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ACT-15-1971Miami Shores Village 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 � Y BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. )(BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: l G D / &)E �(/ Si City' Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Xr �+Ne� Zl-'AIL� Phone#: «%— )2/ A2-W Address: 00 City: /w, /I i✓Ii` a State: Zip: Tenant/Lessee Name: Ph 7/ r /` CONTRACTOR: Company Name: Dti,'lf C_ kS vt '�jj-' ` Phone#: Address: 41�/'D A) YIJ R y/�i J2 City: /yi Stater Zip: 33/%� Qualifier Name: -- -- mac/ State Certification or Registration #: (o 00, d Certji tt#: DESIGNER: Architect/Engineer: ! / 0 Phone#: 305 2-�-3 Address: / -S/ S"S— C'. W 13 y �h S7 �lG City: P4, 4Ir I State: % Zip: J Value of Work for this Permit: $ 9- f at1 (2 • o Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Z/JRepair/Replace ❑ Demolition Description of Work: rep /�rwtjlace Wr'�(/` /�eu/ ` Specify color of color thru We: Submittal Fee $ Scann9ng Fee $ Technology Fee $_ Structural Reviews $ iReviseJ02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ UBPR $ CO/CC S - Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ A 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 MIS 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 t sennccee of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature , -/ f�r�sir • `� • • The foregoing instrument was acknowledged before me this day of , +- 120 �, by �" "r/`�G��►1 �/ - P , who is personally known to me or who has produced Uri v0 i C r' as identification and who did take an oath. NOTARY PUBLIC: Sign: MARIA uru iA CALFRn 5' Notary Public - Slate of Florida Print: • - „ Comm.Expires Apr 1.20177 =�' •J:` Commission # FF 3814 Seal: ;;„;°'' Bonded Through National Notary Assn. APPROVED BY (Revised 02/24/2014) The foregoinginstrument was acknowledged before me this day of , 20 t r , by �C , who is personally known to or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: Plans Examiner Structural Review • Commission # FF 226349 My Commission Expires '�.�, u~•�° May 03, 2019 as Zoning Clerk Miami shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, �^� - L ",11 oes hereby attest that (Property owner) The attached survey, performed by 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 (Name of surveyor's company) For address: l2J ? 64 / 4,- ; Performed on (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building .code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Fu r, t s au Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this 5 1l day of c:�o6__ Affiant is personally known to me, produced as identification. Notary Revised (6/25/12)Revised on 5/22/2009/ Revised on 6/12/09 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. ✓/ COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: _IW�t�u CA-e IV4ZI t4l C( C'rG BUSINESS ADDRESS: , & 3M) NtAJ 5 ✓c CITY 114,,4 STATE 7-1 ZIP 33 4 Io2 BUSINESS PHONE:) FAX NUMBER ( _) CELL PHONE QUALIFIER'S NAME: �` /'"" Ali QUALIFIER'S LIC NUMBER: �� S o7 C) �— � r F S IA I E OF FLORIDA a� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 1. Y-,I r r t t CONSTRUCTION INDUSTRY LICENSING BOARD 1'CNYt�+`1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0703 ALCIBAR, MANUEL JR PARADISE AWNINGS CORPORATION 7586 SW 102 STREET PINECREST FL 33156 (050) 457-1395 Congratulationsi With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's DEPARTMENT OF BUSINESS AND economy strong. _ ICY ` PROFESSfONALIPEGULATION Every day we work to improve the way we do business in order to CGC1512997 ISSUED` ' 07/02/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe r' CERTIFIED GENERAL CONTRACTOR ` to department newsletters and learn more about the Department's t ALCIBAR, MANUEL' JR PARADISE Ab�lIUEL' CORPORATION initiatives. , Our mission at the Department is: License Efficiently, Regulate Fairly. I We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! l ip:ration date! AUG 31, 2016 L1407020001130 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUNI[3ER� I ne UENEKAL GUN I RAC I OR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ALCIBAR, MANUEL JR PARADISE AWNINGS CORPORATION 7586-SW102 STREET PINECREST FL 33156 4` ISSUED: 07102/2014 DISPLAY AS REQUIRED BY LAW r60 ♦ '1 SEQ # L1407020001130 )03445 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS' IS NOT BILL - DO NOT PAY 5686838 BUSINESS NAME/LOCATION RECEIPT NO. PARADISE AWNINGS CORPORATION RENEWAL 4310 NW 36'AVE a31424 MIAMI FL 33142 EXPIRES SEPTEMBER 30, 2015 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PARADISE AWNINGS CORPORATION 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED 006S00258 By TAX COLLECTOR Worker(s) 7 $75.00 08/15/2014 ECHECK-14-141045 This Local Business Tax Receipt only, confirms payment of the Local Business Tax. The Receipt is not a license, permit; or certification of the holder's qqualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws an requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec Ba-276. For more information, visit www.miamidade.aov-hags cto x)4175 Local Business Miami —Dade County, -THIS IS NOTA BILL 6312854 BUSINESS NAME/LOCATION PARADISE AWNINGS CORP 4310 NW 36 AVE MIAMI FL 33142 Tax Receipt State of Florida - DO NOT PAY RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2015 6579222 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF;: BUSINESS PAYMENT RECEIVED PARADISE AWNINGS CORP 196 GENERALBUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CGC1512997 $75.00 08/15/2014 ECHECK-14-141046 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder must comply with any governmental ornongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec Ba-276. For more information, visitwww.miamidade.govftaxcollector tr - PARAD-4 OP ID: TL ACORN" `� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) F0E(MMID015 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite#200 Miami Lakes, FL 33016-5869 Ramon A Rodriguez CON NAMEACT Ramon A Rodriguez PHO"E 305-364-7800 a No): 305-714-4401 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA:*Hanover American Ins Co* 36064 INSURED Paradise Awnings Corporation Marinais, LLC. Jacinto Holdings, LLC. Marinais, LLC INSURERB:*Hanover Insurance Company* 22292 INSURERC:*Brid efield Employers Ins Co 10701 INSURER D : 4310 NW 36 Avenue INSURERE: INSURER F : Miami, FL 33142 CAVFRAGFS 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 LTR TYPE OF INSURANCE ADDL SUBR pOLICYNUMBER MMNDY EFF 'POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxIOCCUR LZJ961768303 10/26/2014 10/26/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 X EBL PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [X] JET LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS qAUTOS AZJ961771203 10/26/2014 10/26/2015 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UHJ961768503 10/26/2014 10/26/2015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED I X I RETENTION $ NIL $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I I STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Awning Fabrication and Installation r_FRTICIrATF MAI 119:12 CANCFI I ATIAN MIASHOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Brown and Brown of Florida, Inc. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD t ® a� Ra CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/1/2015 8 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TriGen Insurance Solutions, Inc. 315 SE Mizner Blvd Suite 213 Boca Raton FL 33432 CONTACT NAME: PHONE No Ex: (877) 987-4436 NC No:(561) 952-2625 E-MAIL certs@trl en rou inc.com ADDRESS: 9 g P INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Guarantee Insurance Company 11398 INSURED (248) 971-1030 INSURER B : Trion Solutions, Inc., et al. L/C/F PARADISE AWNINGS CORPORATION INSURERC: _ INSURERD: 340 East Big Beaver Road INSURER E: Suite 160 Troy MI 48083 INSURER F : nrwco wi+r=c rC0YICI1-ATc AIIIkAQCD- r--r rn a7n7 RFVISIAN NI IMIRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY �_ CLAIMS -MADE E OCCUR EACH OCCURRENCE DAMAGE TO RENTED R PREMISES Ea occurrence _ MED EXP (Any one person) $ _ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY F7 PET LOC $ I OTHER: 1 AUTOMOBILE LIABILITYaccident) ANY AUTO ALL OWNED I SCHEDULED �j AUTOS AUTOS i� NON --OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea $ _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident $ $ $ — — $ F i I UMBRELLA LIAB OCCUR EACH OCCURRENCE Is AGGREGATE $ EXCESS LIAB CLAIMS -MADE _ DED RETENTION $ 1 $ '� WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY FROPRIETOPJPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below �N/A WCP500002702GIC 1/1/2015 1/1/2016 PER % �I ER STATUTE H E.L. EACH ACCIDENT 1 $ 11000,000 $ 1,000,000 ---- E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT $ 1,000,000 I I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage is provided to leased employees and not subcontractors or non -leased employees of PARADISE AWNINGS CORPORATION. Location coverage effective 1/l/2015. Ref: Awning Fabrication and Installation trCK I Ir II.A 1 C MULUCrC v ­­ 11v 1 Miami Shores Building Department 10050 NE 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �3 C la, yr U 19UB-ZU13 AGUKU GUKVUKA I IL)N. All rlgnLS reserves. ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD Page 1 of 1 Miami Shores Village RECEIVED Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAY 0 2 4019 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2011 b BUILDING Master Permit No.1�C� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I ooi 'V City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): z-"r' Phone#:_ Address: lid/ NF �6fu 577 e� 14 FFE: City: d'-,� ' 1 i1res- State: Zip: 3��3 Tenant/Lessee Name: Phone#: G! Email: 14"z ';'&,9 Id- 7 �e Cu ' 00^1 CONTRACTOR: Company Name: Address: City: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Zip: Address: City: State Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ a'j 4j. >yr' Plies c � 166 Permit Fee $ Radon Fee $ Training/Education Fee $ Zip: ❑ Demolition CCF,$ CO/CC $ DBPR $ , Notary ; Double Fee $ _ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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 be charged. Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of r20 by J.IN 9--rq ii.4ib , who is xzgI k o to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: co Seal: _ U i' f„ J ############################# APPROVED BY CONTRACTOR The foregoing instrument was acknowledged before me this day of as me or who has produced 20, by , who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: as ° m Seal: e d Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Arlenis Silvera From: Sent: To: Subject: SilveraA rnsvfl.gov Address not found Ken Lund <klund1273@gmail.com> Friday, May 03, 2019 12:47 PM Arlenis Silvera Cancellation of lund permit AVT-8-15-1971 ---------- Forwarded message ---------- From: Ken Lund <klundl273ggmail.com> To: "silveraA cr,mscdl.gov" @silveraA e,mscdl.gov> Cc: Bcc: Date: Fri, 3 May 2019 12:40:16 -0400 Subject: Cancellation of lund awning permit number AVT-8-15-1971 Hi Please cancel this permit as these awnings were never installed Thanks Ken lund 7147212270