2059 Selva Marina Dr DWAY19-0014 DRIVEWAY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DWAY19-0014
n ISSUED: 5/8/2019
u 800 SEMINOLE ROAD EXPIRES: 11/4/2019
.'.i ATLANTIC BEACH. FL32233
ALL • ,K MUST CONFORM • • • • t • • ' • •
CONDITIONSCODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL
FNOTICE: In addition to the requirements of this permit,there maybe additional restrictions applicable to this property
may be found in the public records of this county,and there may be additional permits required from otherrnmental entities such as water management districts,state agencies,or federal agencies.
20695ELVA MARINA DR DRIVEWAY SINGLE OR TWO DRIVEWAY $14000.00
FAMILY DRIVEWAY
— TYPE OF ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
SELVA NORTE UNIT 01
1695061072CITY: STATE: ZIP:
---COMPANY: . . •
OWNER: ADDRESS:
KENNETH BUSH TRUST 10203 JILL AVE HIGHLANDS RANCH CO 80130
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.
LIST OF CONDITIONS
z
r company must be on City approved list. Container cannot be placed on City right-of-way.PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
l measures must be Installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247
n Erosion and Sediment Control Inspection prior to start of construction.PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 5/8/2019 1 of 2
=_�
DRIVEWAY PERMIT PERMIT NUMBER
DWAY39-0014
CITY OF ATLANTIC BEACH ISSUED:5/8/2019
800 SEMINOLE ROADEXPIRES:11/4/2019
ATLANTIC BEACH. FL 32233
B PUBLIC WORKS
ROLL OFF CONTAINER INFORMATIONAL
Notes: ,.
Roll off container company must be en a Mlist(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on Ory right-
Of-way-4 PUBLIC WORKS
RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
RUNOFF FORMATIONAL
B PUBLIC WORKS
IN
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS
MAXIMUM DRIVEWAY INFORMATIONAL
Notes
Maximum driveway width within the City right-of-way is 20 feet.
T PUBLIC WORKS
CIRCULAR DRIVEWAY INFORMATIONAL
Notes:
Maximum circular driveway width within the City right-of-way is 12 feet.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
00
BUILDING MOD OR ROW 001-OOOOd29-1004
PW REVIEW 0
TOTAL:525.00
Issued Date:5/8/2019
2 oft
City of Atlantic Beach �w APPLICATION NUMBER
" Building Department '-CE.-
Atlantic
� li�s (To be assigned by the Building Department.)
800 Seminole Road
- - � ,r.' Atlantic Beach, Florida 322335445 4J
Phone(904)247-5826 Fax(904)247-5845' '�n 29 Ldp,
E-mail: building-dept@wab.us Date routed: 4
City web-site: http://www.crab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z0C� `J q C—V lZ rtment review required Yea No
Buildin
Applicant: �C,L� I��-17 arming &Zonin
f� Tree Administrator
Project: t�l\ jC—[.1� iWorks
Publics Utilities.
Public Safety
Fire Services
Review fee $ Dept .
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL 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: pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed ; a[e:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. []Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
City of Atlantic Beach APPLICATION NUMBER
J� Building Department (To be assigned by the Building Department.)
800 Seminole Road Dw 1 _OOI`t
�f
Atlantic Beach, Florida 32233-5445 4J l
Phone(904)247-5826- Fax(904)2475845 ,t
E-mail: buildingAept@coab.us
Date routed: 4
Cityweb-site: http:/hwrv�.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ��;19 J C.t-V/�f I W J rtmerit review required Yes No
Buildin
�lC--�J arming&Zonin
Applicant: w _.
ree Administrator
Project:
21U(=- u)4 Ji is od<s
� Public Utilities.
Public Safety
Fire Services
Review fee $ _ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: g Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING �p �
p yy(/ �r~Ci/19 fir SG/k& Too Ir
PLANNING&ZONING V Reviewed by. Date:✓^3' `(
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 0&1812017
Building Permit Application Updated 1019118
n City of Atlantic Beach Building Department -'ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
p Phone: (9004) 247-5826 Email: Building-Dept@ccab.us 15 REQUIRED.
Job Address: 07O ✓ rr A - Permit Numb � wfl ` ( � —OC) (`Y�
/'
Legal Description vi e.L/f •-1y 'QVe V-f /A (PORE p
Valuation of Work(Replacement Cost)$ 0io Heated/Cooled SF Non-Heated/Cooled
• Classof Work: ONew ElAddition OAlteration ORepair []Move DDenno OPOOI OWindow/Door
• Use of existing/proposed structure(s): OCommercial ❑Residential
• If an existing structure,Is a fire sprinkler system installed?: Oyes ONo
• W'll she removed in association with amoosed ro ect7 Elves(must submit mijazate Tree Removal PermitPermitl ONo
Describe in detail the type of work to be performed:
C) r (Ve(.JQ
Florida Product Approval# for multiple products use product approval form
Prooertv Owner Information
Name �1 •'1 Add '7 ✓C UQrn4 ✓•�rG
City /� ' State zip Phone Oa n-4.� ? -� 12�-
E-Ma'lt t7 6 h/ - 3 o
Owner r en (I Age ,Power ff,Attorney or Agency Letter Required)
Contractor informa ion "U — sa-(e$/, Q f g.t 11
Name ofName of Co� B✓N AA n WA /Quali) AP�nt A Tr�1
Address City) R.LI�f ^�A✓•I/t State Zip
Office Phone lob Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone If
Workers Compensation Insurer OR Exempt O Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.l certify that no work or instal lation has
commenced priorto the Issuance of a permit and that all work will be performed to meet the standards of all the 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. NOTICE:In addition to the requirements of this
permit,there maybe additional restrictions applicable to this property that maybe found in the public records of this county,and
there maybe 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
REC IN�0 MMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
neda swof,D to( L aZ01, bir )before met hs1
_ ayof 1 Signed and sworn to(or affirmed)b fore me this—day of
\ by
an ur o try) =cat
tureof Notary]
GERT 824951Personally Known OR f; r9,2919]Produced IdentiflwBon �-r yPro uwrsasType of Idemlflcation: q7" '®7
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SrntE '/�1n' - PLAN AAr t48Z5
MAP SHOWING SURVEY OF
LOT 36, SELVA NORTE' UNIT ONE, AS RECORDED IN PLAT BOOK 39, PAGES 94, 94A AND
948 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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I M1ereuY cedlly that tsurvey meets the
minimum technical fstandard.LSu as set IOHM1 by
ua
tM1e Fbdda Board of Land Surveyom.Pursuant
H. A. DURDEN 0 Seation 472.07 Florida Statutes.
& ASSOCIATE\ ,NC .,,,,,,.,,;�
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,3S57
TION
-- - _ __-City of Atlantic Beach - -- - - 'GHLIGH ED IN GRA
BOO Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED REQUI IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as"CITY'and
Kenneth Bush 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 20SR Selim [9W;Ha Drive lDfiJeulaY�
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'notice by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address 10203 Jill Ave.,Highlands Ranch,0080130
• 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
save ham less by the US from any of the work herein under the terms of this permit and that all of said
'ab'ities are here `as � b e USER.
Date_
Props Owner/Agent nod in presence of Notary Public) f,
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2{/ #day of �r / 20 1�
by h who personally appeared before me and
(p 'nted na of Per)
ack owl dged t at s e signed a instrument voluntarily for the purpose expressed in it.
�- Department Approval:
Signature of Notary Tic,State of a
[ ]Personally Known TGNI GIN9LEfiPERGER
P/roduced Identification 7 e) lI N 5` p1 ur corunlssloNxPP9zsss co I illiams,Pub Ic Works Director
e: ( yP a= EXPIRES:Ockber 6,2919
ry'.tp--_„,;444, EXPIRES:
nWbk 1,11 a
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
AM 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCA;z:
Job Address 2059 Salva Manna Dr. Permit Number
Contractor Information
Company Moderns Pavers Qualifying Agent Justin Canova
Address 215 Stokes landing Rd. qty St.Augustine State FL Zip 32095
Phone 904-537-0411 Email justinQmodernapavers.com
State Certification/Registration If
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 manner of the exe se or attempted exercises by the holder of the aforesaid rights and privileges.
• e ublic WorksDirha b fill 44 hours prior to starting work and again immediately u n mpleti
/jt d Date
Perm (signed in presence df Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL ''�� ((��� r IGL
The foregoing instrument was ac owledg/e/dam/4,hrs J�_day of j 1 ,20 lel
by k9,, M1 R 2 �Y 5 L who personally appeared before me and
(printed name of Permittee)
az owl gad that he he signed he instrument voluntarily for Me purpose expressed in it.
I I Personally Known
I ure of Notary Public,State of ria [ ] Produced Identification(Type) D.c—
vWIIWF uuuucr r Illuurlk HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY 15 REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT a,
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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(l). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPTC&COAB.US)IF IN DOUBT.
V. ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Ob Address: 2059 Sella Marina Dr,Atlantic Beach, FI
)wner Name: Kenneth Bush Phone Number: 720-3232834
Mailing Address:
10203AIIAve. H' IRIS h State: 00 Zip: 80130
Notarized Signature of Owner
-he foiegoing instrument was acknowledged before me this 2�Nay o Y20 in the State of Florida, County
Signature of Notary Public
[ ] Personally Known 0 ] Produced Identification
/n
Type of Identification: J --��cw) k� '
�� _ 9 9 - 07?
,0 IS$I UNuRd 10/24/18
yl MYPIRES Itob Fer .2I19
E%PIflE3'.aip er�Uro maen
gi �a. �� eoaem"wzn
NU I ILL UI- LUMMtNLt--' -'-
\/� Doc#2019130855,OR BK 18816 Page 578,
State of 1 C► 1 d CI Number Pages:1
Recorded 06!05/2019 01:47 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
I/L I V vi \ �L{ 1�"h,'� COUNTY
County of
J RECORDING $10.00
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordanqe with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. h 0 r
Legal Description of property being improved: 'Cl 9- ` ZC1 V Cl
C't Il r r ;3W
Address of property being improved:ZC nn] k i y0 HO u nCl . . ,
3MB
General description of improvements: 1 I'Y1�1'OV�i'Yk�►'l} C (�Y'1�2i 1�
Owner:ken a a�<h Address:Z(Y.2 S:Q I W IN/10 v1 1.2CJ DC, R'-wj L oeqcj
Owner's interest in site of the improvement: _
Fee Simple Titleholder(if other than owner):
Name:��11
Contractor."Ol�I,,
�t�,mo Pb\jers q, 1�
Address: 21 J((��SIST'-,tk ; ( Clndincl red A. AL,12AK-b o 1 �- - 2ZngS
Telephone No.:Q V U" 5-34" l_M I I Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name: Y1� 1 b
Address:/- v((?��"I i O Mcln inCi fir. l�tlUrrri C_ �C ISI JCL 32233
Telephone Nog5A - JC)� --';�12L— Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: RiAw Date:
Before me this day of �� 0 n the County of Duval,State
ANGEUBN4EY Of Florida,has personally appeared e,^^ 3u4'�
MY COMMISSION#FF 897525
a€ EXPIRES:November 8,2019 Notary Public at Large,State of Florida,County of Duval.
Bonded ThruNotary PubGcundelwftrs My commission expires: N" % r,\J19 .
Personally Known: 1��� ( _ �1 (99.y'11�i or