FW-18-2000Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. FIN-7-18-2000
Permit Type: FencelWall'
Work Classification: Wood Fence
Permit Status: APPROVED
:1/2612018
Expiration: 01/22/2019
Applicant
29 NW 99 Street
Miami Shores, FL 33150-
1131010180520
Block: Lot:
AUSTIN & WHITNEY MAYBERR'
Owner Information
Address
Phone
Cell
AUSTIN & WHITNEY MAYBERRY
29 NW 99 Street
MIAMI SHORES FL 33150-
(419)283-2975
29 NW 99 Street
MIAMI SHORES FL 33150-
Contractor(s)
HOME OWNER
Valuation:
$ 6,700.00
Total Sq Feet: 220
Approved:
Comments:
Date Approved: :
Date Denied:
Type of Construction: Wood Fence
Classification: Residential
Additional Info: HORIZONTAL WOOD FENCE - 6FT
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
P&Z Review Fee
Permit Fee - Wire & Wood
Scanning Fee
Technology Fee
Amount
$4.20
$3.30
$2.20
$1.40
$5.00
$35.00
$220.00
$9.00
$5.60
Total: $285.70
Pay Date Pay Type Amt Paid Amt Due
Invoice # FW-7-18-68343
07/26/2018 Credit Card $ 285.70 $ 0.00
Available Inspections:
Inspection Type:
Final
Foundation
Review Building
Review Planning
Review Public Works
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFI>tAVIT: I certify that .II the for-:oing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a i zoning Futhermor I author a he above -named contractor to do the work stated.
natur..Owner. / Applicant / Contractor / Agent
July 26, 2018
Date
Building Departm nt Copy
July 26, 2018
1
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ )(
Type of Work: ❑ Addition
Description of Work:
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2011
Master Permit N&W 15 -ZOoc'
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
Folio/Parcel#:
A/w ?9r Sf2ee--F
Miami Shores
County: Miami Dade
Occupancy Type:
Zip: 32/ SO
Is the Building Historically Designated: Yes NO
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A -US -rZuv ) ` lAWDE
Address:
Phone#: X `7 (9 Zg3 z �f 7 S
City: /!/ l 'Ct" 7 5 State: t- �- Zip: �r�b
Tenant/Lessee Name: Phone#:
Email: +1,-,l Be_✓1.&- y 4 i c yM4-zt__ . c o -
CONTRACTOR: Company Name: 1A-Oi'Q O}Jrrtp Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work: __ 22 Z 0
❑ Alteration ❑ New ❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $ S • (0 0
Structural Reviews $
Permit Fee $34r,'"AtCCF $ 4 . 20 CO/CC $
Radon Fee $ Z 20 DBPR $ 3.30 Notary $ 2
Training/Education Fee $ ) • 4a Double Fee $
Bond $ (� Q
TOTAL FEE NOW DUE $ ass • 70
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage tender's Address
City _*�4_ ` t State Zip
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 the standards of all laws; regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
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 RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding,$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur
•
Signature
OWNER or AGT CONTRACTOR
The foregoing instrument was ackn!edged before me this The foregoing instrument was acknowledged before me this
nn day of Ul VL , 20 18 , by day of , 20 , by
A1JS \-i
me or who has produced
identificatnd wh
NOT
Sign:
Print:
Seal:
***********
who is personally known to
who is personally known to
f i kI;CenS1 as me or who has produced as
ANADY PRIETO
MY COMMISSION # FF 214031
�`• ���.: a EXPIRES: March 25, 2019
;eF °°' Bonded Thru Notaj Public Underwriter,
APPROVED BY
,a
identification and who did take an oath.
NOTARY PUBLIC:.
Sign:
Print:
Seal:
s******.*****.****************#******************
/r ,Plans Examiner
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( ►/ Zoning
r.r. t Structural Review Clerk
,
(Revised02/24/2014)•
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2D't ASPHALT PAYEAMENT
N.W. 99th STREET
(ROYAL ROAD BY PLAT)
Fences Good Side Out. The vertical and horizontal
supporting members of a fence shall face the
interior of the plot on which the fence is located
and the finished side shall face the adjoining
AccepteL. Igy:nr any abl tttinn rinht ' f vvry
Property Address:
29 N.W. 99 Street
Miami Shores, FLORIDA 33150
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_g„A T L',Nu W„C u1v 1 r r11,,L=b Ariu NtCa'.JLATIONS
URVEYOR'SCERfFICATION:IH . THAT THIS BDUNDNTYSURVEY ISATRUE AND
CORRECT RB95EEENTATION ec •' ?, •UNDER MY DIRECTION THISCOAFIIEB
WITH THE MINIMUM TECHN f',: ". ,� FORTH BY THE STATE OF FLORIDABONRD OF
PROFESSIONAL LAND SU. 4'r '''e='� THROUGH BLD-052. FLORIDA
....
ADMNISIRATNECODE PU �- • TUED
SIGNED . i1�
EFRAIN LO - ^�
STATE OF FL • ' • P.S.M. No. E792
FOR THE FIRM
NOT VNIDIRHOUTAND - . -+ •+' .. IC SIGNATURE AND AUTHENTICATED
ELECTRONIC SE.ANDDR THIS MAP IS •_. VALDYVRHOUT THE SIGNATURE AND THECRIONAL
RAISED SEAL OF A LICENSED SURVEYOR AND MAPPER
M.E. Land Surveying, Inc.
10665 SW 190th Street
Suite 3110
Miami, FL 33157
Phone: (305) 740-3319
Fax: (305) 669-3190
LB#: 7989
7AKA
ME LAND
Survey N:B-43963
Client File N: I806-007GR
Page I of 2 Not valid without all pages
PROPERTY UNE
Surveyors Legend
B.R. BEARING REFERENCE TEL TELEPHONE FACIU,ES
END FOUND IRON PIPE /
PIN AS NOTED ON PUT G CENTRAL ANGLE 0.1 DELTA U.P. UTIUTY POLE
LB/ LICENSE 9 - BUSINESS R RADIUS ON RADIAL E.U.B. ELECTRIC UTUTY BOK
LSI UCENSC B - SURVEYOR RAD. RADIAL TIE SEP. SEPTN: TANK
CALC CALCULATES POINT N.R. MON RADIAL DS. 0RMNfIELD
SET SET PIN TYP. TYPICAL A/C MR CONDITIONER
♦ CONTROL POINT I.R. IRON R00 5/Vr SIDEWALK
in CONCRETE MONUMENT IP. IRON PIPE DWY DRIVEWAY
0 BENCHMARK Rt0 NAIL it DISK SCR. SCREEN
ELEV ELEVATION PK KAI PARKER-KALON NAIL GAR GARAGE
P.T. POINT 0f TANGENCY DH. DRILL HOLE CMCL ENCLOSURE
P.C. PORT, Of CURVATURE 0 WELL N.T.S. NOT TO SCALE
P.R.Y. PERMANENT REFERENCE MONUMENT (2 FIRE HYDRANT SF. FINNISHED FLOOR
P.C.C. POINT 0f COMPOUND CURVATURE ® Y.N. MANHOLE i.O.B. TOP Of DANK
P.R.C. POINT OF REVERSE CURVATURE O.N.L OVERHEAD LANES E.O.W. LOGE Of WATER
P.O.B. POINT OF BEGINNING Tx TRANSFORMER E.O.P EDGE OF PAVEMENT
P.O.C. POINT or COMMENCEMENT CATV CABLE TV RISER CONCRETE VALLEY GUTTER
C.V.G.
P.C.P. PERMANENT CONTROL POINT W.M. WATER PETER B.S.L BUILDING SETBACK UNE
M FIELD MEASURED p/[ POOL EOUIPYENT S.T.L SURVEY TIE UNE
I PLATTED MEASUREMENT CONC. CONCRETE SUB q CENTER UNE
0 DEED ESN, EASEMENT pip RIGHT-OF-WAY
C CALCULATED D.F. DRAINAGE EASEMENT I.U.E. PUBUC UTIUTY EASEMENT
LY.E. LAKE 0R LANDSCAPE YMNT. ESNT. L.B.C. LANDSCAPE BUFFER EASEMENT C.M.E. CANAL MAINTENANCE EASEMENT
R.D.E. ROOF OVERHAND EASEMENT LA.E. LIMITED ACCESS EASEMENT A.C. ANCHOR EASEMENT
STRUCTURE
scs= CONC. BLOCK WALL
—K—K— C1WM-LANK FENCE 0R WIRE 4E0CE
--//--✓ -- WOOD FENCE
e o IRON FENCE
— — — — EASEMENT
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WOOD DECK
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r CONCRETE
C/7/1/221 ASPHALT
. ♦-♦ • s • • BRICK / TILE
, WATER
._ .- APPROXIMATE EDGE Of WATER
� ,-,
1 "'^G:. 7 COVERED AREA
0 TREE
Q POWER POLE
On CATCH BASIN
C.V.E. COUNTY UTILITY EASEMENT
I.E./E.E, INGRESS / EGRESS EASEMENT
U.C. UTILITY EASEMENT
Property Address:
29 N.W. 99 Street
Miami Shores, FLORIDA 33150
General Notes: • • •
1.)The Legal Description used toperform this surveywas supplied byothers. •
PP + • • • •
This survey does not determine or is not to imply ownership • • •
2.) This survey only shows above ground improvements. • • • • • •
Underground utilities, footings, or encroachments are not located on this survey map •
3.) If there is a septic tank, well, or drain field on this survey, • • • • u •
•
the location of such items was shown to us by others and the information was not verifietj • • P • • •
4.) Examination of the abstract of title will have to be made to determine recorded instruments, if any, effect this prop
erty.The lands shown herein were not abstracted for easement or other recorded encumbrA8btribt shown on lh• pl
at • • • •
5.) Wall ties are done to the face of the wall. • • • • • •
6.) Fence ownership is not determined. • • •
7.) Bearings referenced to line noted B.R • ' • • •
8.) Dimensions shown are platted and measured unless otherwise shown. • • • • • •
9.) No identification found on property comers unless noted. •
10.) Not valid unless sealed with the signing surveyors embossed seal. • • •
11.) Boundary survey means a drawing and/or graphic representation of the survey work.,erformedin the field•coul t
d be drawn at a shown scale and/or not to scale • • • • 1
12.) Elevations if shown are based upon NGVD 1929 unless otherwise noted • • •
13.) This is a BOUNDARY SURVEY unless otherwise noted. • • •
14.) This survey is exclusive for the use of the parties to whom it is certified. The certifications do non extend tom y It • 1
nnamed parties. • • r
15.) This survey shall not be used for construction/permitting purposes without written consent from the land
surveyor who has signed and sealed this survey.
Flood Information:
Community Number: 120652
Panel Number: 12086C0302L
Suffix: L
Date of Firm Index: 09/11/2009
Flood Zone: X
Base Flood Elevation:
Date of Field Work: 06/29/2018
Date of Completion: 07/02/2018
Legal Description:
THE EAST 25 FEET OF LOT 22 AND ALL OF LOT 23, IN BLOCK 5, NAVARRO SUBDIVISION, ACCORDING TO
PLAT THEREOF AS RECORDED IN PLAT BOOK 12, PAGES 59, OF THE PUBLIC RECORDS OF MIAMI-DADE
COUNTY, FLORIDA.
Printing Instructions:
While viewing the survey in any PDF Reader, select the File
Drop -down and select "Print". Select a color printer, if available;
or at least one with 8.5" x 14" (legal) paper.
Select ALL for Print Range, and the # of copies you would like to
print out.
Under the"Page Scaling" please make sure you have selected
"None".
Do not check the "Auto -rotate and Center" box.
Check the "Choose Paper size by PDF" checkbox, then click OK
to print.
Certified To:
Austin Everett Mayberry and Whitney Evan Mayberry
Harbor Title, Inc.
Old Republic National Title Insurance Company
its successors and/or assigns as their interest may appear.
Please copy below for policy preparation purposes only:
This policy does not insure against loss or damage by reason of the following
exceptions: Any rights, easements, interests, or claims which may exist by reason
of, or reflected by, the following facts shown on the survey prepared by Efrain
Lopez dated 07/02/2018 bearing Job # 8-43963:
a. NO NOTES
M.E. Land Surveying, Inc.
10665 SW 190th Street, Suite 3110 Miami, FL 33157 ME LAND
MEE LAND LLAND
Phone: (305) 740-3319 •
>y 1 Fax: (305) 669-3190 ,
LB#: 7989
Survey #:B-43963 Client File #: 1 806-007GR
Page 2 of 2 Not valid without all pages
Prepared by:
Arianna Goldman, Esq.
Harbor Title, Inc.
320 SE 18th Street
Fort Lauderdale, FL 33316
(954) 565-4311
File No 1806-007GR
Return to:
Laura Bourne Burkhalter, Esq.
Laura Bourne Burkhalter, PA
1508 E Las Olas Blvd., Suite B
Ft. Lauderdale, FL 33301
CFN: 20180423661 BOOK 31059 PAGE 256
DATE:07/16/2018 09:20:52 AM
DEED DOC 3,480.00
HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY
Parcel Identification No 11-3101-018-0520
[Space Above This Line For Recording Data]
WARRANTY DEED
(STATUTORY FORM — SECTION 689.02, F.S.)
This indenture made the 9th day of July, 2018 between QUICK EQUITY BUILDER INC., a Florida Corporation,
whose post office address is 3853 Pine Lake Drive, Weston, FL 33332, of the County of Broward, State of Florida, Grantor, to
AUSTIN EVERETT MAYBERRY and WHITNEY EVAN MAYBERRY, husband and wife, whose post office address is 29
Northwest 99'h Street, Miami Shores, FL 33150, of the County of Miami -Dade, State of Florida, Grantees:
Witnesseth, that said Grantor, for and in consideration of the sum of TEN DOLLARS (U.S.$10.00) and other good and
valuable considerations to said Grantor in hand paid by said Grantees, the receipt whereof is hereby acknowledged, has granted,
bargained, and sold to the said Grantees, and Grantees' heirs and assigns forever, the following described land, situate, lying and being
in Miami -Dade, Florida, to -wit:
The East Twenty Five Feet (25') of Lot 22 and ALL of Lot 23, Block 5, NAVARRO, according to the plat thereof as
recorded in Plat Book 12, Page 59, Public Records of Miami -Dade County, Florida.
Property Address: 29 Northwest 99th Sreet, Miami Shores, Florida 33150
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining.
Subject to taxes for 2018 and subsequent years, not yet due and payable; covenants, restrictions, easements, reservations and
limitations of record, if any.
TO HAVE AND TO HOLD the same in fee simple forever.
And Grantor hereby covenant with the Grantees that the Grantor are lawfully seized of said land in fee simple, that Grantor
have good right and lawful authority to sell and convey said land and that the Grantor hereby fully warrant the title to said land and
will defend the same against the lawful claims of all persons whomsoever.
Warranty Deed
File No.: 1806-007GR Page 1 of 2
CFN: 20180423661 BOOK 31059 PAGE 257
In Witness Whereof, Grantor has hereunto set Grantor's hand and seal the day and year first above written.
Signed, sealed and delivered in our presence:
C\i
r.//�/�o_C(sign)
WITNESS /i�.._-- (print)
_, ...� (sign)
WITNESS a N (print)
STATE OF FLORIDA
COUNTY OF BROWARD
QUICK EQUITY BUILDER INC., a Florida Corporation
By:
P
IB, President
The foregoing instrument was acknowledged before me this 9th day of July, 2018 by PAYMAN TABIB, as President of QUICK
EQUITY BUILDER INC., a FL Corporation, on behalf of the Corporation.
Sigture of Notary Public
Print, Type/Stamp Name of Nota y
Personally known:
OR Produced Identification:
Type of Identification Produced:
NAME:
ADDRESS:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER
/BUILDER DISCLOSURE STATEMENT //Q
1/5\) /`'/% y DATE: 776o/G U
�1�1,0- f c?��5-6
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have
read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner
must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the 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 -family or two-family residence. You may also build or improve a commercial building at a
cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not lie 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
for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is'your responsibility to make
sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on
your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and
with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all
applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I understand that state law requires construction to be done bya licensed contractor and have applied for an owner -builder -permit under an
exemption from the law. The exemption specifies that I, as the owner of the property listed, may act s wn contractor with certain
restrictions even though 1 do not have a license.
Initial
2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial
3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits anl contracts.
Initial u
4. I understand that I may build or improve a one family or two=family residence or a farm outbuilding. 1 may also build or improve a commercial
building if the costs do not exceed $75,000. The building or residence must be forrny use or occupancy. It may not be built or substantially
improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the
construction is complete, the law will presume that I built or substantially improved it for sale or leas which violates the exemption.
� Initial
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It
is my responsibility to ensure that the persons whom I employ have the license required by law and by�counjy or municipal ordinance.
h 4
Initial
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously
implies that the property owner is providing his or her own labor and materials. 1, as an owner -builder, may be held liable and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or employees while worki on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and a aware of the limits of my insurance
coverage for injuries to workers on my property.
Initial
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the
work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by
me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the
Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employe- I understand that my failure to follow
these may subject to serious financial risk. 1
Initial
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and
requirement that govern owner -builders as well as employers. I also understand that the
Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
Initial
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,'the United States
Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html
Initial
11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understaniis that I am the party
legally and financially responsible for the proposed construction activity at the following address:
29 ,Vc) q "14A- 5 .<5 3 7 /Ta
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of thejnfor�mation that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial
loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or
employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder
permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of
the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local
permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property
owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued.
Was acknowledged before me this Z(o day of -
By I $ \A4213\ Kyr
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who was personally known to me or who has
Produced there License or Iy;VAr
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TARY
q; ........ YANADY PRIETO
MY COMMISSION # FF 214031
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s EXPIRES: March 25,
A %;'odBonded Thru Notary Public Underwriter
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