RC-16-1684 (3)BUILDING
PERMIT APPLICATION
F—]BUILI)ING ELECTRIC
PLUMBING 7 MECHANICAL
JOB ADDRESS: 1201 NE 96TH ST
Miami Shores Village
Building Department RECEIVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 jut
Tel: (305) 795-2204 Fax: (305) 756-8972 2 8 1Il
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2011-iSk
Master Permit No. T�l C_'1('p " 1;5
Sub Permit No. V—"ko—
ROOFING REVISION EXTENSION RENEWAL
❑PUBLIC WOR CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTO DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 1-3206-014-3830 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): BKT HOLDING LLC Phone#: 305-904-1608
Address: 2691 E OAKLAND PARK BLVD SUITE 201A
City
FORT LAUDERDALE
Tenant/Lessee Name:
Email: AB@BURKMIAMI.COM
CONTRACTOR: Company Name:
Address:
State: FL
Zip: 33306
hone#:
j
61'V�Phone
City: TQ 6JL State: Zip: q L-3
Qualifier Name: �11,a091z G L Phone#:'3aS -5a�8�'
State Certification or Registration #: GA C Q SA�; 3__Certificate of Competency #:
DESIGNER: Architect/Engineer:
Ad
City:
hone#:
Zip:
Value of Work for. this Permit: $• -%Z F0 O Square/Linear Footage of Work:
Type of Work: ❑E Addition V1 �❑ Alteration El New ElRepair/Replace El Demolition
Description •of WWork: r /r ]�� L _ &A C4
Specify color of color th u tile:
Submittal Fee $ Permit Fee $
Scanning Fee $� Cl. Radon Fee $
Technology Fee $ _, Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE
(Revi:06J02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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.
Signature _ Signatur�
NER or A ENT ,` CONTRACTOR
The foregoing instrument was acknowledged before me this
'Z-`. day of �S-)\i , 20 — by
NUXAY cN9- ��vAWItd-- , who is personally known to
me or who has produced DL "iL - as
identification and who did telAan oath.
NOTARY PUBLIC
Sign:
Print:
Seal: ;
***************
APPROVED BY
The foregoing instrument was acknowledged before me this
C420 day o 20 �Z, by
�� o is personally known to
me or who has produced _ as
identification and who did take an oath.
NOTARY PUBLIC: 'r ; I � /'
Print:
LEONARDO RAMIREZ Seal: "^ W' n '
Notary Public - State of Florida �tao�) aee•o�s3 FbridallotaryServlce,com
My Comm. Expires Mar 17, 2018
Commission # FF 102787
V�-�—�Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
(kjx &rk�,ycw
305 qnq I6oY
2017 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT
DOCUMENT# L13000174332
Entity Name: BKT HOLDING LLC
Current Principal Place of Business:
2691 E OAKLAND BOULEVARD
SUITE #201A
FT LAUDERDALE, FL 33306
Current Mailing Address:
2691 E OAKLAND BOULEVARD
SUITE #201A
FT LAUDERDALE, FL 33306 US
FEI Number: 46-4401483
Name and Address of Current Registered Agent:
BURKHARDT,ALEXANDRE
2691 E OAKLAND BOULEVARD
SUITE #201A
FT LAUDERDALE, FL 33306 US
FILED
Jan 12, 2017
Secretary of State
CC9600644651
Certificate of Status Desired: No
The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.
SIGNATURE:
Electronic Signature of Registered Agent Date
Authorized Person(s) Detail
Title MGR
Name BURKHARDT,ALEXANDRE
Address 2691 E OAKLAND BOULEVARD
SUITE #201A
City -State -Zip: FT LAUDERDALE FL 33306
I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath; that 1 am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and
that my name appears above, or on an attachment with all other like empowered.
SIGNATURE: ALEXANDRE BURKHARDT MGR 01/12/2017
Electronic Signature of Signing Authorized Person(s) Detail Date