RC-17-2626 I k
Permit No. RC-1`1-17-2626
Miami Shores Village Permit Type:Residential Construction
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10050 N.E.2nd Avenue NE' Work Classification:Alteration
Miami Shores, FL 33138-0000
Phone: (305)795 2204 Permit Status:APPROVED
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Issue Date: 11117/2017 Expiration:p�
Project Address Parcel Number Applicant {
9225'NE 12 Avenue 1132050270390
Miami Shores, FL 33138- Block: Lot: LOURDES B KASANZEW
Owner Information Address Phone Cell
LOURDES B KASANZEW 9225 NE 12 Avenue (786)355-1124
MIAMI SHORES FL 33138-2928
9225 NE 12 Avenue r
MIAMI SHORES FL 33138-2928
Contractor(s) Phone Cell Phone Valuation: $ 3,150.00
GUZMAN CONSTRUCTION INC (954)682-3727
.., ..». ._..... .. ..M ., Total Sq Feet: 1135
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved: : In Review Window Door Attachment
Date Denied: Framing
Type of Construction:FLOORING PORCELAIN INSTALLA Occupancy:Single Family Insulation
Stories: Exterior: Drywall Screw
Front Setback: Rear Setback: Final PE Certification
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Building
Certificate Date: Additional Info: Review Planning
Review Electrical
Bond Return: Classification:Residential Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural
CCF' $2.40 Review Mechanical
Invoice# RC-1417-65550
DFee $2.00
DCACA Fee 11/17/2017 Credit Card $ 119.40 $0.00
$2.00
Education Surcharge $0.80
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $119.40
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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 stri t conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I ass me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRI AL P MBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFI IT: certify that all the fore oing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction a oni therm , I aut ri t e a -"e-named contractor to do the work stated.
November 17, 2017
Auth riz�Signa�ture, Applicant / Contractor / Agent Date
Buildingpment Copy
November 17,2017 1
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Miami Shores Village R117GFIVED
Building Department OCT 31 017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 1
INSPECTION LINE PHONE NUMBER:(305)762-4949 .5411FBC 2014
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. Cf 7 !�
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❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑REN,EW
[—]PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
NE
CONTRACTOR DRAWINGS
JOB ADDRESS: 922.5 !� E (2 Aj�-
City: Miami Shores County:. Miami Dade Zip:
Folio/Parcel#: 3 20S0 2 3'0 3'? O Is the Building Historically Designated:Yes NO
Occupancy Type: Q E:% Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titll_ the o de��o J `� ��(�S V�Vy� PhoneAD
ZS J— ` 1�
Address:y�—�\ \� �—YK
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City: 1 � � Y\�(�Q State: \-� Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: G6 VA6 cPm,,Lc t L &tA SNC, Phone#:���Y� 82Z'l 33 8
Address: 9901
City: '76rIWI11a,C'l State: o C_ Zip. 33 3 21
Qualifier Name: Yv!y G o Z MAS Phone#:C9SY)022(3 3 g
State Certification or Registration#: /C&G /-&0 0310 2- Certificate of Competency.#: "
DESIGNER:Architect/Engineer: - Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$�_` Square/Linear Footage of Work: 3 S 0�P'l
Type of Work: ❑ Addition ❑ Alterationp�,,,, ❑ New Repair/Replace ❑ Demolition
Description of Work: F-L001VA)6 Al
Specify<<color-of color-thruytileA. ,okCi✓(AiN/1A0
Submittal Fee$ Permit Fee$ jo(�j CCF$
Scanning Fee$ Radon Fee$ DBPFt
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ tt
TOTAL FEE NOW DUE$ 1 1� 46
(Revised02/24/2014)
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Bonding Company's 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,@ permit,to do the work and installations as indicated. I certify that no work or installation has
commenced� pr or 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 Me 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.
Signature Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum t was acknowledged before me this
31 day of 1020 I by day of 20 by
Loo rdRS A' Ido► 54n2�w"�,o is personally known to �(U� Q � 14o who is personally known to
me or who has produced L_ as me or who has produced L, as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: I
Sign: ryl� Sign: fl,
Print: ��i SAY r Q V Print: JE-1--orm
IGUEZ
EXPIRES:June 14,2021
Seal: Seal: ded Thru Notary Public Undenvriters k
ZUEJASE ELIZABETH RODRIGUEZ
;.; MY COMMISSION#GG 1150Q8
o• EXPIRES:� i fte 14
**ss**s*sss*s ��n� �,�s
^oiarY Public Underwriters
'-APPROVED BY Plans Examiner Zoning
Structural Review i Clerk
(Revised02/24/2014)
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Prepared by and return to:
' Atlantic Title&Escrow,LLC
161.N.Riverside Drive Suite 115E
Pompano Beach,FL 33062
954-960-5225
File Number-: 15=0117
Will Call No.: aR _
t fSpace Above This Line For Recording Data]
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Warranty Deed :a
This Warranty Deed made this l2th,day of August, 2015 between Homer Lee Hickson, a single man whose post
1 office address is 9225 NE 12 Ave, Miami Shores, VL 33138, grantor, and Ivan Kasanzew and Lourdes B. Kasanzew,
husband and wife whose post office address is 108.0 NE 92 St,Miami,FL 33138,grantee:
(Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of
individuals;and the successors and assigns,of corporations,trusts and trustees)
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Witnesseth, that said-grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS,($10 00)�arfd other
good and valuable considerations to said.grantor in hand paid by said grantee,the receipt whereof is hereby acknbw Iedged,
has granted, bargained, and sold to the said grantee,.and grantee's heirs and assigns forever, the folllowirig,de'efflied land,
situate,lying and being in Miami-Dade County,Florida to-wit:
Lot 27,Block 2,Bay Lure,according to map or plat thereof as recorded in Plat Book,,P, ge 63,
the'Public Records of Miami-Dade County,Florida. =r
Parcel Identification Number: 1132050270390
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Together with all the tenements,hereditaments and appurtenance "tlie t
To.Have and to Hold,the same in fee simple forever....- � r
And the grantor,hereby covenants with said grantee that tlfe nto i
grantor.has good right and lawful authority to sell and convey sal at '1
land and will defend the same- against the lawful claimsk of al t
encumbrances,except taxes accruing subsequentftbDDec em. 3Y ,
In Witness Whereof,grantor has hereunto set a
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Signed,sealed`and deliv'ered'in our presence:
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Witness Name; tt1 dtWr/ HomeriLee Hickson
Witness Name:_ W10SMOieK ,B't,?y MPU
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State of Florida
County of Broward t
The foregoing instrument was acknowledged before the this 12th day of August, 2615 by Homer Lee Hickson, who L]is
personally known'br[X]has produced a.diwer's license as identification. ry`=
[Notary Seal] Notary Public
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Printed Name:
. "`"u` 1AISTAPIy►°11BBA�i11111frE8Q,
i _ r DbtM1►ihiONe•$bMdFlotft r My Commission Expires:
Nir t3>�ExpYw$p 16,2015
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