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MC-17-2625 , Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-291692 Permit Number: MC-11-17-2625 Scheduled Inspection Date: May 01, 2018 Permit Type: Mechanical - Residential Inspector: Perez,JanPiet-re - Inspection Type: Final • F Owner: TIKVESLI,ANA Work Classification: A/C•Replacement Job Address:9020 NE 8 Avenue 11 Miami Shores, FL 33138- Phone Number Parcel Number 1132060420090 Project: <NONE> I r Contractor: AIR RIGHTAWAY INC Phone: (754)423-2319 Building Department Comments" ' CHANGE OUT A/C 2.5 TON Infractio Passed Comments INSPECTOR COMMENTS False 1 ` F i r Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 ~ April 30,2018 Page 5 of 32 a 4 I Permit No. C-11-17-262 �sKO1!ESy,� Miami Shores Village st Petmit Type::'Mechanical-Residential 10050 N.E.2nd Avenue NE F... � Work'Classification:AIC Replacement " Miami Shores,FL 33138-0000`•'�' Permit Status:APPROVE© Phone: (305)795-2204 �GORtOp' I issue crate: 111612017 Expiration: 05/0512018 Project Address Parcel Number Applicant 9020 NE 8 Avenue Number: 11 1132060420090 Miami Shores, FL 33138- Block: Lot: ANA TIKVESLI t Owner Information Address Phone Cell t ANA TIKVESLI 9020 NE 8 Avenue (786)206-6419 MIAMI SHORES FL 33138- 9020 NE 8 Avenue MIAMI SHORES FL 33138- Coritractor(s) Phone Cell Phone $ 3,750.00 Valuation: AIR RIGHTAWAY INC (754)423-2319 • Total Sq Feet: 0 Tons Available Inspections: Additional Info:CHANGE OUT A/C 2.5 TON Inspection Type: Classification:Residential Final Approved: In Review Review Mechanical Comments: Date Approved: :In Review Date Denied: Type of Work:CHANGE OUT A/C 2.5 TON Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF' $2.40 Invoice# MC-11-17-65549 DBPR Fee $2.00 11/02/2017 Check#: 1446 $50.00 $99.65 DCA Fee $2.00 Education Surcharge $0.80 11/06/2017 Check#: 1447 $99.65 $0.00 Notary Fee $5.00 Permit Fee $131.25 Scanning Fee $3.00 Technology Fee $3.20 Total: $149.65 In consideration of the issuan to ne of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict nfor iity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assum resp risibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PL BIN,,,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certi t ill the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fut r authorize the above-named contractor to do the work stated. November 06, 2017 Authorized Signature:Owner /� Applicant / Contractor / Agent Date Building Department Copy November 06,2017 1 I F Miami Shores Village F NOV 2017 ,�� 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 20 1 9. BUILDING Master Permit No. M c» -Z6zs PERMIT APPLICATION Sub Permit No. []BUILDING YE TRCROOFING REVISION ❑EXTENSION [:]RENEWAL❑PLUMBINGHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP © CONTRACTOR DRAWINGS JOB ADDRESS: 1 1 City: Miami Shores County: Miami Dade zip: 33l 3A3 Folio/Parcel#: 1204;&— 1'i L—9309 0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): A0--A `(� —Th" (-i Phone#: Address: 13 Aj -.**-- i �r G City: A�OJ State � Zip: 13, (� E Tenant/Lessee Name: Phone#: Email: CONTRACTOR_:Company Name: JM rL 4�5�. Phone#: 15- Address: ^ 2Ang 5m�irt, /� /VCity: coo FVQ_ r� ���i State: Zip: Qualifier Name: ��+4•�t2 j`�.' �c� Phone#:7*�-'�"�- State Certification or Registration#CACI 12(191%i5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: f Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ t Permit Fee$ CCF$2 `-'l O CO/CC Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ '2-0 Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) a Bonding CompanVs Name(if applicable) Bonding Company's Address City State Zip 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: 1 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. E "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 valueex ding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law broc ur will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commenc en must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued." In the ib ce of such posted notice; the inspection will not be approved and a reinspection fee will be charged. Signature Signature or AGENT CONTRACT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this T day of r 20 1 } by I ST day of I�C�b�r 20 t by f�G P - )' VeS� who is personally known to �65, � AAe"G'e q- who is e`rsonally known to # ' me or who has produced �iri�t_t� Lt�C� S as me or who has produced I)rL ,LCs r Cs as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: i Sign: Sign: Print: SSt�.G.L ��Pe�—�r,.,,r rc Print: -r ISAAC LOPEZ-ZA:00RA Seal: Seal: :* '°= Notary Public-State rida"'� Commission#FF 7o,� ,, ISAAC LEORA_* ° Notary Publiof Florida ',;,,�,�� My Comm.Expires Se2019 ssssssssss`s' s f ergggyss s MyComm 1.5,2AM 019 APPROVED BY ?s Examiner Zoning Structural Review Clerk (Revised02/24/2014) 4 Miami Shores Village Building Department f •••• ...�* 10050 N.E.2nd Avenue Miami Shores, Florida 33138 RIDp; Tel:(305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC 1 This form must accompany ALL air conditioning replacement permit applications.Each unit change-out must be on its own data sheet.Multiple units on single sheets are not acceptable. Job Address(where the work is being done): %2_10 X),iE �— City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB. ALL UNITS MUST COMPLY WITH F.E.M:A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED f Change disconnecting means:YES F-1 NO f;ARHI Sheet Attached:YES NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG.UNIT MODEL# (4 — ZJ COND.UNIT MODEL# i 11301 KW HEAT ' NOM TONS AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P 1>0 AHU CU PKG AHU CU PKG 3)VOLTS 2 AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER ' YES NO REPLACING DUCTS YES YES NO REPLACING THERMOSTAT NO YES NO NEW 4"CONCRETE SLAB YES ` YES NO NEW ROOF STAND YES cNa YES NO NEW RETURN PLENUM BOX YES 1. Minimum Circuit Ampacity(Wire Size): 15 2. Maximum Overcurrent Protection(Fuse/Breaker Size): t 3. Voltage of Circuit(208/240/480): µ 4. Size Disconnectingjaon n. Contractor's Company w2 ( �(-) (l��c t ,j�— Phone: -�"1 `"723 23j 1 State Certificate or RegiNo. Certificate of Competency No. Signature Date: 11 ZI r 7F f (Quaftfie gnature) (Revised02/24/2014) i c This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31,'2016. t o rti i rate of Product Ratings AHRI Certified Reference Number: 7493633 Date: 11/1/2017 Product: Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1430AJ1 Indoor Unit Model Number: RBHP-21 Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: Southeast and North (AL,AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC,TN, TX,VA AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, i NY, OH, OR, PA, RI, SD, UT,VT,WA,WV,WI,WY, U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015, are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016, central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. { Series name:, -- - -- -. Manufacturer responsible forthe-ratingof this system combination is RHEEM SALES COMPANY, INC.} Rated as follows in a lcorda ce wit Ah HR Standard 210/240-2008 for Unitary AirLConditioning',and Air-Source Heat Pump Equipment and subject to�,ver`i�fiicati,on of rating acc�Orracy Iby AHRI'-'sponsored, independent,'third party testing: - I �- T� �_I Ij I 1 t J r Cooling Capacity(Btuh): 29800 t i "4 . r f EER Rating (Cooling): 13.00 SEER Rating'(Cooling): 16.00 IEER Rating (Cooling): Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerale. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS n D This Certificate and itsscontents oncontents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link we make life better" and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 131540392279503632 A i ft INC. Inv 325$ AIR CONDITIONING & REFRIGERAT CAC 1817893 2909 Stockholm Ave. www.air-rightawayinc.com Cooper City FI 33026 Date Airrightawayinc17@att.net DADE BROWARD / moi/ 0 Like us on Facebook M 786-586.-0054 754-423-2319 m �— yy Customer Information p Name A6 1 (�ED< Email Address City '�'�- g� Zip Home # Wk# Cell # Payment: Cardholder Name ❑ Cash $ Credit Card Account Number ❑ Check# ❑ Visa ❑ MasterCard Exp. Date ❑ Amex ❑ Discover CW Technician Repair/Service Description (Flatrate) Amount Total Parts & Labor Tax Total 1 year warranty on parts, 90 days labor. Please No guarantee o freon charge without leak repair We assume no iabijity for food loss or water damage. Pay No refunds. X By signing I validate my wa anty and agree to all of the abo% . P White- Customer Yellow- Office a Al _� i r, ♦�r � #Y � 6re'� ♦ a + s w ..* a a i r-., 116 k STATE-,OF FLORIDA . •. <� DEPARTMENT OF:B.USINESS Al'r1D :,•: Y PROFESSIONAL REGULATION • rr .. r ti CAC'18:17893 f,SS�[ ED 408I14l2016` y, ,.�-CERTIFIED AIR C,01 NICO ,a i MENDEZ RAFAE`C Efl1lA -D fA .*AIR-RtGHTAWA'i 1 +SIC .: All As C•ERTI.FiED*u�der`fliens=provisioo G,ii.489 FS. _ � . ,Fo'T"*'4 �fL- , j ,y e�x r a ♦x x `,,. - � �..k, �''k} ''r` s'`r;' a '►'a►S -. .Y. s'-t. .' '" w '. ... f OMN 1 Local Business fax Ike .:p , Miami-Dade Countyce1pt -TMls►sNoraei �'St State Florida Ay 5357637 BUSINESS.NAM AIR RIGHTAWAy INC DOING BUS IN DADE CO RENEWAL EXPIRES 5595278 SEPTEMBER 3t1r2018 Must'displayed at place f business Pursuant to County; a Chapter 8A-Art.9&10 OWNER AIR RIGHTAWAy INC SEC.TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED Worker(s) 1 CAM17893 By TAX COLLECTOR $75.00 09/19/2017 Businaft TaxReceiptonly con6 CHECK21--17-082756 tion o1 the Irolder s quall8�o�ro do 6uaLo al�n��cMe Receipt Is not a license. or a°ngavammemal►egulatory laws and raWi►emems which e� Holder mph vritlt The RECpPi N0.above must be apply to the business any 9ovemme.l �Pleyed on all commercialvehicles-Miami_Dade Code Sec tte�27� For om,ialaneation.visit^' iamidada •- a t i t t I 1 ) AG O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/02/17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES �. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED fREPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ; IMPORTANT: If the certlftcate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain poitcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LUC1a Estrella NAME: Accurate Group Llc PHONE FAx Arc,�a�Exnc (305)226-8727 IA/c Not• (305)226-8767 _ 8300 West Flagler Suite 114 DORIEss luciaestrella@bellsouth-net Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIC# Phone (305)226-8727 Fax (305)226-8767 INSURER A: Covington Specialty Insurance Company { INSURED INSURER B: Air Rightaway Inc INSURER C: 2909 Stockholm Ave INSURER D: i Cooper City,FL 33026 754-423-2319 INSURER E: -- INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: (—THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD j { INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR { ADDLSUBR POLICY EFFPOLICY EXP LTR I TYPE OF INSURANCE IN _ WVD POLICY NUMBER I MMfDD/YYYY)I(MM/DD/YYYY) LIMITS GENERAL LIABILITY ( EACH OCCURRENCE I $ 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(EaEa occurrencu�_I $ 100,000.00 ❑ CLAIMS-MADE OCCUR (A VBA554473-00 MED EXP(Any one person)�$ 5,000.00 i ❑ Y Y 07/26/2017 07/26/201$I PERSONAL&ADV INJURY { s 1,000,000.00 F1 — I GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 O POLICY ❑ PEO- ❑ LOC is AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL AUTOS OWNED SCHEDULED ❑ AUTOS { BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUT SEED I I i PROPERTY DAMAGE $ El ❑ Per acadenl � I $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ _I ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ i ❑ DED ❑ RETENTION$ i WORKERS COMPENSATION I I WC STATU- 0TH- I AND EMPLOYERS'LIABILITY Y/N El -B`Lll iv�S ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ I OFFICER/MEMBER EXCLUDED? N/A { If yesadesrryriibe under E.L.DISEASE-EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ j I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) License#CAC1817893 I I CERTIFICATE HOLDER CANCELLATION f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' Miami Shores Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REP Lucia Estrella ORD CORPORATION. All rights reserved. ACORD 25(2010105)OF The ACORD name and logo are registered marks of ACORD i STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW EFFECTIVE DATE: 7/28/2016 EXPIRATION DATE: 7128/2018 t PERSON: MENDEZ RAFAEL E FEIN: 270792720 BUSINESS NAME AND ADDRESS: AIR RIGHTAWAY INC 2909 STOCKHOLM AVE. { COOPER CITY FL 33026 l SCOPES OF BUSINESS OR TRA iEATING, VENTILATION, .SIR-COND A F ft ' CONDITIONINGAIR . s ' b Date: State of rttv� rA -- County of —rD, . Before me this day personally appeared VAW-4 .4— e . I'tFWM* — who, being duly sworn, deposes and says: f That he or she will be the only person working on the project located at: A,t,rte 1 Contractor Signature Sworn to (or affirmed) and subscribed before me this day of 20 n , by �i�- �►R4,4K)tt 'L Personally know �- OR Prod I ific n �—��fLw►� Type of Identification Produced ,....m y ="sitw : 4 W o�p��R1DA**����\�`` Print, Type or Stamp Name of Notary ftttlitt 2909 Stockholm Ave.Cooper City FL 33026- 754.423.2319 S�ORF,S �I1G H32 s� ��► Miami hores Village Building Department artment 10050 N.E.2nd Avenue ��ORIDA 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 �,v� day of AA u Eh,3 6y)— ,20 1-7 . By /•I u A YREQ O 1 /✓3 Vr,,z L y who is personally known to me o odueed as identification. No ao�Ao� E3HIL-1dVil �dV S3211dX3 6SEAL: o1SSUVWOO Aw �f10R1 I u'dnda�io� A �