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Permit Shed 44 Coral 2011 f r j CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD �� °� ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 '' 4 .219 Application Number 11- 00001741 Date 3/10/11 Property Address 44 CORAL ST Application type description SHED PERMIT Property Zoning TO BE UPDATED Application valuation . . . 4500 Application desc NEW SHED 12 X 3 Owner Contractor ACRI OSSI CONTRACTING LLC 13349 STONE POND DR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224 (904) 610 -3125 Permit BUILDING PERMIT Additional desc . Permit Fee . . . 75.00 Plan Check Fee . . 37.50 Issue Date . . . Valuation . . . . 4500 Expiration Date . 9/06/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED TO MEET 120MPH WIND LOAD. * AN INSPECTION WILL BE REQUIRED OF THE HOLES THAT THE 4X4'S ARE SET IN BEFORE CONCRETE IS POURED, LAG BOLTS AT 4 CORNERS TO BE INSPECTED BEFORE COVERING UP IN THE CONSTRUCTION PROCESS. * Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE DCA SURCHARGE 2.00 ENG REV BLDG MOD OR ROW 25.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 75.00 75.00 .00 .00 Plan Check Total 37.50 37.50 .00 .00 Other Fee Total 29.00 29.00 .00 .00 Grand Total 141.50 141.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 ' (S i, Office (904) 247 -5826 Fax (904) 247 -5845 414R V S' -- Job Address: 4" C- s'7" Permit Numb — 7V / Legal Description / 6 fr7- D 1 LS - 23 E . o7 * � �` Parcel # 2 0 T 3 b' k Floor Area of Sq.F't. Sq.Ft Valuation of Work $ 45 Proposed Work heated /cooled non - heated /cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door Use of existing/proposed structure(s) (circle one): Commercial vtesidential If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: /Jew 12 K 3 S7 - Vfoo7 F,Qleh Property Owner Information: Name: AI leia. A-GIL , Address: 1/ Nd/r14 -0 C2 seN7 o _ ._ City 7/5e0Nr0 ONTA C/1+ -AA4 -State Zip f1341SS , - . - 76 IIIILt LyfJ1 w E -Mail or Fax # (Optional) - IN Information: MAR 0 3 U 20 1 1 IA Company Name: 005, Co %i *k-c r Qualifying Agent: B Address: 3 - S ZW P _ ___ - City Aso....,'/ 4 State - '"""tom,•. - r - : .� Office Phone 9 LW G ,'O -2/ RS , `t , I t 1 u m� - .`"_` ° --- -- - -- 7 _ State Certification/Registration # lb! 411 A FOR 1 1 ' a I, i Architect Name & Phon 1 Mt' I _ ' t .,,,N,.�,.,,,,». „,.,w a,.�, ,.,,:;� *-i, Engineer's Name & Phone # 1 SE _ . - - , A _ Fee Simple Title Holder Name and Addr1 s REQUIRE .r _ . a . _ MI 1 i ' • Bonding Company Name and Address _ , _ um ■ 1 Rai R 11 Mortgage Lender Name and Address ! ' ' '' ��! , r IZ2 =1 /Pl'i ,, __ . _ _ 1 _ ■ Application is hereby made to obtain a permit to do the work and installations as indicated ceri I that • ,• • nstallation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a of six f6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc 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 I YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give auth• 'ty to violate or cancel the provisions of any other federal, state, or local law regulatnnt; instruction or the performance of construction. Signature of Owner 7 ,ti / ^ / QIX(( Signature of Contractor . / / Print Name 4� 4 ND (%le , (T(1' I Print Name lC (�fs, . Sworn to and subscribed before Die Sworn to nd subscribed before me this 2 S'Day of AreAL !+ It , 20 /l this a . i ' : 20// l 1 Notary Public s" � " ires7 / A r i . tary 7+Ri sr7t, m ' � : u b ltxp1 r _; q „inc ¢ o,,, n c;;;� ' Florida Notary Revised 01.26.10 Hu .a.uuuuu.uus....uu..ou.a....u.! 1 Prepared By: .- 4' °I ^r.a�yeatrs.��e.. -. �.. y ,7 3 `�. EXACTA 1- L. . 77 _. a ,. Stic St ,:... Z•: jC P & 17,11' p „ x " PROPERTY ADDRESS: 44 CORAL STREET, ATLANTIC BEACH, Florida 32233 SURVEY NUMBER: FL1005.1139 FIELD WORK DATE 5/ 2314010 REVISION DATES) ,rev 3 5•25,20' 01 > Y �V CORAL ST. 40' ww LXIVAL COUNTY ASPHALT DIW FlP 1/2. 100.001P) • 1 R1W O • co LOT i . S 89°5T50" E 100.28'(M) w co C • taut CORNER) BK6 LESS THE I N. 54.45' OF D 1 LOT 3 ow BLK6 `i r i A . O I DRIVEWAY 1 EASEMENT i LOT4 1 I BLK 6 t i FlPC 1? 7 tn T DE PJ 12°8715 LOT f . 102 i 31.3 - 0.3' ' ' D/W i 1 9.T 11../4 s s NWOOC L -1 2 STORY RES 54.45(D) h *44 S 00'12'00" E 54.52'(M) 8 13.7 . w (8.R. Assumed) - a \ /7 8.2' L -2 PORTION w ° 11.5. 17.3 / N m 50.00'(P) 12:r N 39 ° E 50.021M) B 6 O.8 — .- - �� 493' ma( 0 60.55(D) t _ ' 0 — 0.5' S 00'1238' E 60.84'(M) FRC lr e F221/2 L ILLEGIBLE L - 4 NO 10 50.00'(P) In N 89'3237' W 50.101M) LOT 12 LOT 6 LS BLK 6 BLK 6 60.55(D) N 00 W 60.3T(M) { ` f A IOkN NOTES - d I hereby certify • .' i " etch • i : of the hereon described - � crib - FENCE OWNERSHIP NOT DETERMINED. 4 knowledge let it b a true and representation of a property has • made my • n and to the best of my M - LOT APPEARS TO BE SERVICED BY CITY WATER AND SEWER s survey that m 1 , .. • •• ■ • • set forth by : the Florida " Of • . : as described in 30 0 15 30 • u Chapter 6J-17 •..-;: FIo Mellmin -...�. : Code. g � , 34 ' 1 L S tntvs l o� $ GRAPHIC SCALE (In Feet) f 1 inch = 30' ft. �/ �:. � A. Johnson Mark s (. Steed Fkrlds ptafaaeiorrl Stnayo. and Shipper , ' � ,: a License No. 6572 1) Use OPThis Survey for Purposes other than Intended, NSthour Wrgteo Vcnficauan, earl be at the User. Sole gkh and Without L.aM4ty to the Surveyor. Nothing hereon shall be Construed toGee ANY Rights n Benefits to Anyone Other than those CMified. sO '.'. _ -?a: , ,. r 3'? • , n2 t, L sF,.?!1 . -i "e{ " 7'3. :� _. -o ` POINTS OF INTEREST; 1.FENCE IN EASEMENT. S 2.A/C PAD IN EASEMENT o o c FLOOD INFORMATION: C By performing a search at www.fema.gov, it appears to oe the property to be located in a X zone with a Base Flood Elevation of NA. This Property was `ound m m CITY OF ATLANTIC BEACH , and community number 120075, dated 4 /17/89. c CLI ENT NUMBER LMT 10-299 DATE 5/25/2010 (.. h'1 N , 111 Exacta land Surveryors Inc. is a g ' BUYER ANGELA ACRI AND WILLIAM W ACRI full service, bonded land survey firm ' . ' registered with the state of Florida o 1 SELLER: ALFRED MILLER, IV AND MARY CLAIRE MILLER CERTIFIED TOt ANGELA ACRI AND WILLIAM W. ACRI, LANDMARK TITLE " EXACTA 1 E A LLC; FIRST AMERICAN TITLE INSURANCE COMPANY; N/. P This is page 1 of 2 and is not Exacta Land Surveyors, Inc. F �? - t valid without all pages. w � ' °'' ww.exactaland.com S k_ tea,.. 1 1/4.1 (tI\ -- E ....c kA t Zt"•••• ..- fb. -.... -4. \ ... czi,....—. a.) Q...._ v) .t....2. _____r) GL d e] (^ s Pa Et Nctc w a A _ = u.E E = rg ;" M 4,:j r tom, A tatl t1�1 .9 9 a -g° 2 O tix.• If ant. E fii '� _.......,, _.. rer . ,, r - _ter. " ""` F f �.`'a t,i_, pp OZ 0 I . Q : . ° � � e ms + y ` W�0 94 a W ,ca q y 4,. Ol , cki ;I i e- U. o .a co u.o 0 . y ,�� Q it W 13$`t li t ill 0 lia i ileilli 0., .......araw...... _ _ r s r .2f'J J , . i _ _ i • *jc,f r r , 1 44.3 1 C, . _ I x ! & �a i Va y w�+� V ".. _ _ .. _ y .jam . - N . ■ ___ _ . _ . _ is t ... _ , 1 . Vv__ _ __ __ _ __ __ l f -: *, "1 ° T.-- _ �c h k Doc # 2010142198, OR BK 15281 Page 438, Number Pages: 2, Recorded 06/21/2010 at 09:01 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $18.50 DEED 'DOC ST $2208.50 Prepared By and Return To: Landmark Title 4540 Southside Boulevard, Suite 702 Jacksonville, Florida 32216 File No.: LMT 10 -299 Grantees TIN: General Warranty Deed Made this June 10, 2010, By Alfred Miller, IV and Mary Claire Miller, husband and wife, whose address is: 4714 Wadham Lane, Jacksonville, Florida 32210, hereinafter called the Grantor, to Angela Acri and William W. Acri, wife and husband, whose address is: 11 Nomad Crescent, Toronto, Ontario, Canada M3B 1 S5, hereinafter called the Grantee: (Whenever used herein the term "Grantor" and " Grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) t ~� fJ Witnesseth, that the Grantor, for and in consideration of the sum of Ten Dollars, ($10.00) and other valuable consideration, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the Grantee, all that certain land situate in Duval County, Florida, more particularly described as follows: LOT 3, EXCEPT THE NORTH 54.45 FEET THEREOF, BLOCK 6, OCEAN GROVE UNIT NO. 1, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 15, PAGE 82, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, SUBJECT TO A DRIVEWAY EASEMENT OVER THE WESTERLY 10.2 FEET OF THE NORTHERLY 20 FEET THEREOF. TOGETHER WITH A DRIVEWAY EASEMENT OVER THE WESTERLY 10.2 FEET OF THE NORTHERLY 54.45 FEET OF LOT 3, BLOCK 6, OCEAN GROVE UNIT NO. 1, ACCORDING TO THE PLAT THEREOF RECORDED IN PLAT BOOK 15, PAGE 82, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, ALONG WITH A DRIVEWAY EASEMENT OVER THE EASTERLY 9.7 FEET OF THE NORTHERLY 74.15 FEET OF LOT 2, BLOCK 6, OCEAN GROVE UNIT NO. 1, ACCORDING TO PLAT THEREOF RECORDED IN PLAT BOOK 15, PAGE 82, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. Parcel ID Number: 169566 -0525 Subject to taxes accruing subsequent to December 31, 2009. Subject to covenants, restrictions and easements of record, if any; however, this reference thereto shall not operate to reimpose same. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the Grantor hereby covenants with said Grantee that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land; that the Grantor hereby fully warrants the OR BK 15281 PAGE 439 title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances. In Witness Whereof, the Grantor has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: (Seal) Alf Miller, Witness Printed Name C• JAI (Seal) l , / ^� ff r Ir filler Witness Printed Name ? 'ti/ �1 �'t Ya rrm st IF State of Florida County of Duval The foregoing instrument was acknowledged before me this 10th day of June, 2 and Maly Claire Miller, husband and wife, who is/are personally known to me or who has produced as 1 n fication. Notary Public : //�� USEELLEN C. SAWYER 4 my COI ssmNIDD915467 EIS' Dw'srnrer9.2013 ?; <' Naga! Thai uNav . < hie Undrnw� rtLA..4. City of Atlantic Beach APPLICATION NUMBER 6 Building Department (To be assigned by the Building Department.) 800 Seminole Road j /�, / � Atlantic Beach, Florida 32233 -5445 . `1 Phone (904) 247 -5826 • Fax (904) 247 -5845 k m E -mail: building- dept @coab.us Date routed: 0 / -y // City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4/7 66„ L Department review required Ye No V Applicant: � e iea. d 'n1 ina Tree Administrator Project: ,„<H Wo PQFrr. 1 itilities Public Safety Revi � 14, o u, a a k P11; c Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: proved. ['Denied. (Circle one.) Comments: - j _ 4 ; 4 , fie F G' S � � T� LE• i S C b � S C � � "I G'� r �' ic r ✓1 � � C „ 6, BUILDI pr n T-et /0-pr PLANNING & ZONING '7 ,� Reviewed by: / r Date:.' - " g TREE ADMIN. Second Review: DApproved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 vr City of Atlantic Beach APPLICATION NUMBER ate • l Building Department (To be assigned by the Building Department.) 800 Seminole Road j - I • r Atlantic Beach, Florida 32233 -5445 � Phone (904) 247 -5826 • Fax (904) 247 -5845 oj3 9» E -mail: building- dept @coab.us Date routed: j /3/,/ City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: .0 &,& L Department review required Yes No "uildinq_.` Applicant: rn a d lann.:Mg , &_ Zonivtg / Tree Administrator Project: J y �6 blic wo ir. I itilities 7 Public Safety Fire Services Review ; fee $" '� ��� Dept Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: []Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 05/14/09 RECE i ... -s r. City of Atlantic Beach MAR A 4 2011 APPLICATION NUMBER -# Building Department �+ (To be assigned by the Building Department.) kinv 800 Seminole Road ,. . Atlantic Beach, Florida 32233 -54• '- �`/ /' Phone (904) 247 -5826 • Fax (904) 247 -5845 it >r E -mail: building- dept @coab.us Date routed: 4 City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: .4 &ea L. Department review required Yes No ui� lding_ ' Applicant: 0 ? t - lea 6 nk .. • & icul ig Tree Administrator Project: :S y i-4 _ I iic w i ' c i ltilities Public Safety Fire Services Review''' $ i y e t } Dept S gnature. =V Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: FApproved. [Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: 51—// TREE ADMIN. .. Second Review: [Approved as revised. ['Denied. P , ,, e - - Comments: lCUTII — // PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [Approved as revised. [Denied. Comments: Reviewed by: Date: Revised 05/14/09 RECEIVED C ity of Atlantic Beach MAR Q " Z011 APPLICATION NUMBER r 4 Building Department (To be assigned by the Building Department.) t 800 Seminole Road j Atlantic Beach, Florida 32233 -5445 BY:----- ---:1 1 1/4 Phone (904) 247 -5826 • Fax (904) • - 5845 r J3 U» E -mail: building- dept @coab.us Date routed: j /3/// City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4/4 6 Ket L De artment review required Yes No uildinq._' Applicant: 5 c7 77",C u 9.. & Zoj Tree Administrator Project: ie I Itilit s Public Safety Fire Services Revie*fed $ ©" A*D6pt Signature '' Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: lJ BUILDING , PLANNING & ZONING Reviewed by: / Date: 3l F/ 1 / TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 MAR -10 -2011 15:47 FROM:CLERK OF COURTS 904 270 1512 T0: 92475845 P:1'1 Doc A iOTICE OF COMME.KCEMENT Number Pages' ire. Or; �n.'�5y, Pie lose Racorcled 0311 0/2011 at 025.5 PM JIM FULLER CLERK CIRCUIT COURT DUVAL Permit No. /l /7* I COUNTY Tax Folio No.16 - O5Z RECORDING 510.00 THE UNDERSIGNED hereby gives notice that impr veracnts will be made to certain real e 7J 3J 3 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENaldance with Section 1.Description of property (legal description): 1 5—S 2. (R- 2 S — .2 4 E .07 chi yJ G,Pd tl a) Street (job) Address: ¥/y GO4At £ No / 2.(}eneral description of improvements: S_7" � � �` ; 33 3.Owncr Infomtati i on tt - .:t� a) Name and address: Av.1&EL4 A-c-R. I ( ( kl0fv1A -fj sit e g Er 7`OaoMro • b) Namo and address of fee simple titleholder (if other than owner) '- a�ri'14Rtp M sal S� c) Interest in property 6ctr,'j c ( 4.Contrrctor Information - --� —* a) Name and address: J (Ur Qt Q $S1 Colt- j"eaCit / 43 7eNe p . 0 b) Telephone No.: _ 9Q V:- 4/ -_,0,4 c ^ — N D Q J7 —fi a K. j Q 1/4 5.Suroty Information o . ` () - e a) Name and address: - b) Amount of Bond c) Telephone No.: . No. G.tcndcr _ (Opt.) a) Name and address: 7. Identity of person within the State of Florida designated Phone No. a) Name and address: by owner upon whom notices or other documents may be served: b) Telephone No.: Fax No. (Opt.) " 8.1n addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 71 3(1)(b), Florida Statutes: a) Name and address: _ b) Telephone No.: Fax No. (Opt.) _' 9.Rxpiration date ofNotice of Commencement (the expiration date is one 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 TILE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I; 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. , . c STATR OF PLORInn OF meccas 0 tr.,/A4- 4— 10. / �� s�- - wncr or Owner's Authorized OfTiccr,Direciar ." dFO • cr/Matiol er 0 /4L AgA.,rej PYI e a (4421__ PrirrNaore• The foregoing instrument was acknowledged before me this a ~ d a of a•'G�n y .xott,by f as _• (type of authority, e.g. officer, trustee, attorney hi fact) for _ (name of party on behalf of whom is CLIFFFORD ALAN • t ER f wail pleec • ,.i personally Known ✓ OR Produced Identification N signature � �' E Tres 7/2f2012 N o t ary Si aturC Cf �G�' - � Type of Identification Produced ' v :" F lood. fir , the s N ame (Print) C�+ff� �4,GA Ii?, i OR Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, l declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. rr>RMwaoc Md :V1U X u enrol person S rgnin�: rinds i . A-bov