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N 0 ~ .... ::u C\ J: m ~ 0 0 000000 c ~ \ ~Q ::u C)"'",o~ S ~ CIJ m >--0 ~ ~ z ;:u C1JRlRli:C) Z C'tl'tl'tl~ 'K~ > C) R- c ~S;:5:S;:c ~ ~ >ooz:;; _mm-t_ . ::! ~ z ::tI!!l!! ~ E 0 -tz - m ~ !'1 en> Z -t, C) <1Ierfifirafe nf @rrupanrl! CITY OF PRIOR LAKE ~tparfmtuf of ~uil~iug Jluspttfiou ~inal Permitted D Conditional C.O. Expires f This Certificate issued pursuant to the requirements of Section 110 of the D Residential / D International Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior Lake regulating building construction or use. For the following: Use Classification .51/\/6 t E F/7 1"/ / L-i./ Bldg. Permit No. 0 5"_ (; 813 , Occupancy Type 1<:3 Type Construction ;/IJ' Zoning District f.c: I'::::'.f) Legal Description k'L_..5 39 Owner of Building Site Address +85/ Ie u/c.-E DGE- sr. Contractor's Name & Address /...I;:E S.T"{'/L.C: liGP/tf.'~ , , //V" let f;;'{; t:::~ . ,HUiC./-I/ NSr:;}j'7--' City Planner Bmldmg Official / / / It r ." I (. I ;?-5z5 J1//LLIrI (LiS UK-'j lfFt: 2+7 e IvlU t;; V 1-/ IV E. k:,q NT I E-K. Date: Date: CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d (p . (p , 05 White Pink Yellow File City Applicant PERMIT NO. Os-.. 06/3 (Please at bottom) ADDRESS ~51 f<Ll-t-Jea ZONING (office use) IC 15"D st.~b LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION IZ L.$' :3 PID OWNER (Name) (Phone) {qS2)Cf1Lf--31~ SE.733-=J- (Address) ;;),6::L5 Apl-: 24i- I BUILDER. .' (Comp,ny Nam')~~S Z [t.<>Ply11(-s' I ne: . (Contact Name) ~s.n ~ (Address),S 2.5 WI II " . ~ 'Dr -, :2I-ft (Phone) (QSZ)qqt.j..,- ?tl8D (Phone)(q,SZ) qq 4-,39 ~() 3'T- TYPE OF WORK~ew Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace ~. DAddition OAlteration OUtility ConnectIOn 0 Misc. CODE: !:LR.C. OLB.C. Type of onstntction: I II III IV V A B Occupancy Group: A B E F H I M R S U Division: I 2 3 4 5 PROJECT COST IV ALUE $ ~3J I r\(')O . Dc) (excluding land) I hereby certify that I have furnIshed mformation on this application which is to the best of my knowledge true and correct. I also certIfy that I am Ihe owner or authorlzcd agcnl for Ihe above-mentlOned property and that all construction will conform to all exisung state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg official can revoke thIS per It for Just cau e Furthermore. I hereby agree that the CIty official or a deSIgnee may enter upon the property to perform needed mspecuons. x' ~o45~5oo ~UJI05 Signature Contractor's License No. Date Water Meter Gas Fireplace Permit Fee DO , 0 0 OD,of' .?S'": s-a () rt9 0 Park Support Fee SAC # # Permit Valuation Permit Fee Plan Check Fee State Surcharge Penalty Plumbing Permit Fee Mechanical Permit Fee Sewer & Water Permit Fee Pressure Reducer ". , Water Tower Fee Builder's Deposit # # ~ .~ ~ N Q\. Sewer/Water Connection Fee ,. " .,~ ~ g;::oo~n.p: :';;:;,. Buildlll!! Ofticial ( Date T. hls IS to certify that th.e request m the above applicauon and accompany 109 documents is 10 accordance with the City Zoning Ordinance and m~a proceed as requested. ThIS document when signed by the City Planner consUtutes a temporaty Ceruficate of Zonmg comphance and allows construcuon to commence. Be!ore occ!!p, ~ CertIficate of Occupancy must be r lS~u', ~~ Dl=PClS'lrCJF" a. ~Ot-J~~(.. le1: ~h~ q' 'l-rj6S- OF="~9'~ +IL ~ ~<S\ P~T'e'b. Planmng Director ~ Date Special Conditions, if any 24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 f . :~u'-'2~~~o51~-11 I~y -.. ..~- ._-:J 2525 Williams Drive Suile 247 Bumsville,MN 55337 Phone 952-994-3980 Fax 952-736-7961 E-mail m_husnik@hotmail.com Homes & New -. Remodeling <1: /'rqleIIy Ma__ I ,loA /7 kac::Uo grant Mitchell Husnik (Lifestyle Homes & Properties Inc.) permission to place a retaining wall on the west side of my property to help accommodate a new home and solve some drainage issues on the adjacent property. I fully understand that this will change the grade of my property permanently. I also understand that this retaining wall will be the responsibility of both property owners in the event that someone might need access in the future. Grantor 0,1;-- 7/2J/oj Grantee 7Jt,i/,Ir ;z1 7/ ZS / 6 S- , I ~~p/ 7P3/dS CHRISTINA J. BOTSFORD ~~. NOTARY PUBLIC. MINNESOTA ;; My Comniallon Exp!ree Jan. 31, 2010 5: ,; ;\ " ~. . Message Page 1 of 1 Mike Gleason I?~~~~ .~L&~-L From: Jeff Matzke Sent: Friday, September 15, 2006 3:52 PM To: Mike Gleason Subject: RE: Tree replacement plan 4851 Rutledge Mike, The planning dept. is ok with the trees at 4851 Rutledge. You can issue the final C.O. on the permit. Any questions, let us know. Jeff Matzke Planner City of Prior Lake 17073 Adelmann Street SE Prior Lake, MN 55372 phone (952)447-9810 fax (952) 440-9678 Email irnatzlse@city_Qfgriorlake.com From: Mike Gleason Sent: Thursday, September 07,200611:47 AM To: Jeff Matzke Subject: Tree replacement plan Hi Jeff, Is the planning dept. OK with the tree replacement at 4851 Rutledge ST.? Please let know to issue the final C.O. Thanks, Mike G. 9/1512006 White - Building A~n:.!lry - Enaineering "nk - Plann~ BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ,.. i ,- APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: <' / / i:..... L ~ Accepted With Corrections Accepted Denied ~ ~ -t.. 0' I~'- k~? - ~ '" If. P C. DO )A ~ aRR -p....... .~ , --JJ. ~ T~ ~ \a.~ *'rc;cm .~R...QJ.-J~ q. ~50~,,,,,,,,-;-....~ ~ ~ .h~' (fll/g r ~ .I~~l:i::G.- ~LQ J ~ tLcCL pO/j:-t;;~. -~ Reviewed B . comment$h "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." White - Building ~arv - ~nglneerln~ Pink - Janning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED .,.-.-- ..- -" .--- J-J..//'v/,---,- J' /'/_ /'.....~.- '. ,/ V /,j-' (,i (J/ / r-.:..- '--~_-=) 1:-.....- f' ~...... -..; , t-' '--'" - -- -- /" I., /) c::- \( . Ct.!, ,-../ ......-' The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: .( ,r: _ I cL 7"': L'-, I -r- .._.J,-' j;"-j I ~ '/ I .,.--;. "'; /'::- .....'-- .., .'.' ,. , t.- f!, -di-.- ~- ~_.- I l-- ....'. .~' '--1 ~ ,- , I '--' I . ,.- -- ,-~)6 Accepted x Accepted With Corrections Denied ~ Date: g- L/- CJ~ Reviewed By: Comments: :. See Reverse Side for Additional Informationl See AttaGhments: 1) Grading Plan, 2) Erosion Control Measures "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." '-., ~ - BUil~~ "'--.... :::~ I J Engln ring ~nk - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST_____. NAME OF APPLICANT - LIFE 57YL-t::. ftOl1eS C;;.&.05 APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 485/ teUTt-6DCj6 sr. 56" Accepted Accepted With Corrections ~/ Denied Reviewed By: ~ ~~ Date: 0/'2.-%~ Comments: KVJ:4._ ~ ~. ~~ ~~. ~4/a."~p;...j ~ .Ae3-u~' M1~ f~ ~./f<- ~ t7-o ~ fr,- ~Mf ~ p~ ~ ~ ~<rV 'It-t- .::b,"'D ~ ~ ~. b/5"oo..a0..-i2.i'';;dd.."" ~ ~ k ..vrA;rz-"J;JJ ~I'~ ~ ~ d>- ~ e 1 tJ ~ ~~~~Ie,pr "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT /Z/ t.LJ~ I Blue File I PERMIT NO ~ 2 Gold City . &:'. 13 J Yellow Applicant V_ ADDRESS ZONING (office use) ~~5/ ;evr~bO ~ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID I OWNER (Name) (Address) (Phone) APPLICANT (Name) ~oH,v U4L.~ ,I)~L.:PV& I ~..s.sO \!:> ~E. L.";S."'''- p.-1€, (Address) (!iIAlll.::lL & #iN dLL~ (Phone) qf>~ 4~S- L.\~l>,\ ~~'\.o~E..€... f;S ~,~ (City) (Zip Code) (Address) (Contact Person) (Phone) (011.. - C11 '1-- J 5'-1 'z.. /2. ~ 20"'S APPLICANT SIGNATURE DATE APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain Water Softner Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (lor 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE Industrial. Commercial & Multi-family 1 % ofioh cost with a $39.50 minimum Estimated Cost $ Residential, New One & Two-Family $99.50 ResidentiaL AdditIOns & Alterations $39j5r;j Ru;ld;ug P"m;l # J.} J D f5 u ~ PLUMBING PERMIT FEE $~ P (jr'l// "D {:/' ~ STATE SURCHARGE .50 V TOT AL PERMIT FEE Building Official Date (Office Cse Only) This Application Becomes Your Building Permit When Approved 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714 CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec' d I. Pink 2. Green 3. Yellov.' File City Applicant I PERM/TNO.~ ZONING (office use) ADDRESS st. 5~, S S- 3 7~ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER 5teve. fl.' / IN' (Name) (Phone) (Address) 4ffs-1 R",+le4 ~ ~ f. S.:, {', ~ot Let ke. APPLICANT (Name) 5 fev.e (4.' I(o..r- (Address) L--1E'5:1 AlI\.t1ed"Je. <;+_.s:c. (Address) (Phone) f~'OI'la.k~ (City) S.s3 7 ~ APPLICANT SIGNATURE (Phone) DATE (Zip Code) 15: ~ - <'19'-( - ~ 9.80 I~/ i 'f ICJ~ (Contact Person) APPLICANT PLEASE COMPLETE BELOW EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL (C(l'fje~ I^KA 30.-;).,{J FUEL f/t:Ilt<<h:.! Go,J.' FLUE SIZE TYPE OF SYSTEM RETURN OPENINGS INPUT OUTPUT DWarm Air Plants 1SjGravity o Mechanical DAir Conditioning DVent. System HEATING OR POWER PLANT o Steam o Hot Water o Radiation o Special Devices o Other Devices PLEASE NOTE: Air Conditioner Units and Fireplaces Cannot Encroach into Required Side Yard Setbacks. Fireplaces with Box Additions or Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL Residential, Heating & AIC (New Construction) Residential, Heating Only (New Construction) FEE SCHEDULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 $64.50 $39.50 Industrial, Commercial & Multi-Family Residential, Additions & Alterations Residential, AC Only $39.50 $39.50 Estimated Cost $ Building Permit # HEA TING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ PAID WITH 8U/~P'NG PERMIT (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Date Buildinl! Official 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Avenue, Prior Lake, MN 55372 Date Rec' d CITY OF PRIOR LAKE PLUMBING PERMIT 12./9, CiS ~. ~~~ ~:~y I PERMIT NO~ ] Yellow Applicant . ~ ZONING (office use) ADDRESS 4 SS-t R'^+ led.ge sJ.3€, 1'/01 Lcttre. jV1 rJ 5 S; 3"7 ~ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) ~ 1eve ~.". /I ,a., /' (Phone) (Address) L.{ g.s:- i f?V\11t.d.9~ 5 I. ~c< pr /'ct- L CiKe APPLICANT ..$ I M II (Name) 7 e,,' ~ " d..1' (Address) L.( & 5" ( P. VI f l-ecb-e 5 f, -5 e fh'CJ/' /-0. kc:. (Address) (Contact Person) M,'le}, f/,^st1t'tr" APPLICANT SlGNATUR~~~--- (Phone) CjS;::{- C, 9'-(-3 qgo S!'-.~1 :( (City) (Zip Code) (Phone) 9-:;-:z~ g94 -"31.8'0 DATE (;;l,/I9-/or Quantity Type of Fixture Quantity Type of Fixture ~ Bath Tub with or without shower Rough-ins j Dishwasher I Water Heater I Floor Drain I Water Softner t.f Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine) I Laundry Tray (lor 2 compartment sink Sewage Ejector ~ Shower Stall Backflow Assembly I Sinks Backflow Assembly Test I Bar Sink Lawn Sprinkler '\ Water Closet (Toilet) Other APPLICANT PLEASE COMPLETE BELOW FEE SCHEDULE Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50 Residential, Additions & Alterations $39.50 Estimated Cost $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOT AL PERMIT FEE $ .. PAID WfTH ~lOfNGP~R . c 'M/T (Office lise Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Date Buildin~ Official 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714 12/20/2005 12:59 9524926006 GLOWING HEARTH N HOM PAGE 01 ..~./M:,}~>t.:~."" :!. ' . ,". .'. '.:', . .. . :'>'''If,~~' .. '/," ~;~ ' .:< .' . " ..,~.~., .......': 'U2ti ~, '...:,.:'.'~..;,.:. ':~. NO: '.' ',.- . D:~~?~ I 06,':;i:.{~;,..:. t.~ lU!' "','.' . I\illl't! ',..... . .' .." ..' ., .' ADDR$SS 1/'-6 c:: \ . R~.:.',~'\.:..~. c\ ae..,:(..."'~.."~'L LJ '-"~~.".,"':(l;"> ,",--' t\/\ - ) '1 U \j ()T u~ .,((-6:~riL.a~ Illtv' . . ..."... .'. ~.. " . i L::;~;;~::: "', '.' ".?tt: . .' .'." . "'J',~' .' .... .' Zd~'(officcl1~c>1 . .~;.. ,":", ' .: ,'.:, Z.' ..-1 , .OWNER (NflJne) " '. ,'~ '.::":'.~' . ~ . (Plien~) .~ .APp.Ii~' .... . .. .,,' ...~:.":.o:.. (Nain;) . c'I(\\ l \\n~ ',8:~:n~;t.~~~~~.~.~~~ :" (Add1:c!$) . .l C\ () '. f.. \ d t:):( 0. 0.1:).. ,TIf\'\J~ ':,-: . . . '.~~~*:: . _ I . '~. ... ..~J (Contact.Person) \ \ fY'\ 6 ~ \fY\€ ~ . AP}'#: ( ""Y,SIGl'{:AT:UU:.'\\~,..)\\\fy'\et.. ~. ~-\ \:~ c.fi!.? ~ ' .,..~. . . i\~ .... .. ,,'... .,. .. . ... .. IJI~:. .~ ~..'::;..-"::.J":'>';:.;::,,:1; . i.,",. , :,.: ii.':"::":)~ I:.::TEM: ,'. .' FURN*CEMAAEA~nMO~L'l..- (:(j~_61lt,. a~'C' /~C:\'e61c.~ 1:t' FtJJi . (;0. S . FLME'S~" . :' "::,:':R1imRN~~:". :.' ,,:::.-:"'.:.:~','i~T ' . '-~UT ~-4i1)\~Sm:B~. ~~~:;t!OWBRPL~ R=~w~lmsT?~~~~tet ~.... ,~..,. o.:~~~ .:OV~.t,:s.t~ .. .,... FIREPLACEJ~;fAKEA'Nt)~~.'- ~., .. :":',,:,,;, .' . . .. .-.., " . . ..:'""_~ '':i:( '~I~'~~ .'. <;Ph." ..-Ji q~. 9 01110 'n'b~, ~o.,J ~,J 55 :lSd-. . -: .. - . "j tCity),(Zip!C~~ . _ ..'~Jtone) 4 C\d - ~cl1 b \ \i:{ CJ3 PtEASE NGXE: Afr ConditioMr" Units . CannqtEnerctcbmto ..R~q~1mt!SideY8.rd ..,Setbatb '. '. _ ,- ',"'~' ," .. . Indulltrie.1.Q(lmmerel$.l~&Mt1lli4~:a.mlly . Rcsidcl1tial,Neating& tAlC (N~wG!:lrmt\1c:fi'el\~ Re!lidl:ncls.!. H~1lt111g0il1y(NcwCon'StM:til'lt'IJl .' .....\~t.$ iI~ol'Ord~'~~r' . Res\t1i!ltti itl.~GllS'FireplqQe Sn5Qi:tlUtd~ S-~;-$O ,.,. :l~esHltllti8J; A'dditlons'& Ailtel'llnMS $'64.:50 Re9HI~ntiiil; AC'Oeriy $39,50 $39.SO $39.50 E9tiIiratc!d Cdlit&. .BuildittgPe~l# ,'BEit~ji~j;e~., l ~~.1:~~~'hr,r::t.:n;dh' . '$. " J~i~"X:.cjO:bI~~~12":" ",. . .. :.. ibtfi:L~i~1tMt1'}riJt ., . " .'. . . " " PAID WITH :,.i~D'NG PERMIT (Omce',Uie'Oilly) .", "I...". . TIlLs,'Appl1~tt:~econreJ ..~';'U:r.lJuJ.ratng~btffil~;wJi.~it'~P'Pr,ti~ .. .. . '. ..';" . Ihilliflil'riOmejil ... , '. , " ..... '.1: '. ..' ..l1~(t .... '._ . ~ .UE_\~t1ti..~\~r>t~~fu;';(9.52)'(41~9850.~~' (~~)"447~424S . il~Q:~~1,:,et~~~~;li1tll'J;~~JMN:SS,3'72 I j:P' No DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS NATURE OF WORK USE OF BUILDING PERMIT NO. 05.08/3 DATE ISSUED CONTRACTOR ~ ~S, OJ" PHONE SZ. " NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT FOOTING FOUNDATION (Prior to Backfill) PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS OCCUpy UNTIL ABOVE HAS BEEN NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all inspections have been approved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. FOR ALL INSPECTIOt\l" f~":"" II /'-- ::'850 _._....~..._-""._--=--\ CITY OF PRIOR LAKE [C... .' I, .'" \\, ,. \~ i", '\ Impervious Surface Calculations li:,'\ JUl 2 5 2005 lU il (To be ~ubmitted with ~uildir:g Pennit Applicario~) . \:),.1, Li\or AJl PropertIes Located ill the Shorbland Dlstnct (SD). ~;;::..._The.Mfhjmum Impervious Surface Coverage Permitted in 30 Percent. . r. 0, j.l? ,qc..r 1"9 Property Address ij t# ~ e iL. e-oG6 :5 /, E J2 ~ :5 JIll' .39 Lot Area ) ~9t) 3 Sq. Feet x 30% = .............. . ~ 57 J **********************************************************~************* x = SQ. FEET 2Zzb HOUSE LENGTH f,2t2e6 WIDTH x x = ATTACHED GARAGE = TOTAL PRINCIPLE STRUCTURE......_.............. 2Z 2, <,;, DETACHED BLDGS (Garage/Shed) x x TOT AL DETACHED BU1LDINGS....................... DRIVEWAYIPAVED AREAS U.rZ6~ (Driveway-paved or not) (Sidew:1ll<1Parking Areas) x = /2100 x X = = TOT .>\L PAVED AREAS......................................... /2(10 P A TIOSIPORCHES/DECKS ::r .e.e eu..,. X = 60 (Open Dec\c.s '/.- min. opening be(\l/~n X = boards. with a pcr'ious surwc~ below. arc not eor..sider:d [0 be imp::rvious) ~ 10 80 X = :5,oc>P f/A-rlt? TOT..\.L DECKS..................._..._....._..........._......... J ,,10 x X = OThER = TOT.>\1. OTf!ER..--_..n_--....._.___._..n--_...~-....._...... TOTALI~ERV10USSURFACE ~~OVER -- Prepared By 6t..c-I\.Ir--1 r-4-e/.Me:: L-/- ~~ /4d!~~~Lf Company 3eH' ENe, { 3 ~6 fJ? r 7" '7//~/~F " r. Date Phone # 95Z- Bqf5-604/~