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RC-16-1684 (8)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