1502 William Clark Ave - BR18-004334 - REROOFOCT 2,018 -jI
CITY OF I/
PERMIT APPLICATION
7, SkT40RD '
BUILDING DIVISION 1 g _43ApplicationNo: 3
Documented Construction Value: $ t O ,.b-n. 3 D
Job Address: \S Oal 0"V G Historic District: Yes No
Parcel ID: 3 (o - R -3 0 - G 1 %4 - O 000 - 0044 u Residential ER Commercial
Type of Work: New ® Addition Alteration Repair Demo Change of Use Move
Description of Work: LZE- QLOQVr-
Plan Review Contact Person: C2A.se7 t4-vv a-.-t Title: 0W-WcEX.J t'Cltc eT 12.
Phone: 0-1--13-"12(e2 Fax: 4931 Email:G2yyVr Gnome -- D Q-V-Lbe g Vl1a ,CJ tii
Property Owner Information
Name Vkt]a ,tsT-Dt"0AF%e . Phone: Llo "1- 3 a 3 " T C 19 C. Street:
43 Oa LJ \LLkya vK C Resident of property?: V E S City,
State Zip: 7:53 V4-,Xr---o XO P-U 3 F-17L l Contractor
Information Name
C e w.MtAA,._ it sr tdlvftt . 'hone: Street:
tU32 Owvs',_ h -D-k_CV4 -Tcsw0 Fax: `lC)') - 81B --\A22' City,
State Zip: D . C-L 3 Q-11Sy State License No.: 0 e f- t 3 3D to 0 9 Architect/Engineer
Information Name: P
e: Street: Fax:
City, St,
Zip: E-mail: Bonding Company:
Mortgage Lender: Address: 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 lawsregulating 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: 6`s Edition (2017) Florida Building Code
NOTICE: In addition to the requirements ofthis permit, there maybe 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 ofsubmittal. 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.
611 l o a %'? 3 to
Signature of caner/Agent Date Signatt re ofContractor/Agent Date
11—J. C\`J Ctii l I l.VY11r7N
Print Owner/Agent's Name
Si aAre of Notary -State of Florida Date
cA.S czi
Print Contractor/Agent's Name
6/z-3/1gl
7sin ure otary-State ofFlorida Date
Owner/Agent is X Personally Known to Me or Contractor/Agent is K Personally Known to Me or
Produced ID Type of ID Produced ID.'
ry u is late of Florida
Tiffany Burleson
E]H] State of Florida ' ExpiresCommission GG 173997eson %OFn01/09/2022
oe GG 173997B OW IS FOR OFFICE USE ONL9/2022
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Product Approval Specification Form
Permit # I'S 4-53
Project Location Address 1SOa C Oe.. 3Q-1 11
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.floridabuilding.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 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 vy— Q \
Underla ments 00
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 up
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
C2 Syl G S c-YY1Applicant's Name
Please Print)
June 2014
Central Homes Roofing
1182 N. Ronald Reagan Rd.
Longwood, FL 32750
407) 732-7262,
Ann Williams
1602-William Clark avo
Sanford, FL 32771
Removal
Roof Sheathing Inspection
Underlayment
Sates Representative
Nick Coggon
38 6) 216-2064,
centralhorhesnick@gmail.com
2722
10/16/2018
Tear off and haul away the existing shingle roofsystem (one layer). An additional
35/sq. for removal of each unforeseen additional roof layer will be added.
Inspect the roof sheathing fastening system and supplement (re -nail).
Supply and install one layer of Rhino Synthetic felt underlayment.
fa,
Homeowner Name Total f .; $10 077.30
gHomeownerSinature Mn ate Total $10,077.30
Central Homes Rep.
SPECIAL INSTRUCTIONS
Payment Terms:'I, THE HOMEOWNER AGREE TO PAY THE balance due upon completion of scope of work. DUE TO OUR"NO MONEY UP
FRONT' POLICY, WE ASK FOR PAYMENT IMMEDIATELY AFTER THE SCOPE OF WORK IS COMPLETE. PLEASE WITHHOLD 10% OF
THE SCOPE AMOUNT IF YOU ARE WAITING FOR FINAL INSPECTION, CLEANING OF ANY PART OF YOUR PROPERTY, OR WAITING FOR
SMALL REPAIRS TO GUTTERS, SCREENS, ETC. Central Homes must pay our suppliers and workers immediately to avoid liens on your
property.
A surcharge of 3.5% will be added to above price if paying with a credit card.
Any unforeseen decking repairs and/or wood rot repair will be done at a cost of $55.00 per sheet of plywood and/or $5.00 per lineal foot of fascia.
This proposal is null and void if not accepted within 10 days of the date referenced in this proposal due to price volatility in asphalt -related products.
I have read and accept the Additional Terms and Conditions printed on the back of this.page. The prices, specifications and conditions of this
proposal are satisfactory and are hereby accepted and Central Homes LLC is authorized to do the work as specified. Payments will be made as
outlined in this proposal.
ch'k nct,I d 'S'R rice on dt
q07-S?&761
oiri j
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: VAa%g,,,'
an agent of:e czt'l"t -'e t V-Owlc—:-S I -.LC,
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: \ O
License Holder Name: — 2•l C-'tS 47 t.VVI 4 u
State License Number: LC-C.. \3''S 0(., O Q
Signature of License Holder:
STATE OF FLORIDA
COUNTY OFS EmtKioLis
The foregoing instrument was acknowledged before me this may of 0 c-t ,
200A'Z,_, byT:pAKC.isc.0 1: W-ti A ---A who is ;personally known
to me or who has produced
identification and who did (did not) take an oath.
S"ture
Notary Seal)
07 Py Notary Public State of Florida
t+ Tiffany Burleson
My Commission GG 173997
Expires 01/09I2022
Rev. 08.12)
jjf&nV gyr10M
Print or type name
Notary Public - State of
Commission No.
My Commission Expires:
as
CITY of
Building & Fire Prevention DivisionSOR. D RESIDENTIAL RE -ROOF POLICY & PROCEDURES
FIRE DEPARTMENT 9—q
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
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 &c 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.
c
DATE: CONTRACTOR (OR OWNER/BUILDER) SIGNATURE
PERMIT # _ " W
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: `s Da W L. L 'a'm UV41-y. f4vs• "V%iiF-cxL0 3 -A-1-i 1
STRUCTURE TYPE: 4jpSINGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF)
DECK TYPE (PLEASE SPECIFY): 7 L W liC) ics
PLEASE NOTE: ONL Y 100 SQUARE FEET A THE EXISTING DECK IS PERMITTED TO BE REPLACED
ROOF VENTILATION: ®OFF -RIDGE O RIDGE OSOFFIT OPOWERED VENT OTURBINES
SKYLIGHTS: O YES ® NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: N\ V%.—
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
SHINGLE E (Z'r 1v T&Lsn FL# SJ %ALiq — , f`
O METAL FL#
O MODIFIED BITUMEN FL#
O TORCH DOWN FL#
O INSULATED FL#
O TILE FL#
O OTHER: FL#
ROOF EXTENSIONS (PORCHES, PATIOS. ETC.) **IF APPLICABLE**
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#
OTORCH DOWN FL#
0INSULATED FL#
O TTLE FL#
OOTHER: FL#
Grant Malo , Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst #2018122084 Book:9237 Page:798; (1 PAGES) RCD: 10/23/2018 1:08:15 PM
REC FEE $10.00
1 CLERP G hE <_
ANC FLORIDA
THIS INST.A4W PREPARED BY: SEN^ai';r' OU ,
RU
Name: Judith Underwooda CLERK
p ones Reagan v BY ,
Longwood, L 32760 pate
NOTICE OF COMMENCEMENT
PNeiit Nr,o,b.r:
Pace! ID Number. 5G - ko - S tom - J t %A - oocp O
The un lerslyned hereby cIve3 notice that improvement wA be made to carmia real P W6rty, end In ao ordanCe Myth Chapter 713, Florida Sta U1*4, the
fdb86V In WTk1tl0n is provided in this Notice or Commencertrortt
1. DESCRIPTION OF PROPERTY:(L.aa1 desalt ton ofthe and street address tf avaaablai
E tlz of t_M %+ W F I—Eay.
2. GENERAL DESCRIP nON OF VAPROVE ENT:
3. OWNER 00OFMATM OR L.ESM MONIATiON IF THE LESSEE CONTRACTED FOR THE ANW0 31ENT:
Nameand sdar:sc+Q:i g-•-cal-kx - Y d 2t; c t L tlltut_w, — soa 4 t tw=L '',\.4G,QySd ur-otcn
InwestlnmVpMr. ow -L le - 3a 1
Fee Simple Title Holder (d other than owner listed above) Name:
Addross
4, CONTRACTOR Name: Central Homes, LLC Pfwne Number: 40-1 733 7Z6Z
Address: 1182 N. Ronald Reagan Blvd._ Longwood, FL 32750
5. SURETY (tfspplleatJ a copyof the paymen! bond isaftotw k Names,
Amount of Bond:
LENDER: Name: Phone N6mtber.
Address:
T. Persons within the State of IRottda Dedpn>dd by Owner upon atom notice or otfwr documorms may be served se Peovlded by Sstdiort713A3fta)7., Fiorids Sta Ww
Nlarlte: Photo Number
Addtees:
In eddItion. Omw designaeea
to recaive a copy d the LJar+or's Notice as provided In Section 713,13(1) ft FloridaStatufee. Phonenurnbor.
Evh ion Date of Notice d Corn menoment (rho **iretion is 1 year from date of reoodiq; unim a different dale is spoc&od)
WARNM TO OWAC-R: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTits OF COMMENCEMENT ARE
CONSIDERED UrPROPFR PAYKENTS UNDER CHAPTER 713, PART 1, SECTION 713,13,. FLORIDA STATUTES, AND CAN RESULT IN YOUR
PAYING Timm FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FW= INSPECTION. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE. OF COMMENCEMENT.
r
PWAkn atCunvolasw.orGww%atLoma's (Pry f.INm+0t' Q+9gnbrYtTArOfb?
staaof FCW county a'3EmLy%L LLM -
The foragobv instrumant was admoerladged bebr a me dds o; 3 day of DC--r _
Vq S W L l-L- r-VMS Who Is Personally known to meX OR1, dor+.ar+euana=ft"=
who has produced ids*ficada+ 17 tyW of Idetdiftcallon pno&cod•
o°aid"P, MARIAT• BUTCHER i
MY COMMISSION # GG101540 rbmyspn a,r.
EXpiRES May 04. 2021
Frontage Depth : Units Units Price ( Land Value
127.00 150.00 0 j $174.00 $22,761
http://parceldetail.scpafl.org/ParcelDetailInfo.aspx?PID=36193051400000040 10/23/2018
SCPA Parcel View: 36-19-30-514-0000-0040 Page 2 of 2
1 SINGLE > 1997 8 3 i 2.5 1,637 2,054 1,637 CB/STUCCO $83,703 $90,982 ' Description Area
FAMILY FINISH -- —'
FIONEN
RCH 20.00
ISHED
GARAGE
FINISHED 397.00
E
Permits
Permit # I Description Agency Amount CO Date Permit Date
00007 REPLACING SHINGLES; PAD PER PERMIT 1907 S LAKE AVE SANFORD i $706 `'. 10/1/2004
01282 BUILD 22 X 35 POOL ENCLOSURE W/7 X 20 ALUMINUM ROOF INCLUDED SANFORD 2,486 2/1/2000
111,11I...
01227 2118 SQ FT SANFORD 75,000 ; 6/20/1997 3/1/1997
Permit data does not originate from the Seminole County Property Appraiser's office. For details or questions concerning a permit, please contact the building department of the tax district In which the property is located
Extra Features
Description YeaBuilt VaNewCost Units lue tYCOVERED
PATIO 1
10/1/1999 1 $400 ; 1,000 PATIO 10/1/
1999 t $1,0001 2,000 SCREEN ENCL 2
10/1/1999 1 $2,400 POOL 1 10/
1/1999 1 $9,000 15,000 http://parceldetail.scpafl.
org/ParcelDetaillnfo.aspx?PID=36193051400000040 10/23/2018
CITY Of .
ORD Building & Fire Prevention Division
RESIDENTIAL RE -ROOF A FFIDA VIT
FIRE DEPARTMENT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: I" 3 ADDRESS:
i , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFIT
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE#: CCC \33 0(QC7
COMPANY / CONTR ACTOR:
1
El'C12. '"C IJ WI S L..L.C. — QIA n G ` S - 1dL-
CONTRACTOR SIGNATURE: DATE: N oV 1 I ) O
MUST BE SIGNED BY LICENSE H DER OR OWNER/BUILDER)
A FINAL ROOF INSPECTION IS REQUIRED:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF 1Se`m'%n0\e
Sworn to and Subscribed before me this I day of NOVC,rnbeAr 20 k by:
S Ct--- j7Ak N rA V . Who is N/Personally Known to me or has Produced (type of
identification) as identification.
Signature o Notary Public ,.
a x cStateofFloridagam• -.. Notary Public State of Florida t'
Tiffany Burleson
t l n 1-7Lr)ej m , My Commission GG 173997
1'vl
orn Expires 01 /09/2022
Print/Typ /Stamp Name
of Notary Public