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DS-16-3260 Permit NO. DS-12-16-3260 `5µ s yam! Miami Shores Village Permit Type:Driveways/Sidewalks/Slabs 10050 N.E.2nd Avenue NE ' Worts Classification:Addition/Alteration Miami Shores,FL 3313&0000 PenPermit Status:APPROVED Phone: (305)795-2204 F+<ORtDp' Issue Date: 1/5/2017 Expiration: 07/04/2017 Project Address Parcel Number Applicant 10666 NE 11 Avenue 1122320280690 Miami Shores, FL 33138-2121 Block: Lot: ELIO& LAUDY PEREZ Owner Information Address Phone Cell ELIO&LAUDY PEREZ 10666 NE 11 Avenue MIAMI SHORES FL 33138-2121 10666 NE 11 Avenue MIAMI SHORES FL 33138-2121 Contractor(s) Phone Cell Phone Valuation: =5,200.00AG STAR CONSTRUCTION INC (305)457-9970Total Sq Fee Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved: :In Review Final Date Denied: Foundation Type of Work:REMOVE ASPHALT DRIVEWAY AND REP Additional Info: REMOVE ASPHALT DRIVEWAY ANC Review Planning Bond Return: Classification:Residential Review Planning Scanning:3 Review Planning Review Building Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# DS-12-16-62223 CCF $3.60 DBPR Fee $2.00 01/05/2017 Credit Card $647.60 $0.00 DCA Fee $2.00 Bond#:3293 Education Surcharge $1.20 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $647.60 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 AFFIDAVIT certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zon' . Futhermore,I authorize the above-named contractor to do the work stated. January 05, 2017 Authori ed Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 05, 2017 1 Miami Shores Village PZEc9TVF DEC 01 2016� Building Department partment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S FBC 20H BUILDING Master Permit No.� I(n - PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:1.0 6 G �l- Av City: Miami Shores County: Miami Dade Zip: _3 3 13 K Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): LCtU�!V LVnrA P-Crfz Phone#: 305 ,338--,3 Address: 10 6 6 G U• E 114-" A-vfKy-e_ City: wcuy'4l 5�16y-a5 State: Zip: 1 Tenant/Lessee Name: j Phone#: Email: L.PUJV (UVB A Aa i 1 • CC�u� CONTRACTOR:Company Name: 5' 04' GKSlI^U_J Oil -r\AC- Phone#: -��r� r_ Address: tk-9'j W.t t1 5 5�y'ic�e - . 3 r (� 6 City: �A &41.i State: -t-tol Zip: 331 a'S Qualifier Name: Old I dam eZ Phone#: : 1 1`T©,�y Q State Certification or Registration#: C E/' ('_ /JAI 6�oZI Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: /n�'' Value of Work for this Permit:$ �����00 Square/Linear Footage of Work: ''"- Type of Work: El Addition ❑ Alteration) T El '- New 'Repair/Replace ElDemolition Description of Work: A4'Ao t!t- G'6 JQk.1 t U�j song at44 w.�4 L ri c.� joay�Er� joaver5 on sp%"d ovt,- ' 011-4 J fi'l"erGk w 4-k Specify color of color thru tile: v a4 n ge6j- 4n Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) • Bonding Company's Address W 6 6 City M( awL; State Zip �� 1 Mortgage Lender's Name(if applicable) Mortgage Lender's Address City 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 AG T CONTRACTOR The fore ping instrument was acknowledged before me this The fore oing instrument was acknowledged before me this day of /l,ov .20 { ` by '� day of J 20 , by n 4 ���� who is person W/4 tirfay�who is personally known to me or who has produced L -� b :� me or who has produced as identification and who did take an oath. '9�;; '� identification and who did take an oath. NOTARY BLIC: a m NOTARY PUBLIC- " UBLIC: / pp1p, 7 a>�� Sign: z w F, Si n: v 1 � � g Print: 'Z + Print: Seal: Seal: wow ****s*�*************s******s** s«* ** ******a************s***�•�*:****s**********************sss* ********** i APPROVED BY J Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) She�,,of 3(Sketch Z y):`ee Sheet 3 0(3 for Legal Description,Certifications,Property and other Survey related data.SURVEY IS NOT COMPLETE VVITHOUT ALL SHEETS y r LEGEND.' UNETYPE LEGEND CA DENOTES CENTRAL ANGLE BOUNDARY LINE CATV DENOTES CABLE TV.BOX PC DENOTES POINT OF CURVATURE BUILDING LINE C:03: DE DENOTES DRAINAGE EASEMENT E FIP DENOTES FOUND IRON PIPE —'—'— CENTERLINE ci4 SCALE:I"_ N FIR DENOTES FOUND IRON ROD ------------ -- EASEMENT LINE (0 1 FN DENOTES FOUND NAIL M DENOTES MEASURED —,—,-,— CHAIN LINK FENCE W 0 a OHC DENOTES OVERHEAD CABLE P DENOTES PLAT WOODEN FENCE E PP DENOTES POOL PUMP 1 R DENOTES RADIUS — — — — OVERHEAD CABLE Y a TR DENOTES TELEPHONE RISER ENCROACHVE',-5SrOWNINREDLEi ER,;. AERIAL PHOTOGRAPH UE DENOTES UTILITY EASEMENT (MAY NOT SHOWLA TESTIMPROVEMENTS) coQ 0 UP DENOTES UTILITY POLE (NOT-TO-SCALE) I-: WMDENOTES WATER METER W (n o 01 co LL 2 0Q o L LOT 20,BLOCK 4 ` 1j 130.00TW) 25.00 t / }�*•; m 'Lbw, PIP, • LIJ 58.79' 36.00 35. �- f,i ..f �! f `� �6' V- — a 20.85' b \t r tr ZD lo om `C\! ¢ I7. 11 �` m LLJ E �- 'a � N 10.00' .►�_ rl ''�o�Q � � 1 �^ 0 0 in i� I#Iv,`� o d a — �►� -0.6' b ONE STORY 1.40' 1255.32' i",�'�� LLr ~ o RE5IDENCEk IOGGG $ �'J!._ I Z N th 59.74' 43.50' —26.76' 2\ ai o 25.00 da I 130.00'( Wi b JLOT 18,BLOCK 4 I r I Miami Shores Village DD�� I1�.LiCET `TE D ••• •• ••,.••••ApPROVtD 8Y DATE JA '70"W3 r N U b 2016 : •••`r• PT • • • s ,..:.. . •••,•J ^t DG 1,GPT CORD I 9RfrMTi( I�RELIANT UPON 1�NGULAR • •s / •,•,•• PLEASENOTE: _DATA ONLY.ALL ANGULAR T}C'SHC4M IiE✓Z"REFERENCEDTi ftTO. • • SUBJECTPROPERTYIS SERVICED SYPUB�LIC-UT1LMES. _ _ •**so •+••• ••••• Notable Conditlons Pleasen�ole th lollowfng:' t"rmh� ��I-AEC FEDERAL •••••• • ••• ••:•� NONE. • • • • • FY 'IIII F c •• •• •• • •,••s• ANn17 r ULRTInNS ,�•••••• • •� Landtec Surveying offers services Ihroughout the State of Flaida,Please refer to our website at Invoice—Number:01-60302 : • : • • .••,:• ••••,• www.LancItecSurvey,conn for up to dale information about our locations and coverage area. • � This survey has been issued by the flowing Landtec Surveying office: Drawn By:E.VARELA ---^^ , , • ,•••• 21000 Boca Rio Road-Ste.Al2 NteofFeWWok 03/24/2014 — "• Boca Raton,FL.33433 n: �-- F Office:(561)367-3587 Fax:(561)465-3145 Revision: LAND SURVEYING - RESIDENTIAL SERVICESProudly Serving Florida's Land Title&Real Estate Industries www.LandteeSurvey.com Revision: U.S.DEPART$ENr OF HOMELAND SECURITY, ELEVATION CERTIFICATE FERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important:Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owners Name Laudy Luna Perez Policy Number. A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number. 10666 NE 11d'Avenue City Miami Shores State FL ZIP Code 33138 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Parcel ID:11-2232-028-0690 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat. 737 Long.80.17541W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) Q sq ft a) Square footage of attached garage WA sq It b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Village of Miami Shores:120652 Miami-Dade County FL B4.Map/Panel Number I B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone Effective/Revised Date Zone(s) AO,use base flood depth) 12086C:0306 L 09/11/2009 09/11/2009 AE 1310. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date:N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction `A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones At A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARAE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item AT to Puerto Rico only,enter meters. Benchmark Utilized:MDCOM•626RA•Elev=17 23 Vertical Datum: NGVD 29 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 ❑NAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 2-fill ®feet ❑meters b)Top of the next higher floor WA. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) WA. ❑feet ❑meters d)Attached garage(top of stab) WA. ❑feet ❑meters e)Lowest elevation of machinery or equipment servicing the building 8.$3 ®feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 7.72 ®feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) $7} ®feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support Z.7Z ®feet meters SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and seated by a land surveyor,engoser,erarchitest aulhoriaedtly law to certify elevation r information.I certdy that the information on this Certificate represents my bes:AA to i+*4h4 data available. I understand that any false statement may be punishable by fine or idle fiso ftrt uQd41 f 0.9.Code,•Section 1001. ® Check here if comments are provided on back of form. WI&IatltdtlQ anti tongitude4in Seatien A provided by a licensed land surveyor? N Yes ❑ No ❑ Check here if attachments. � Certifiers Name Andrew Snyder ••• ;• •Cif'erysfl dumber�S_n Title Surveyor&Mapper Company Name 1-41r tec�tn/t:ym9,;n0 ; ' ; • • P�y d by AM-S"��r • DN:cn=Andrew Snyder,PSM, Address 21000 Boca Rio Rd-S.Al2 City Boca Raton tate L ZI Code 33433 o-�ech w�;,y, C--US Signature / Date 03/28/2014 ••• • .Telephone 561-367-3587 pate 2014.03m 1731300 9 04 �/��a[eiL • • . • • • • i ••• a • Replaces all previous editions. FEMA Form 086-0-33(7/12) Seet��er sI*fBl;Cogt�t�tdn.0• ELEiiAT10N CERTIFICATE,page 2 IMPORTANT:In these spaces,copy-the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 10666 NE 11"'Avenue City Miami Shores State FL ZIP Code 33138 Company NAIL Number. SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Section C2 E-A/C unit Latitude and Longitude derived from Google Earth. Signature -''Z Date 03/28/2014 SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOMB-F request,complete Sections A,B, and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(se�_ a ges 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or p below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordnance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable items)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: •• ••• .• • • [,�feet meters Datum Local Official's Name 00• • • ;itls • • •• Community Name Telephone \ Signature . . • • • . . . • Comments ' •• •• • • • •• ❑Check here it attachments. • • 000 • • • • • • • • • FEMA Form 086-0-33(7/12) ••• • 0 • 000 0 0 Replaces all previous editions. ,ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number: 10666 NE 11`"Avenue City Miami Shores State FL ZIP Code 33138 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View'; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Front Rear "six I I 6 A Additional View Front Additional View Side b�w ••• • • • • ••• • • FEMA Form 086-0-33 (7/12) .•• •'. Replaces all previous editions. i r ELEVATION CERTIFlCATE,•pag6 4 Building Photographs Continuation Page IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSURANCE CO.MI:PJWY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy N4mben City State ZIP Code Company NAIC Number. If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. 1 • • •• • • • • ••• • •• ••• •• • • • •• •• • • • • • • • • • •• •• • • • • •• ••• • • • • ••• • • FEMA Form 086-0-33(7/12) i••• e i ••a i Replaces all previous editions. ••• • • • ••• • • ti 5�►URES G!� s� 7- Miami shores Village BIN Building Department 10050 N.E.2nd Avenue �LOR1Dp` Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of C. _,20 14- By who is personally known to me or has produced as identification. Not v, RICARDO J.MARENC SEAL: *_ MY COMMISSION 8 FF 946818 r EXPIRES:January 2,2020 . p; Bonded Thru Notary Public Underwriters 1827 NW 1''STREET,MIAMI,FL.33125 OFFICE: 786 262(1038 FAX: 786 464 0854 ROOFING & GENERAL CONTRACTORS FL License CGC 1516021 Datta:-1 - -- �-- - State of County of Before me this day personaPIy appeared fW1 �_ who being duty sworn, deposes and says: That lie or she will be the only person working on the project located at: I� 666 `V, 6 /l Ave r �1 yam, Sir&-e-. 3 Sworno (or affir =ibserbed before me this day of �6�20 /b/ by �c.t,- �*m I re) ovo-,:r, Personally Known OR Produced Identification i-L'2_ /5AO-�J -355-0 Type of Identification Produced YP ------- T— FPr-int, _t:ANA M �.-00r COM I EE204181EX WPI oM11r Stamp lUan f Notary I W4..102 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-OO NOT PAY 6333041 BT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AG STAR CONSTRUCTION INC RENEWAL SEPTEMBER 30, 2017 1827 NW 1 ST 6599865 must be crisosyed at F'==s&txt?s hers MIAMI FL 33125P4.� -�t3 Cc---v Co* ZA-rri 33'- OWNER SEC.TYPE OF BUSINESS AG STAR CONSTRUCTION INC 138 GENERAL 8U:LB:NG CC`iTRA"�0? aY T���� ;GCi51E021 Worker(s) 1 $45.3') 39,'-.8/2016 CROITGC X16--0521 This Local Business Tax Receipt orty ccu!'irms paw of&e L6c2i 8 Tax Th2 Pz-;t-s eat it permit,ora certification of the holders gaarification to do bmina or nongovernmental regulatory in"* requiremerts"wch appty to dte builmms The RECEIPT N0.ab"a n3 be d'rspiand oo OR cOmmemW sddcks-ids-3z!_-Cc-"S-'r i-. For mon inforn aticn.visit w-M- iRmA e4012 F k Y-� w�