5500 Fleet Landing Blvd Nancy House 2014 J�U\j-
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003873 Date 3/26/14
Property Address . . . . . . 5500 FLEET LANDING BLVD TP01
Tenant nbr, name . . . . . . NANCY HOUSE STRUCTION
Application type description COMMERCIAL NEW CON
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5400000 --- ----
-- - - - - - - - - - --- - - - -- -- -- ------ --- - ----- ---- --- - - - ----- --- - ---------- -
Application desc
new commerical building ------- -------
-------------- -- - -- -- -- -- - ------ ----- ---- - --- --- -- - --
Owner Contractor-- --- - --------
---- -- - -- -
-- - - --- ------ -- -- -- ----- ELKINS CONSTRUCTION INC
NAVAL CONTINUING CARE
RETIREMENT FOUNDATION, INC P 0 BOX 2396 FL 32203
1 FLEET LANDING BLVD JACKSONVILLE
ATLANTIC BEACH FL 322334599 (904) 265-5585
--- Structure Information 000 000 26000 SQ FT NEW BUILDING "NANCY HOUSE"
Construction Type . . . . . TYPE 5-A
occupancy Type . . . . . . BUSINESS
Flood Zone . . . . . . . . ZONE X - --------------
-------- -- --- - ------ -- -- ------ - - ---- - ---- ---- -- - -- ----- - - ---
Permit . . . . . . COMMERCIAL NEW
Additional desc - - Plan Check Fee 5740 - 00
Permit Fee . . . . 11480 . 00
Issue Date . . . . 2/14/14 Valuation . . . . 5400000
Expiration Date . - 8/13/14 - - - - --- -- --- - ----------- --- -----
------- ------- -- - -- -- -- -- --- --- ------ - --- - --
Special Notes and Comments results to Malcolm Clemons at
Send backflow preventer test ic Beach, FL
Public Utilities Dept . , 902 Assisi Lane, Atlant
32233 .
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE lled at the property line .
A sewer cleanout must be insta oncrete box with
Cleanout must be covered with an RT1 c
metal lid. Cleanout to be set to grade and visible .
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O .
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE To REMAIN ON THE WINDOWS
*PROVIDE ACCESS To ALL WINDOWS TO INSPECT FASTENERS
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
PERMIT IS AMRLTeaVtN )ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 13-00003873 Date 3/26/14
------------------------------------------------------------- --------------
Special Notes and Comments
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction. -----------------------
-- -------------------------------------------------- 172 . 20
Other Fees . . . . . . . . . STATE DCA SURCHARGE
DEV REVIEW-PUBLIC/INSTITU 150 . 00
ENG REV COMMERCIAL BLDG 150 . 00
STATE ELEC DCA SURCHARGE 6 . 08
STATE ELEC DBPR SURCHARGE 6 . 08
STATE DBPR SURCHARGE 172 . 20
UTIL REV COMMERCIAL BLDG 75 . 00
---------- -----------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 11480 . 00 11480 . 00 . 00 . 00
Plan Check Total 5740 . 00 5740 . 00 . 00 . 00
Other Fee Total 731 . 56 731 . 56 . 00 . 00
Grand Total 17951 . 56 17951 . 56 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
oil
Application Number . . . . . 13-00003873 Date 3/26/14
Property Address . . . . . . 5500 FLEET LANDING BLVD TP01
Tenant nbr, name . . . . . . NANCY HOUSE STRUCTION
Application type description COMMERCIAL NEW CON
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5400000
-- -------------------------------------------------------------------------
Application desc
new commerical building ------ -------
-------------------------------------------------------------
Owner Contractor
------------------------
------------------------ ELKINS CONSTRUCTION INC
NAVAL CONTINUING CARE P 0 BOX 2396
RETIREMENT FOUNDATION, INC FL 32203
1 FLEET LANDING BLVD JACKSONVILLE
ATLANTIC BEACH FL 322334599 (904) 265-558S
--- Structure Information 000 000 26000 SQ FT NEW BUILDING ,NANCY HOUSE"
Construction Type . . . . . TYPE 5-A
occupancy Type . . . . . . BUSINESS
Flood Zone . . . . . . . . ZONE X ---------------
---------- --------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc - -
Sub Contractor COASTAL ELECTRIC COMPANY
405 - 00 Plan Check Fee . 00
Permit Fee . . . . Valuation . . . . 0
Issue Date . . . . 3/25/14
Expiration Date - - 9/21/14 ------------------------
- ----------------------------------------- --------
Special Notes and Comments esults to Malcolm Clemons at
Send backflow preventer test r
Public utilities Dept . , 902 Assisi Lane, Atlantic Beach, FL
32233 .
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
A sewer cleanout must be installed at the property line.
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible .
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS To ALL WINDOWS TO INSPECT FASTENERS
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
�NAftnced 'Disposal, Realco, Shappelle' s and Waste
I ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
PERMIT IS APAW600VIV A CORDANCE WITH
BUILDING CODES.
S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ro
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 13-00003873 Date---3/26/14
------------------------------------------------------------- -- -------
Special Notes and Comments
management . )
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction. -------------------------------
-- ----------------------------------------- Credited Due
Fee summary Charged Paid
----- ----------- ---------- ---------- ---------- ----------
Permit Fee Total 405 . 00 405 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 405 . 00 405 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH 3/26/14
BP20OP16 Application Master Maintenance 13:39:47
Position to 5500 FLEET LAND—ING BLVD — —
Number Pre Qual Dir Street name Sfx Pst Pst Apt
Dir Qual
Type options, press Enter . 5=View 6=Names 7=Fees
2=General info 4=Delete 11=Permits . . .
8=Subcontractors 9=Misc info 10=Structures Type Status
opt Number Property Address ELEC PI
-j-4 6000-0126 5500 FLEET LANDING BLVD TP01 ELEC CL
06 00033932 5500 FLEET LANDING BLVD TPOI. MECH cc
11 00002292 5502 FLEET LANDING BLVD MECH cc
12 00000168 5503 FLEET LANDING BLVD MECH cc
12 00000270 5509 FLEET LANDING BLVD MECH cc
12 00000266 5510 FLEET LANDING BLVD RAAR CO
09 00001308 5517 FLEET LANDING BLVD MECH cc
12 00000482 5603 FLEET LANDING BLVD WIND cc
11 00002403 5607 FLEET LANDING BLVD More. . .
F3=Exit F5=Refresh F6=Add F8=Switch view F11=Toggle view F17=Subset
F18=Set maint path F23=More options
Walker, Jennifer
From: Donskey, Gerald W. [DonsGW@jea.com)
Sent: Tuesday, March 25, 2014 3:04 PM
To: Graham, Shirley; Leggett, Shannon K.
Cc: Walker, Jennifer; Jones, Mike; Theodoridis, Constantine; Gale, Harold T.
Subject: RE: 1 Fleet Landing Nancy House
Shirley, DING BV address.
JEA has a meter at the I FLEET LAN
Meter at 5500 FLEET LANDING was removed and building demolished for this new building. (also 5SOO-1 & 5550)
Could we use the 5500 address for the Nancy Building?
14 Master Premise records found P1
o+r-1 FLEET LANDING 8V
1 FLEET LANDING BV 116
1 FLEET LANDING BV 5001
1 FLEET LANDING B'k..,'5106
r7l 1:�:T I i
1 FLEET LANDING BV PS90
6
4000 FLEET LANDING BV
5000 FLEET LANDING BV
5000 FLE E T LAN D I N G BV
5498 FLEET LANDING BV S1301
5500 FLEET LANDING BV
1�_5500 FLEET LANDING BV 1
0.-5500 FLEET LANDING BV TP01
1j)_5550 FLEET LANDING 8V
:0.-6000 FLEET LANDING BV
From: Graham, Shirley [mailto:sciraham&coab.us]
Sent:Tuesday, March 25, 2014 10:34 AM
To: Leggett, Shannon K.; Donskey, Gerald W.
Cc: Walker, Jennifer; Jones, Mike
Subject: I Fleet Landing Nancy House
Building Permits Technician
800 Seminole Rd
Atlantic Beach, Fl 32233
9042475800
suaham��coab.,us
---- ------------------------------------------------------------
Florida has a very broad Public Records Law. Virtually all
written communications to or from State and Local Officials and
employees are public records available to the public and media
upon request. JEA does not differentiate between personal and
business e-mails. E-mail sent on the JEA system will be
considered public and will only be withheld from disclosure if
deemed confidential pursuant to State Law. Under Florida law, e
mail addresses are public records. if you do not want your e-
1
mail address released in response to a public-records request,
do not send electronic mail to this entity- Instead, contact JEA
by phone or in writing.
2
. I I.% % Z
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003873 Date 3/27/14
Property Address . . . . . . 5SOO FLEET LANDING BLVD TP01
Tenant nbr, name . . . . . . NANCY HOUSE STRUCTION
Application type description COMMERCIAL NEW CON
Property zoning . . . . . . . TO BE UPDATED
Application valuation . . . . S400000 ------
-- -------------------------------------------------------------------
Application desc
new commerical building -------- --------------
-----------------------------------------------------
Owner Contractor--------------
----------
------------------------ ELKINS CONSTRUCTION INC
NAVAL CONTINUING CARE
RETIREMENT FOUNDATION, INC P 0 BOX 2396
1 FLEET LANDING BLVD JACKSONVILLE FL 32203
ATLANTIC BEACH FL 322334599 (904) 265-5585
--- Structure Information 000 000 26000 SQ FT NEW BUILDING "NANCY HOUSE"
construction Type . . . . . TYPE 5-A
occupancy Type . . . . . . BUSINESS
Flood Zone . . . . . . . . ZONE X ------
---------- ----------------------------------------------------------
Permit . . . . . . MECHANICAL HVAC PERMIT
Additional desc - -
sub Contractor . . CERTIFIED AIR CONTRACTORS, INC
Permit Fee . . . . 177 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . - 9/23/14 -------------------------
------------------------------------------- -------
Special Notes and Comments esults to Malcolm Clemons at
Send backflow preventer test r
Public utilities Dept . , 902 Assisi Lane, Atlantic Beach, FL
32233 .
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
A sewer cleanout must be installed at the property line .
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible.
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE To REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
DisRosal� Realco, Shappelle ' s and Waste
d OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
PERMIT IS AMUffio(YA4�N�k(?A�UCE WITH LL CIT
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 13-00003873 --------Date---3/27/14
--------------------------------------------------- ---- -------
Special Notes and Comments
management . ) ust be installed and
Full erosion control measures m
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction. ----------------------------------------
------------------------------------STATE MECH DCA SURCHARGE 2 . 66
Other Fees . . . . . . . . . STATE MECH DBPR SURCHARGE 2 . 66
-----------------------------------------------------------------
---------- Paid Credited Due
Fee summary Charged -- --- ------ ----------
------ ------
----------------- ----177 . 00 ----177 . 00 . 00 . 00
Permit Fee Total . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00
Other Fee Total 5 . 32 5 . 32 . 00 . 00
Grand Total 182 . 32 182 . 32
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MECHANICAL PERMIT APPLICATION
N CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
J55W Laiyl- GUS 247-5826 Fax (904) 247-5845 PERmrr#
111 10 tiIIIIII
. Is!! oil
JOB ADDRESS:
PR OJE C T VA L UE $ F-� y ARI# REQUIRED
Air Handling Equipment Only >� Air Handling Unit & Condenser Condenser Only
NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION
Air Conditioning: Unit Quantity Tons Per Unit Vd 736-��l
itv r�,,-Al BTU's Per Unitf-7z.,,p., n.talSeer Rating
Heat: Unit Quant jffQUIRED
Total CFM
Duct Systems:
/ 3 (=ee 5%, L&Al M INSTALLATION
REPLACEMENT AIR CONDITIONING & HEATING SYSTE
Air Conditioning: Unit Quantity Tons Per Unit Seer Rating
Heat: Unit Quantity BTU's Per Unit ffQ—UIRED
Duct Systems: Total CFM
FIRE PREVENTION Quantity (Requires 3 sets of plans)
Fire Sprinkler System Quantity (Requires 3 sets of plans)
Fire Standpipe Value (Requires 3 sets of plans)
Underground Fire Main Quantity (Requires 3 sets of plans)
Fire Hose Cabinets Quantity (Requires 3 sets of plans)
Commercial Hoods (Requires 3 sets of plans)
Fire Suppression Systems Quantity
FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace Qty— Automobile Lifts BTU's
Gas Piping Outlets Boilers
Elevators/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps BTU's
#Vented Wall Furnaces Refrigerator Condenser
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
OTHER:
is suspended or abandoned for six months.I hereby certify that I have read
Permit becomes void if work does not commence within a six month period or work ming this work will be complied with whether specified or
this application and know the same to be true and correct. All provisions of laws and ordinances gove nstruction or the performance of construction.
not. Tbe permit does not give authority to violate the provisions of any other state or local law regulation co
e-f o(!!� Phone Number
Property Owners Nam 7?,$b
hone Fax
Mechanical Company C.�42�6�-I !f� office P
Ave— C k-%a W 0,
Co. Address: city State—Zip
License Holder (Print): State Certification/Registration# C-IeO 92-5-1
Notarized Signature of License Holder
day of 20
e ore me thisa?7 0
d
LC7,2 M J7
WO—M SIM ignature of Notary Public
im, w...
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003873 Date 4/10/14
Property Address . . . . . . 5500 FLEET LANDING BLVD
Tenant nbr, name . . . . . . NANCY HOUSE
Application type description COMMERCIAL NEW CONSTRUCTION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5400000
----------------------------------------------------------------------------
Application desc
new commerical building -----
----------------------------------------------------------------------
Owner Contractor
------------------------
ELKINS CONSTRUCTION INC
NAVAL CONTINUING CARE
RETIREMENT FOUNDATION, INC P 0 BOX 2396 FL 32203
1 FLEET LANDING BLVD JACKSONVILLE
ATLANTIC BEACH FL 322334599 (904) 265-5585
--- Structure Information 000 000 26000 SQ FT NEW BUILDING "NANCY HOUSE"
Construction Type . . . . . TYPE 5-A
occupancy Type . . . . . . BUSINESS
Flood Zone . . . . . . . . ZONE X ------
----------------------------------------------------------------------
Permit PLUMBING PERMIT
Additional desc NEW WATER SEWER SERVICE
Sub Contractor TOUCHTON PLUMBING Plan Check Fee . 00
Permit Fee . . . . 1070 . 00 Valuation . . . . 0
Issue Date . . . .
Expiration Date . . 10/07/14 -----------------------
-----------------------------------------------------
Special Notes and Comments
Send backflow preventer test results to Malcolm Clemons at
Public Utilities Dept . , 902 Assisi Lane, Atlantic Beach, FL
32233 .
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
A sewer cleanout must be installed at the property line .
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible.
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
'�cl �91A�&�PktttORIDA
PERMIT IS(ApP0NF9ffdLY&dArea=a2C )!APO 5011GITFt4 1kT19kNTk1"P?4JIA�AciL
BUILDING CODES.
SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 13-00003873 Date 4/10/14
----------------------------------------------------------------------------
Special Notes and Comments
Management . )
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
-----------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 16 . 05
STATE PLBG DBPR SURCHARGE 16 . 05
-- -------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1070 . 00 1070 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 32 . 10 32 . 10 . 00 . 00
Grand Total 1102 . 10 1102 . 10 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845 PERMIT# 1 *3 ofxu_3
JOB ADDRESS: 'a, "J:�I, 'f-'.
NEW OR REPLACEMENT INSTALLATION: Project Value$ 9boll ow ' 00
TYPE OF FIXTURE QTY TYPE OF FiXTURE QTY
Bathtub Septic Tank&Pit -7
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
o Sewer Replacement 0 Back Flow Preventer F-1 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Ej Lawn Sprinkler System-Number of Heads Ei Well
** SJRWD Well Completion Form. Complete&—form to be submitted to tfie—Building Department for final inspection."
o Other 5ewet CC)nneC'4-CV1
x— ed or abandoned for six months.I hereby certify that I have read
Permit becomes void if work does not commence within a si month period or work is suspend
and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
this application and know the same to be true violate the provisions of any other state or local law regulation construction or the performance of construction.
or not. The permit does not give authority to Phone Number
Property Owners Name --!2 bl�
38q_Ci.2_q--) Fax Z)G
Plumbing Company C11 h- u-na b'% _Office Phone
"0 7)w I le State V:G Zip
Co. Address: '.4 city
on# V-0- 0 t5(a 14_�6
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Notarized Signature of License Holder tl 20 't
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