IDNumber 29 — 19 ^ 31 ^ SOi Qpfjp (2,3p The
undersigned hereby gives notice that improvement will be made to certain real property, and In accordance Statutes, the withChapter713, Florida followinginformationisprovidedinthisNoticeofCommencement. 1.
DESCRIPTION OF PROPERTY: (Legal description of theproperty and street address if available) LOT7 'Z 2.
GENERAL DESCRIPTION OF IMPROVEMENT: 3.
OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED.FOR THE IMPROVEMENT: Nameandaddress: La q 3Zy eOtlC M fA a C y4 p ('(, 32) 1) Interestinproperty: O L, 3 ^.) C S. — Fee
Simple Title Holder (if other than owner listed above) Name: ; 4.
CONTRACTOR: Name:.A Epwygq,Qg M O> PhoneNumber. %?I . 7(a 6 3 Address: i2-jo WCkel `..sit C>rg-P,nAc 325Y03 5.
SURETY (If applicable, a copyof the payment bond is attached): Name: Address: 6.
LENDER:
Name: Amount of Bond: Address: Phone
Number. 7. Persons
within the State of Florida Designated by Owner upon whom notice or othe "documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name: Phone
Number:
8. In
addition, Owner designates 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 (Theexpiration 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 COMMENCEMENT ARE CONSIDERED IMPROPERPAYMENTSUNDERCHAPTER713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITEBEFORETHEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. . Signof
s , or Owner's orLessee'sAuthOeloedarectoNPariner/Manager) dnt Name and ProWde Signatory's Title/Offlce) State of
OR.% o a County of C*_EaC. °1 C, r The
foregoing
instrument was acknowledged before me this day of by L—
tS P1 4t Name of person
son making statementWho Is personally known to me O OR who has produced
identification Erttype of identification Droduced: Y Po,PETER.
IAMESARCOMONE sSMY POMMISSION 0
GO MMIO 3'9 moo
EXPIRES- October2,2020 orvW' thru8udgmNM rsarr>
ms CERTIFIED CORM G '
NT MALOY„__ ,,, LEici COURT _ .. r '':
AND COH
i )L rP.uy LE
N F ORIDA DEPUTY CLERK T
19 2016
SEMINOLE COUNTY MUL TI %UR ISDICTIONAL
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
iDate: I C, " i I I
I hereby name and appoint:. \
an agent of: ,1 ayds
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):
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
Expiration Date for This Limited Power of Attorney: I C) I QA I t 9
License Holder Name:
State License Number
Signature of License F
STATE OF FLORIDA
COUNTY OF
The foregoing ins rument was ac novylegged before me this `T day of l_1117-
20 , by ?f-C6 d Ua who is L/personally known to me or
who has produced as identification
and i did not) take an oa
A1, Cl cFT/9r,Cd IA44 Signature
of Notary Print or type Notary name o
r
RENEE C. COWNS C=
M4810it # GG 172994 Notary Public -State of — rim E*
rea January?, 2022 p Popnc'
sawwnn,auaDON00110Wes Commission No. 177r 9 Notary
Seal) My Commission Expires: I % ZZ
CITY OF
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQufRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: 1 0-03-1 8
CITY OF
N, S ORD PERMIT #
Building & Fire Prevention DivisionFIREDEPARTMENTBuildingRE-
ROOF SCOPE OF WORK JOB
ADDRESS: 324 Conch Key Way, Sanford, FL 32771 STRUCTURE
TYPE: @) SINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE -
ROOF TYPE: O REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS) O
RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF DECK
TYPE (PLEASE SPECIFY): 1/2 plywood OR 1x10 plank decking PLEASE
NOTE: ONLY100 SQUARE FEET OF THE EXISTINGDECK IS PERMITTED TO BE REPLACED" ROOF
VENTILATION: @)OFF -RIDGE ORIDGE OSOFFIT OPOWERED VENT OTURBINES SKYLIGHTS:
O YES O NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN
ROOF AREA ROOF
SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 @) 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O
SHINGLE GAF FL# 10124-R20 O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# OINSULATED
FL# O
TILE ' FL# O
OTHER: FL# ROOF
EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE** ROOF
SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE
OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O
SHINGLE FL# O
METAL FL# O
MODIFIED BITUMEN FL# O
TORCH DOWN FL# 0INSULATED
FL# O
TILE FL# O
OTHER: FL#
j "1 ADDRESS: Z L L
PERMIT #: `
L Isd
D , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
I
J
OFING CONTRACT ,ENGINEF
THE
ER, ARCHITECT, OF FiS. CHART ALLROOFINGCOMPONENTS LISTEDON THE SCOPE OF WORK OT THE O -
ATE AND THAT FOREGOINGINFORMATIONISTRUEANDACCURAEXISTINGBUILDING. IN ADDITION I CERTIFY THE INSTALLATION RMETROFITTODE
ABOVE
REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE C REQUIREMENTS —SPECIFICALLY FLORIDA BUILDING CODE, REQUIREMENTS
FOR SECONDARY WATER CHAPTER;
3 NAILING44 G OF THE ROOF DECK, IN ACCORDANCE WITH THE MANUAL
REQUIREMENTS (BASED ON F.S. LICENSE #:
I
n ?,
COMPANY /
CONTRACTOR: lJ
DATE:
E: d l ( CONTRACTOR
SIGNATURE: MUSTBESIGNEDBYLICENSEHOLD R OR OWNER/BUILDER) THE
FINAL ROOF SIGNED
AND NOTARIZED AFFIDAVIT MUST;BE PROVIDEDHE ROOTHE SHOWINGIN DJOB SITEATETAILOCOMPONENTS (DECKING, THISTHE DECK ALONGWITHDIGITALPHOTOGRAPHSOFEACHPLANEOFTMARKEMUST
INCLUDE A RULER OR MEASURING DEVICE TO CONFIRMINSPECTION INEISPACING
PROCEDURE
IJNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY FOREACHINSPECTION. THE PHOTOGRAPHS MU OVERLAPS,
INCLUDING DRIP EDGE AND VALLEY ALL
REQUIREMENTS. REFER
TO THE RE -ROOF POLICY AN PAPERWORK
FOR FURTHER EXPLANATION FAILURE
TO FOLLOW ALINSPECTION, A
RE —INSPECTION FEE AS L REQUIREMENTS
WILL RESULT IN A FINE R TO CERTIFY, ASED ON PERSONAL r' ' ARCHITECTORENWELLASREQUIRINGADESIGNPROFESSIONALATIONOFALL; ROOFING COMPONENTS INSPECTION, THEINSTALL . STATE OF
FLORIDA COUNTY OF lama L/ by Sworn
to
and Subscribed before me this Y da ofme 20 Wrho is
APersonally Known to me or has Produced (type of tific n
as identification. =
o t9Y Poe, RENEE C. COLUNS Commission # GG
172994 N Expires
January 1, 2022mg Public jFornopP
5wiMltuuB48tNos
me+ Signature of
Notary State of
Florida Print/Type/
Stamp Name of Notary
Public