830 SAILFISH DR DWAY22-0002 Paver DrivewayOWNER:ADDRESS:CITY:STATE:ZIP:
THOMPSON ERROL N 830 SAILFISH DR ATLANTIC BEACH FL 32233-4217
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171157 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
830 SAILFISH DR DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY PAVER DRIVEWAY $6000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878.
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
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.
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.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 2/3/2022
PERMIT NUMBER
DWAY22-0002
ISSUED: 2/3/2022
EXPIRES: 8/2/2022
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $125.00
3 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
4 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
5 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
7 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
2 of 2Issued Date: 2/3/2022
PERMIT NUMBER
DWAY22-0002
ISSUED: 2/3/2022
EXPIRES: 8/2/2022
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $125.00
DWAY22-0002 Address: 830 SAILFISH DR APN: 171157 0000 $125.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R18680 $125.00
Printed: Thursday, February 3, 2022 1:17 PM
Date Paid: Thursday, February 03, 2022
Paid By: THOMPSON ERROL N
Pay Method: CREDIT CARD 582633061
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R18680
Final Plumbing
Final Electrical
Final HVAC
CC Final
Final Building*
Swimming Pool Steel
Swimming Pool Safety
Electrical Grounding & Bonding
Swimming Pool Final (Bldg)
Swimming Pool Final (PW)
Formed Columns/ Beams*
Masonry Cell Fill
Structural Steel*
OTHER:
OTHER:
OTHER:
OTHER:
OTHER:
Power Pole
Silt Fence
Piers/ Stem Walls
Underground Plumbing
Underground Electric
Foundation/ Footing
Slab**
Retaining Wall Footing
Driveway
Sewer (Building Dept)
Sewer Tap (Utilities Dept)
Rough Electric*
Rough Plumbing/ Top Out*
Rough Mechanical*
House Wrap
Wall Sheathing
Roof Sheathing
Tie-down Framing Connections
Rough Framing
Roofing In Progress
Window/Door In-Progress
Insulation Ceiling
Insulation Wall
Exterior Lath
Stucco Scratch Coat
Exterior Siding In-Progress
Brick Flashing & Ties
Early Power
Gas Rough
Gas Final*
* When all rough electric, plumbing, mechanical are complete but before any work is
covered up.
* When all gas piping is complete and wallboard is installed but before gas is
attached to any appliance. All outlets must be capped and pipe pressurized at a
minimum of 15 lbs.
* For new living space: When all construction work including electrical, plumbing,
mechanical, exterior finish, grading, required paving and landscaping is complete
and the building is ready for occupancy, but before being occupied
Additional inspections may apply to your project if your project
contains these elements:
INSPECTIONS REQUIRED FOR BUILDING PERMITS
To verify compliance with building codes, inspections of the work authorized are required at various points of the construction.
The following inspections are typically required for residential projects:
Date: Initial: Date: Initial:
_____________________________________________________
Permit Type
____________________________________________________
Permit No.
__________________________________________________________
Job Address
____________________________________________________
Contractor
POST THIS CARD WITH PERMITS AND PERMIT
DOCUMENTATION IN FRONT OF BUILDING
Construction Hours per City Code: 7am—7pm Weekdays; 9am—7pm Weekends
Building Department Public Works/Utilities Fire Department
Phone: 904-247-5826 Phone: 904-247-5834 Phone: 904-630-4789
Fax: 904-247-5845 Fax: 904-247-5843 Fax: 904-630-4203
* When forms and reinforcing steel, anchor bolts, sleeves and inserts, and all
electrical, plumbing and mechanical work is in place, but before concrete is poured.
* When all structural steel members are in place and all connections are complete,
but before such work is covered or concealed.
** FORM BOARD ELEVATION CERTIFICATE MUST BE ON-SITE FOR SLAB INSPECTION
Y-Ai ?),.. Building Permit Application Updated 10/9/18
f City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r'`;
IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.us -
k- wiN7 Z Z _0C- z
Job Address:70 t I CIi Ori A-1-16_(---, l:: - -22:7,--z,
Permit Number: k `a-0—Q i c
Legal Description R_ci Li (AA FQJm.S Jf\I* 1.—pi- -'j a 1 k 4— ) E# oils-7_000c)
Valuation of Work(Replacement Cost)$x,000.00 Heated/Cooled SF Non-Heated/Cooled
Class of Work: w Addition DAlteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial R sidential
If an existing structure,is a fire sprinkler system installed?: Yes No
Will tree(s)be removed in association with proposed proiect? Yes(must submit separate Tree Removal Permit) +iNo
Describe in detail the type of work to be performed:
en-4e C S Pc-Dv-- iq 0 es_ce---(4- J 00 K.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
p
Name I1S J Address YSO t(1—i y UK
City State F( Zip 3-2_22S-)› Phone 51'
04—7751-—C(-W-J-
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)0-,,e-.
04-1 .._fre._
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Num.
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date
Application is hereby made to obtain a permit to do the work . d installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and that all .rk will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a sep. ate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. 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.
OWNER'S AFFIDAVIT: I certify that all 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. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECQRDINC, UR NO E OF COMMENCEMENT.
am-
Signature f Owner or Agent)Signature of Co ractor)
igned and sworn to(or affi . before me this? day of Signed and sworn to(or affir d)before me this day of
a' 702?,biAIili by
Sig ii' re oya. `l Signature of Notary)
Personally Known OR t TONT GINDLESPER Or [ ]Personally Known OR
4;i ., MY COMMISSION#GG 3ProducedIdentification Produced Identification
wP; EXPIRES:October 6,2023
Type of Identification:
Bondcd Th,aN tory Publiu UnJciwdters
Type of Identification:
rrej
fRIGHT-
OF-WAY/ EASEMENT PERMIT APPLICATION
City of Atlantic Beach
ALL INFORMATION
HIGHLIGHTED IN GRAY IS
800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED.
Nkuoj
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES IC.-.tf O1 .)—C)(11-744-2,—
Job Address oZ \V-i5. K. T c .3,2,-, Permit Number R.E--5-2....Q.-0 l `
Contractor Information
Company w..CQualifying Agent
Address City State Zip
Phone Email
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt Expiration Date
Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial
and underground and the accurate locations are shown on the sketches.
Whenever necessary for the construction, repair,improvement, maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles,
wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of Project Superintendent)
with(Company Name) Phone
All materials and equipment shall be subject to inspection by the Public Works Director.
All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
manner satisfactory to the City.
A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of
and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
expenses arising in any ianner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
The •_: is Work D. e. or shall be ••ified 24 hours prior to starting work and again immediately upon completion.
Date / /4f/-"Z2
Permittee(signed in presence of Notary P .lic)
STATE OF FLORIDA,COUNTY OF DUVAL /
The foregoing instrument acknowledged this ( LI day of J an 20 2,
by / -a , Wt..../-‘..Wt..../-ersonalwhop a••-. -. . -..-.••.
printed name Permittee)TOS i1 GiNDLESPERGER
acknowledg hat he/s sign•c the instrument voluntarily for the purpose expressed in it. MY COMMISSION#GG 353178
EXPIRES:October 6,2023
p' ,.0 Bonded ThruNotary Public Underwriters
ebb. Personally Known
Signature of Notary Public,State of ori.a Produced Identification(Type)
H:\Applications&Forms\Word&Excel Document Originals V01801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
L.,,,,,-,"'"
y
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: IZC=S 2...oCV(
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER
OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: /...:
4_./e...,:,(
O Sa( ( .--- s .., {i` 1 P-, I "3---3
Owner Name: (K./e. ( lam,- 5 c (.1 Phone Number: 9 v-4-Z 7 0-U -1(f
Mailing Address: O Sat ('L,L, CCity: T LN State: / ( Zip: 32 .23 3
Notarized Signature of Owne( A _
The fiaregoing instatnent was acknowledged before me t,/ t 4day 0 202 444 the State of Florida, County
of V UVLv
Signature of Notary Public
i ..,r/ C.6--
r----
personally Known OR [ ] Produced Identification
PERGE;
1MISSION#GG 353178
Q;, EXPIRES:
pe of Identification:
i ''FOF F,4s' Bonded Thru Notary Public Underwriters
s
sn., Updated 10/24/18
L::.... 141..
zor;?v'P4e' , TCNI
lstr'.''a r`:,.,..
G,VOLESPERGER
r :_ MY COMMISSION#GG'"s5'7„*" .... ?',-''
EXPIRES:OctFo ` Bonded Thru Notary F be.6,
i
7-3- Z 8ENC,T4A ARK . 802
1621
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ELEV. + 9,72 [NAW-5491
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IMPERVIOUS CALCULATIONS
1' cs, TOTAL, AREA OF LOT 7,50D,45 SO
EX-t 0.5
A 05
k 5). EXISTING IMPERVIOUS AREA 179g.52 SO I
DE-10.5 d•
x\
POST IMPERVIOUS AREA 2 779,9'4 SO I
N85.20.02-,,,, 0°ri4
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FOUND..............„.„----
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Er
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LB 7261
I
ALL INFORMATION
11.A1f4 Revision Request/Correction to Comments HIGHLIGHTED IN
A' City of Atlantic Beach Building Department GRAY IS REQUIRED.
Y‘
Wit. 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: RC5 - Z'i 9 --1
n Revision to Issued Permit OR I I Corrections to Comments Date: y' (—Z—Z
Project Address: C.-15: 0 im s,I,
Contractor/Contact Name: c . iL :..) 1 I ,-.) `.----- S 0( f
Contact Phone: (vc4 7 } L7 -7 Email:C-rC- hI ( c:,)U C"`-
Description of Pro osed Revision/Corrections:
QQ_\1‘oe_ck-L6 1-e__ f\O_ is-L\ricI e i'' .., \L
I (K_.i U t L__..v,' ) & affirm the revision/correction to comments is inclusive of the proposed changes.
printed name)
Will poposed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f.to be added:
Will p9posed revision/corrections add additional increase in building value to original submittal?
Yes (additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent: C ,_'
Office Use Only)
Approved Denied Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services
Updated 10/17/18
REVOCABLE ENCROACHMENT AGREEMENT
ALL INFORMATION
City of Atlantic Beach
HIGHLIGHTED IN GRAYr' 800 Seminole Road,Atlantic Beach,FL 32233
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under, laws of thf S of Florida, hereinafter referred to as "CITY"and
of Atlantic Beach, Florida, hereinafter
referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'noti }y CITY USER,s i otic to USE, shall I.}e,given y rtifie I,return
receipt reguested,to the followin address > v.l am( 3 l/ Z 3
In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
iabilities are her- .V .ssumed y the USER.
Date /--2---C-
7/— ZZ.
Property Owner/Agent(signed i resence of No ary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 21 h day of JA N U Pt-Ry 20 )2 ,
by C V)u S hon '_. (7/JL.l who personally appeared before me and
printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
k7,t CHRISTIAN GILES Department Approval:
MY COMMISSION#HH 117153
Signature of Notary Public, State of Florida