PL-18-2270 (4)geoaes Miami Shores Village
10050 N.E. 2nd Avenue NE
r
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FCORiDQ'
Permit NO. PL-8-18-2'270
Permit Type: Plumbing - ResidentialPeritWorkClassification: Gas
Permit Status: APPROVED
Issue Date: 8/30/2018 1 Expiration: 02/26/2019
Project Address Parcel Number Applicant
1199 NE 102 Street 1132050190010
ANELIA SHAHEED
Miami Shores, FL 33138-2649 Block: Lot:
Owner Information Address Phone Cell
NIHAR PATEL 1199 NE 102 Street (248)561-1523
MIAMI SHORES FL 33138-2649
1199 NE 102 Street
MIAMI SHORES FL 33138-2649
Contractor(s) Phone Cell Phone
SUNGAS SERIVCES COMPANY (305)635-8682
Type of Work: INSTALL GAS LINE AND TANK PER PLANS
Type of Piping:
Additional Info:
Bond Return :
Classification: Residential Scanning: 1
Fees Due Amount
CCF 1.20
DBPR Fee 2.63
DCA Fee 2.00
Education Surcharge 0.40
Permit Fee 175.00
Scanning Fee 3.00
Technology Fee 1.60
Total: 185.83
Valuation: $ 1,200.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due I
Invoice # PL-8-18-68667
08/30/2018 Check #: 8182
08/23/2018 Check #: 3107
135.83 $ 50.00
50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Press Test
Review Plumbing
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 strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio oning. thermore, I authorize the above -named contractor to do the work stated.
9,1 evti G August 30, 2018
Owner r / Agent
Building —Department Copy
August 30, 2018 1
q gSU-Sq-Zu&`3
Miami Shores Village RScE1VED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LIN PHONE NUMBER: (305) 762-4949lr FBC 20/7
BUILDING Master Permit No. ec 5 191245
PERMIT APPLICATION ZAG Sub Permit No. flu 13- 2-C-Po
F-IBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
LP6. CONTRACTOR DRAWINGS
JOBADDRESS: Iyd nc/ :M City:_ Miami
Shores County: Miami Dade Zip: Folio/Parcel#:
11,3205C 19--)01(D Is the Building Historically Designated: Yes NO Occupancy Type:
Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (
Fee Simple Titleholder): k int'r, 1 Lt 1 ° 1%e II G %ft"CrPhone#: qg7 Ao S 2 I Address: /4
qq A)C 100#q City: M)
CM i S nu S State: 110f) 10 Zip: Tenant/Lessee
Name: tiA Phone#: %-4 a10I `J a Ice Email: _(I
I(11;1 lase P Ia i'1.ccm CONTRACTOR: Company
Name: (SLnQCks S e ro C aS Phone#: 366— 05 - <?(V Z Address: 2ch-
D ULW ALl 5_ City: In
CM I State: floAc 1CG zip: 3 9l Lfa. Qualifier Name:
ne#: State Certification
or Registration #: lJ Certificate of Competency #: DESIGNER: Architect/
Engineer: Address: City:
Zip: Value of
Work for this Permit: $ If Z 60 Square/Linear Footage of Work: Type of
Work: Addition Alteration New Repair/Replace Demolition Description of
Work: _-b%tQJ 1 n015 hO r? CrY I IML Pee ,0fW Q7)r, n )e-0S PC' " It ' 1 a 4 5 V fir
14Ile
i )P Specify color
of color thru tile: Submittal Fee $
15W Permit Fee $ 1 q Scanning Fee $
Radon Fee $ Z • 0Q) Technology Fee $
Structural Reviews $
Training/Education
Fee $ CCF $ DBPR $
L •
G3 CO/CC $
Notary Double
Fee $
Bond $ II
TOTAL
FEE
NOW DUE $ 1 — Revised02/24/
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
y day of ,0vCr0t l— , 20 by
h-J-X ,w -d , who is onally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 1 O'2
Seal:70
w
o1FNW." Public StM od nieeBoolm,
My
Cmitin"m 30 408 09 Signature
CONTRACTOR
The
foregoing instrument was acknot, ledged before me this day
of 20 L by l
Z-41!,! rr-L who is personally known to me
or who has produced as identification
and who did take an oath. NOTARY
PUBLIC: r
Sign:
Print:
Notary
PublState of Florida Seal:ComMissionNGG1090d14w !YMyComm, Expires Apr 18, 2022 lorded through National
Notary Assn. APPROVED BY Plans
Examiner Zoning Structural Review Clerk
Revised02/24/2014)
MOW 24SVeeUb#A1aft,f1a3142,7M
305.635-> ,DFaX305-637-41017- --
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BY DATE ZONING
DEFY BLDG
nEPT SUBJECT
TO CCNIpUANCF \mTH ALL FEDERAL STATE
AND CCUM yRuL-=S AND REGULATIONS PLUMBING
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LEGEND
ABBREVIATIONS:
URTIT`011 DF ADTND42ATi09 J t9-IFUS
Survey Pros, Inc. A ARCCDISTANCESTANCE
Al AIR CORIRBCOUN PAD
RBUILDING COUNTY RECORDS
8300 MILLS DRIVE SUITE 148, MIAMi, FL. 33183OLOTCTel: 106, 767.8802
IV ^DLNCHMARK
LIDO OF SEARINCS WVVVV.8Urvey-pro8.0om
COS ^ CONCRETE OLCC•c & STUCCO
LOCATION MAP: C) :• CALCULATED
C&C •• CURB k GvTTCR
CLF C•1AIN :NK ?E\CE NOT TO SCALE
CO. •• OtTJMNC
DRAINAGE F.ASI'MCN1
D.M.L. DRAINAGE k MAINIFNANC:
EASCVENf
C i ""'•''il !` r'' iO3•+{ t+i:.,- •s
IF,' I ••
I
D/Y, •• DRIVEWAY d '
x,I. k a AED - Et.ECiRIC BOX
ENC. • ENCROACHMENT
CP • EDGE OF PAVEMENT
a
LW ,• E.DGE OF WATERy Irj
10•, rOJND DRILL HO:I.
IT ,• I'MSI,ED FLOW! ELI,VAUON
o - A
ns) •. rOUND -RON PIPE (NO t0)
ra rOUND IRON ROD (NO ID)
FN . FOUND NAIL (NO ID)
1 =' 'N( 5C r /f , rFPL •• FLORIDA PAR R LICHT
TRANSFORMER PAD R.p• - 'L,r° l
L.E. .. LANDSCAPE EASEMENT
1I.,M,E. LAKE MAINTENANCE EASEMENT
N) - MEASURED
MOCK ,• MIAMI-DARE COUNTY RECORDS PROPERTY ADDRESS:
MN ^ MAN HOLE
FIT,. MO\UV.ENT LINE110 NE 102NO STREET, VIAMI SI/ORES. Ft- U138
P) - PIAt
PD •• PLAT BOOK
PC - POINT OF CURVATURE
PCP PERMANENT CONTROL POINT
PE POOL CQUIPMENT PAD LEGAL DESCRIPTION:
PG ^ PAGE LOT 1. OLOCK 175. Or REUSED PLAT OF MIAMI SHORES, SECTION S, ACCORDING TOPIPQNV7OFINTERSECTION
pL -PLANTER THE PLAT iHEREOF, AS RECORDED IN PLAT BOOK 43, PACE 87, OF THE PUOIJC
t><III „PORT OF OECSANINO HECORDS OF MIAMI•.DADE COUNTY, FLORIDA.
oOC ^ PONT OF .COMMENCEMENT
PRC „ POINT Or REVERSE CURVAtURE
PAM a PERMANENT REFERENCE
MONUMENT
PT - POINT OF TAbNOCNCY
FLOOD ZONE INFORMATION: 11 ^ RADIUS DISTANCE
R) •, RECORD
A/W RIGHT-OF-WAY BASED •ON 111E TLOOD INSURANCE RATE MAP W 114E rEOERAL EMERGENCY
TIES RESIDENCE MANACEMENT AGENCY REVISED ON 09/11/09 AND INDEX MAP REVISED QV
SIP - SIP 1.0/8023 09/11/09 THE GRAPHICALLY DEPICTED111JILDING(S) SHOWN ON THIS MAP Or SND .
SET NAIL k DISK LO/0923 SURVEY iS WITHIN ZONE X BASE FLOOD ELEVATION Dt/A COMMUNITY NAVE h S1L .SURVEY TIE LINE 5" -
SIDEWALK NUMijER W uy Alta 5 j200D2 MAP it PANEL NUNUC1l 120806m SUER% L TVP) ••
TYPICAL SURVEYOR181`
101M UnlyBoxU.
L.--UUTILITY EASEMENT 1. ELEVA110\S ma SHOWN REFER TO 1920 NATIONAL GEODETIC VERTICAL DATUM W/r - W000 FENCE NGVD
1929). 2.
NO ATTEMPT. N'AS VATIC 10 LOCATE roolmo5/rCuNDARONS. OR UNOERGROUNO SYMBOLS:
UTILITIES UNLESS OAtERWSE NOTED. THE
SHOWN IIEREON HAK FACT OLEN ABSTRACTED IN REGARDS TO MTELEPHONERISER3. LANDS MATTERS
OF INTEREST BY 01I1ER PARTIES, SUCH AS EASEMENTS, RIGHTS Or WAYS, pCABLETVRISERRESERVATIONS, ETC, ONLY PLATTEb EASEMENTS ARE SHOWN. II •
WATER METER 4, Ti4S SURVEY WAS PTB;PARED FOR'AND CERTIFIED 10 111E PARTY(ICS) INDICATED 0.
00 •ELEVATION HEREON AND IS NOT TRANSfERADLE OR ASSCNAOIF. WITHOUi WRITTEN CONSENT or BD) -
ORIGINAL LOI DISMNCE RRS FIRM. IES IS THESURVEyASATEDByTICCTHIISFitoA ^
CENTRAL ANGLE EAL-CSTATENT TE iRIIS FORAHSACTON OR MORTGAGE REFIw%cmGSURVEY IS SNOT CCNTLR
UNL 10 HE USED FOR ANY OIVER PURPOSE Wt IIARIY(II.S) WITHOUT THE WRITTEN wV
j -
WATER VALVE AUIHORIZATIOV
OF THIS FIRM. 8. ,,,
IS SURVEY IS N01 IKIEWED rGR NEIIHLR OL9QV NOR COYSTRUCHOV PURPOSES. FOR 114M PUHPOSES, A TOPOGRAPHIC SURVEY MAY Fit REQUIRED.CURB
IDNICURBINLET 7. ALL BOUNDARY LIMIt rtNICATORS SET ARE SIAVPLD LO( 8073. 9.
THE 'BOUNDARY L•MITS ESTADLISIICO QV THIS SURVEY ARE BASED ON 111E LEGAL nFIR£ HYDRANT DESCRIPTION PROYDCO BY 11ir. CUE141 OR ITS fILPRESENtA11VL L
j1 LIGHT POI F. 0,
rENCE'.OWNERSHIP IS NOT DETERMINED. T0. •
ADDITIONS OR OEt.EIFONS 10 TNTS SURVEY MAP AND/OR REPORT BY SOVLDNE CONSENTOfrOTHERTHANTHESIGNINGPARTr(ICS) IS PROHIBIiEO NITIOUT WRHiEN a .
CATCH BASIN O,
UIIUIY POLE THE
SIGNING PARTY(IES)• 11• BEARINGS WHEN SHOWN ARE TO AN ASSUMED MERIDIAN AND BASED ON PLAT. ORAINACE
MANI0LL f11E CLNTERLINE OF NW 61j111 51NLEt HEARS NilOW00%, CERTI
FII DTO: SEWERMANHG:.£ a
IRCN ILNCL u-•
u— = WOOD FENCE ANER SNA4EE0 ANO %IHAR PATFL CHAIN
LINK 1 LICE OVF.
R{IrAD UTILITY WAE CORETITLE
LLC NORTH
AMERICAN 11IIt INSURANCE COMPANY E__] [
71 IIRSI
nDME MORIGACI ODKPORAIICN RLY1S
O IiS);. ASPHALT
CONCRETE. PAVERS H;.iS COVER SURVEYOR'
S CERTIFICATE_: I
Crj,!r 1 1 IIII$ SURVEY 15 TRUE. AND C04RECT 10 THE BEST .Or MY NNO'ALLOGE AND OCLICT AS DATr
aF /min MW; T7/
TB/17 IiCRED, RL'CEtiTLY SURVEYED AND ORAWI, UNDER VY DIRECT104 AND MEETS TI,E VNIMUM IEC14MCAL STANDARDS SET THEFLOR.DA STATE BOARD OF SURV:Yois AND MAPPERS •N CHAPTER 5:_±7 1'L04.f7A ADVIV151RAtIVE fiT21745 FORTH
BY CINH
PURSUANT TO SLCTIIIV K77.077 FLORUA STATUE, DRAIBTV DY•y-AYCK. SEAL
j CAD ntc: YArt7. AUMENiTC
COPIES OI IHIS j SURVEY
SIiALL BEAR 7111. l` verr T Dr I ORIGINAL
SIGNATURE AND NICOL,AS UEL. VENTO RAISED
SFAL OF TIfF PRCFESSIONAI. SURVEYOR & MAPPER AI
ILSIING RLCISiEREO STATL: OF ILOTiIDA UC, 9 6945 SURWYOR
AND !ANIiIER
1
f. , 1
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
2005 Apalachee Pat'icway
Tallahassee, Florida 32399-6500
Master Qualifier Mailing Address
JOSE A. IZAGUIRRE
SUNGAS SERVICES COMPANY
2950 NW 24TH ST
MIAMI, FL 33142-7008
Certificate Number
09726
Licensed Location Address
SUNGAS SERVICES COMPANY
11710 WILES RD
CORAL SPRINGS, FL 33076-2159
License Number
13545
This Master Qualifier Certificate is issued pursuant to Chapter 527, Florida Statutes. This certificate
is valid only for the person and licensed holder listed. Any changes to the Master. Qualifier status
such as transfer or termination of employment) must be reported to the Bureau.of Compliance
at (850) 921-1600 immediately.
The Master Qualifier Certificate is valid only through the date noted on the Certificate. A notice of
renewal will be sent to you in advance of your expiration date. A Master Qualifier Certificate may be
renewed if certification of a minimum of 16 (sixteen) hours continuing education is provided along with
the renewal form. If training cannot be documented, an examination must be taken.
If there are any errors on the certificate, please submit all changesin writing to:
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
2005 Apalachee Flarkway
Tallahassee, Florida 32399-6500
Cut Here
t ,
State of Florida
41 Department of Agriculture an4,.Donsumer Services
Division of Consumer Services Certificate No: 09726
e f Bureau of Compliance Exam Date: October 28,1983
850) 921-1600 Wsue Date, 13,2017
Expiation Date: February 12, 2020
Tallahassee, Florida Exam: 0601
MASTER QUALIFIER CERTIFICATE
This Certificate is issued under authority of Section 527.02, Florida Statutes, to:
JOSE A. IZAGUIRRE
Valid for
License Number: 13545
SUNGAS SERVICES COMPANY ADAM H. P UTNAM
11710 WILES RD COMMISSIONER OF AGRICULTURE
CORAL SPRINGS, FL 33076-2159
Florida Department of Agriculture and Consumer Services
P.O. Box 6700
Tallahassee, Florida 32399-6700
License Number: 13545
Business Mailing Address Licensed Location Address
SUNGAS SERVICES COMPANY SUNGAS SERVICES COMPANY
29M NW 24TH ST 11710 WILES RD
MIAMI, FL 33142-7008 CORAL SPRINGS, FL 33076-2159
Thn liquefied aetm-leli n gag licenses at the hnttcxn rA thip form is valid ONLY frN the CO-uany located at the addressonthelicense. Each business location of a company must be licensed. All LP Gas licenses must be renewedannually. Any license allowed to expire shall become inoperative because of failure to renew. The fee forrestorationofalicenseisequaltotheoriginallicensefeeandmustbepaidbeforethelicenseemayresume
operations.
IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS F-.USINESS LOCATION: This license may be
transferred to any person, firm or corporation for the remainder of the current license year upon written request tothedepartmentbytheoriginallicenseholder. License transfers must be approved by the depart-- 'Ail licensing
requirements must be met by the transferee and a transfer fee of $50 will apply. To apply for a transfer, contact the
Bureau of LP Gas Inspections at (850) 921-1600.
Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proa f of licensure to any consumer,
owner, or and user upon request when engaged in the business of servicing, testing, repairing, maintaining or
Installing LP Gas systems and/or equipment.
For future changes
and/or yourrllicennssed Ication a resslease ske
and rrnetu the UPPER PORneeded
co-rections TION Jth corrections our
to ss mailing address POST
LICENSE CONSPICUOUSLY
Florida
Department of Agriculture and Consumer Services P.
O. BOX 6700 Tallahasc-
se, Florida 32399-6700 Cut
Here State
of Florida Department
of Agriculture and Consumer Services k
Division
yof Sonsumer Services License Number: 13545 Bureau
of Liqud ied Petrolqum Gas -Inspection rDate: August 018 of bar117850) 921-
0600 License Fee: $426.00 Tallahassee, Florida
Typp and class: 0601 Liquefied Petroleum
Gas License CATEGORY I
LP GAS DEALER GOOD FOR
014E LOCATION ONLY ANY CHANGE
OF OWNERSHIP OR SALE OFA HLID I BUSINESSRENDERS THIS LICENSE This license
Is issued under authority of Section 627.02, Florida Statutes, to: SUNGAS SERVICES
COMPANY 11710 WILES
RD COMMISSIONER OF AGRICULTURE CORAL SPRINGS,
FL 33076-21.69
B
R Y INSURANCECERTIFICATEOFLIABILITY
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.
IMPO ANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 endorsernen s .
PRODUCER BiIlle Tucker
lamerson McLean Corporation "
II E •80039"M
FA't g07 58 8508
P.O. Box 621149
IL bUli mcleaninsurance com
825 Executive Drive INSURIR(S)AFFDROINGCOVERAGE
INSURED
Sungas Corporation of Florida
Sungas Services Company, Grill N Propene
2950 N.W. 24th Street
OCVIAEAM MIIaaRFR•
GOVERAGEa vrr%r.rr.^--..v.nw. —
POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODTHISISTOCERTIFYTHATTHEANYREQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THISINDICATED. NOTWITHSTANDINGCERTIFICATEMAYBEISSUEDOR 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 D B POLICY EFF POLICY EXP LIMBS" IMMODWYM
LTR TYPE OF INSURANCE —NUMBER
DOO
GENERAL LIABILITY OCCURRENCE
a IADAMAGETORENTEDs<1
A X COMMERCIAL GENERAL LIABILITY
508.890537--2 0910=7 09J03i1Q18 MED EXP M ono 5 0
CLAIMS4AADE XC OCCUR
PERSONAL6 m IN RY s1 000000
GENERAL AGGREGATE 2 O00 OOO
PRODUCTS - PIOP AGO 2 000
GEN•L AGGR TE LIMIT APPLIES PER:
3
X POI ! -1FrTPRO- OC COMB INGLE LIMIT , 0mOOO AUTOMOBILE
UABIUTY (Fa n=bdwQ BODILY
INJURY (Per person) S A
X ANY AUTO ALL
NED SCHEO 5O8$9DW-2 091031 17 09A312018 BODILY INJURY {Per aadderrO i AUTOS
NON-OWNEDSPROPERTY DAMAGE $ X
HIRED AUTOS X AUTOS 5 X
UMBRELLA UAB X OCCUR EACH OCCURRENCE U AMUAWRE13ATE
4 0 = A
EXCESS LIAR 1,CLAIMS4MDE 52W016.4 09I03017 O91Q O18 IX
O WC
STATU- OTH XWORKERCOMPEN9ATtONSE.L
EACH ACCIDENT 1000000 AND EMPLOYERS! LIABILITY yI ANY PROPRIETOR/
PARTNERrxECUTIVE N/A ZM8182715 09M O17 O9M018 EL.D
ASE-EA 1owwo B OFFICER/MEMBERO(CLUOED? IJ Mandatory in
NM r e
deeoribe under E.L. DISEASE - POLICY LIMIT 1000 OW DESCRIPTION OF
OPERATIONS I LOCATIONS I VEISCLES (Attach ACORD IM, AddM*nal RwnWa 8dredule Ir more epau a rewind) LP Gas
State Contractor 013545 Village of
Miami Shores Building Department
10050 NE
2nd Avenue 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 REPRE3MATIVE
100P*1*-
0did J wownwhooft 01988.2010 ACORD
CORPORATION. All rights reserved. ACORD 26 (2010105)
The ACORD name and logo are registered marks of ACORD
To: Page 8 of 9 2018-08-23 16:43:59 (GMT) 18668155763 From: The Permit Professionals / Danto El
115 S. Andrews Ave., Rm, A-100, Ft, Lauderdale, FL 33301-1895 — 9.54-831-4000
VALID OCTOBER 1, 2017 THROUGH SEPTE.MBE.R 30, 2018
sA Receipt #:1 s 9 - 412 2
x DBA: ALL OTHER TXPZS CONTRAC R
Business Name: SUNCAs SERVICES COMPANY Business Type:
l Owner Name: josE IZAGUIRRE Gm Business Opened, 04./2"2/1.959
Business Location: 11.710 WILES RD State/County/Cert/Reg:13545
CORAL SPRINGS Exemption Code:
Business Phone: 954-752-8885
P Roams Seats Employees Machines. Professionals.
s
2
l
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 0.0.0 7.00
t
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A'TAX RECEIPT This tax is levied for the privilege.of doing business within Broward County and is
non -regulatory in nature. You must meet all County andfor Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. Thisreceipt does not indicate that the business is legal or that it
is in compliance with State or local laws and regulations. Mailing
Address: DOSE
IZAGUIRRE GM Receipt #10B.-16-00002036 j!
j1Q WILES RD Paid 07/13/2017 27.00 CORAL
SPRINGS, FL 33076 2017 -
2018