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RC-12-20-3011
�;\�\�\���y i���R�\�f��.��\�\\\�\��.��1ia�.� 5����\1il\\1��c;. l� 2k�t ��;���. �`,\t�?���1�,�:. :� ����4����\\z� � �l �.� lt��c c � � �»�\�\� ', ��`�� � � � � '�4�9�� `� `\\``,�����3 \1i ti11�}\l�l���\ `� � �; �x`���.i t> > �� ��'� �; �� � ��.: ' ` i� ; � ;� ��i � \\\`\ \� .\\� � � �O y� ti D� t��':,0���\ �\`��,� `�\ � � �. t,�� Ic"iC11f�f1f�PE$�E1���@ ti ������Z�;�� \\� � ` �� �� � \tii�`� 11� �` �zil�� l �\��� ��`` �� � �..�`. ��' �� \ �\t�� �t�`?t1�����\�` l � s � � 1QC>50 NE 2 AV2 z � s ' ` \ ���C���`i��t l�l�����t�\�ti����\����\ \�\ �� �� MiarYti Shares FL 33138 !o `�\� � s o ���> >� 1t� ������Zt�O���'€������ ir`�r i�� ���i����.` t- r�. �Q�J-7��-22.�4 � \: �\l`�.� � , `� ��}� ��� \ \ , �i l ti �'�`.}���\1 .��� ��0� t wxi� � V � � V �.� A� �1 � � � } ��t � �9"fir''�" �t) � tl v �����A��x����� � � ti \i � < �� \� \ � � .L tib s�� � �.v� �� � � �A� � O �V�.. � ; ��� } {> �, �5[t3 i �� �A ��<�,���\ �������� � 1 L�\Z� ,< ...d,. ..., �.:�� ��. '������` � �„a.;i �z�t\ > � �'`��,�`�`,��`�`���`�����'��������,, EXpir�liC�Pt e (��/12/2�21 � ,t ,v�: �� ..�� � .�. � Lcacation Address Parcel Number .s� � �,�,�����_�_ ��_�._�a� �a��� �,� �m��.�,,x�,v.�� �.� a.,y�� �� € 43�GRAN�COfVC,tttii�mi Shores,Fl 333.38 12320601?�C�4� . �����Q��aa.e Contacts r PATRICft Tt}OMEY f�vsrner SLUYTEft CQhlSTRUCTiC�N C�rttra�t�r = 438 GR�(VD CQNC,Miami Shares,Fl 33138 GREG ALLEN S�t1YTER � 237 NE S02 ST,MIAMI SMORES,Fl.33138 ; Business:97Q3799730 sluyterconsfiructi€�n@gmail.com l ,�_�a,.�� m e._��R��.w�,�..n�.�_��m��_._�..� .��- a� � .�,�.m_m_�m_���� �._�_ ���_.,. � �, ` Ins eettan R� uests � D�scription:KITCM�N RE[VOVATIO(V.REP�ACE AC�.CABINETS Yaluati�n: �24,OQ0.�4 � ��� � � � z ��. � AND APP�IANCES IN SAME L{�CATION� i �>��� � � � ' �� ti � ? ; Tatal Sq Feet: 18{?.00 � ��� � ° � � � �� ' � ,�,�........ ,� ,,,:, r,�... . ..<�..... ..,�...w ,. �;�. �» � ����sa� �� ��a � ' Fees Amount p�yrry�nts Date Paid Am4 6�aid ApplieaCian Fee-Other $SO.QO 1'ot�I FeeS $$3�,20 ce� s�4.�a cn���#9�0 oa/ia/Zoza ���7.za Certifict�of Completian for Single Fam $50.00 Credit Card 12f 31J2020 c�sp,p� and Duplex Q�FR Fee $10.�0 �mount Qu�: $0,04 DCA Fee $7.20 Educatian Surcharge $4.8Q Permit Fee $67Q.Q0 Scanning Fee $12A0 Techncalagy Fee S1&.QQ Totat: $837.20 il �n e nt y !n c�nsideration of the issuance to me of this permit, I �gree ta perform the work eovered hereunder in compliance with all ordinances and regulations p�rtaining theeeto and in strict ce�n�ormity wfitht tt�e plans; drawings, �tatement� or sp�cifications submitted ta the proper autht�rities �f t�iami Shor�s Village. In accepting this permit I assum� responsibility for all work deane by either myself, my agent, servants, ar emplayes. I under�tar�d that sep�rate permits�re required for ELECTF�IGA[.,PLUMBIPVG, M�CH,RNIGAL,V11I�tDUWS, Dt�ORS, ROOFING and S1t1�IMMING PQt��work. OWNERS AFFIDAVIT: 1 certify that al! th� foregoing infoemation ia aecura[e and that �Il wark will b� don� in compliance wi4h a(I appiicable lews regulating cans uction d�oning. Futhermare, i au4harize the abov� named contractc�r to do the work stafed. ; �� �� �� Z Authorizec!Signatuee:C?wner f �pplica t t Contract�r l t�gent D�te Fetaruary 12,2Q22 Pa�e 2 of 2 ` L �\� \ . 1 � \ �\ .�+� \�t� 2 \ 1l \ 1 \ jj,��y' �'�V�.�&, � \l�� \\ s \� � � �����m� ,d'"����������Z����\ � � ��1 ��. � � � \� .) �� . � 1 \\ 4 ? ����' ��,� ��m�Shc�res l��ll��� ��, �� � � � ' � 10050 N E 2 Rv2 � ti � �� ��� ��i�i � ��� t� �� 3 � � �� � ti� �\� �1��'� i . �9 � r IR � � � � � Miami Shores F�3313� �i � � � z 1 �� � q�� � � tic rt ^snn \� \ ` "'.�l\\ 2� , � � \\ � \\\ \ . � k'\S s�\\1 \ � 1 \. S.- .,,, �.+,��, �V..a^�J�-L�S./4 iU�2 �i 1 � 1) \ \ . � \ . ? �i �� � . \ � � . '+�F `�m" CS": ? \ t �� A Al� t�� � \� \ r4 (�y �'1 N�"� �A� \S����ti � i � 1�A� � � ������'���'"����f�?i�' � ) �� t . ,;, o , a�.t„?, .��s.,�. � ,�.2.���' ��t����� � � �l ���V1 �� \ �;��v ���� � � t ..:. . t � z� t � ���� � �� ���Df�}IP�ttQ�P9: �$��.���{.��� -. �,��2t'��L����\�� ��\\\„�, i.ti.� 3 L . � ,lt. tac��ion Addr�ss Parce!Number ��v.......�������,�m� �..�,�. �,.�� ����� �� �.��.��m�����._��.�.��.._�Q���._.�� ����v� ...�....w.�..�, � 4���a�tARiR�C�IV�,�tliami Sh�r�s,FC 3313� 11320601`T00�0 Cor�tacts ,..�.�.�,.�__._.� �_��,�E.w�._�.�.�k� ������� �� ����n���.���.�������� _�,�,��.,��.e��m.� ��.a����«��,�en,�m_�.,�.�a�� � PATRICK Tf?C?M�Y Qwner SWYTER Cf�NSTRUCTIt�N �or�trae$or � �38 GRAND CQR1C,Miami Shores,Fl 33138 GREG Al E EN SIUYTER ; 237 NE 1Q2 ST,MIAMI SHORES, FL 33138 � � � Business:9703799730 sluyCercor�struetion@�mail.com s � �.�_���n��������_� �.����.e�.����.� ���.._.�.�.,� ���...�.�.a...�.,�..�..�.w��m, � = Ins eettor�Re uests � Descripti�n:KITCNEM1I RENC1VATfON.REPLACE ALL CABlNETS ; Valuation: $ 24,OQ0.00 � y � � �� � �,<, ; AN€�APP�(ARICES iN SAME L{�CATIONS ; � ���'����� � � Tot�l Sq Feet: 1$Q.Ot� � � � : ��" � Fees Amaunt Payments Date Paid Amt Paid Application Fee-Qther $SO.QO Tatal Fees $�37.2Ct CCF 514.40 Cheek#990 02/12f2Q22 $7�7.20 Certificte of Completion far Singie Fam $SO.QO Credit Card 12(31f 2020 and I�uplex $50.Q0 DBPR Fee $2Q.&4 Amount Due: $Q.pO DCA Fee $7.20 Education Surcharge $4.84 Permit Fee $67p.OQ Scanning Fee $22.QQ Technology Fee $1&,04 Tota!: $�37.20 � 11� Ct'� Far Insp�ctions, C�11 (305} 762-494�9 �r Log on at hfitps.lfbldg.miami�ha�re�village.��m6c�p/. �equests mu5t b� receiv�c� by 3pm for foll�wirtg day insp�cti�ns. NOTICE: In addition t� the requir�ment� of this permit, there may be ANCi 1'HEE2E MAY �E ADD[TIt}NAL. RER�fIITS R�QUtR�� FRQIN OTHER additianal restrictions applicable to this property that may be found in the {aQVE�IV@AEtdTAt�ENTITIES�UGH AS WATER MAN,���MENT�ISTRIGTS, public r�cords of this ec�ur�ty, ST'ATE I�GEP�CIEB,t?R F�D��AL AG�NCIES. F�brsaary 22,2021 Pag�1+�f 2 s �Y q ���.d�..�.�,.J.��`��a��.,,� A E fi 4 � C � ��'°`�' � i � ?,a.',3,.' � � e � ��� { � � � � �;�� �e, � 4 �.m... a 1 5�h�,E.2r�cE�u�n�ae,�i�mi SF�eares,F��ric3�3323& � ���.{��s}�s�-�z��F��:(�o�}�s����z �r�s����rr����������E��r����.q������zA��� �� F � 2� � � 1 � �st�r��rrr�it tv�. `'�. h � �`� �� " � � 1 1 s�b��r i��v�. �r������ � ���c-rR�� � �c�ca�E�� � R�v�s�ea� � �x-r�r�s€ca� �R���w�� ��ur��F�� � �nEc���E��� ������cvvc���� ������ �� �����L�-r�ca� � s�c�� co���t�c�rc�� ���v����s ��a�����ss: � �l"�� �c� �fS � Cit : i r�i S r�s �a�a�� : �r1i��ni(�ade i ; � � F�lica�'P�r��a��c ��'0'������,�„�' ��_�� C�th���ait�fr��FI�sCese�i���}���sigr►�t��>Y�s NC} � Oc�up�ncy �ype' P,aP"� c�ad: Cc�ns�ruction Type ,,,�Ficrcad Z�n�: _�FE: FFE: �����.��m�{���s��„����rtt��n�i���-}: , �c�`� �'� �����#: � � � Addr�ss: � a City: t � St�t�: Zip: T�n��tJG�ss��N�me: Fhe�ne�: Em�il: ��a�r���-��:c��,���,�r���,�: .� �. ��,��,�#; � ? � � Aadr�ss: � � City: �� S��te: Zip: Qu�li�i�r Rame: C `^� � h� Phar�e#: ��,� St�t�C�rtefic�tie��or R��istrati��#: � C�rtEfica�e€�f�srv�p�t��cy#: �ESEC�I�E�:Arehi��ctf En�ir�e�e: Phcar�e#: �iddress; City: Stafie: Zip: ��1��caf�t�r�f�r fi�t€�P��r�it:� ,,�.T�Sc�s��r�/E,1ra��r Fc��t���sf l��rk: "T �y��f�f�rk; � Additis�r� �tl��rati�n � �1ew Rep�ir/Repl�ce ��rnolitia€� l��s��ri�t3��a�f Wot�: i�� ( �� �� � �- � ,;: 5����fy��������`��1�r°��rr� ��1�. .����,� �. s�����c������ � , �,' � ������� � ���� � �..� ,�; �x c������: � S+c�nr�ir��F��$ F��dc�r�F��� ��F�it� ��#�ry� T'��hra�1���F��$ Fr�i��e�gf Ed�s��ti�r►F��$ �a�l�F��� Stru�t�a�°�1��vi���$ �r��$ 'T�'fia�E.FEE AE�Vl1 D�EJ�� -���.,��. . � „� ���V���dozf2a/zox4� � 4 t �ondin��c�mp�r�y's Edar�t�(if�pplicable) ��r��in��camp�r�y's Address — �ft�+ _S4at� Zip ��rC��g�G�nd�r's�l�r��(if applic�bl�} M�rt����L�nd�r's Addr�ss Clty St�te Zip A�(��tC��ICkYt IS�t@F@�Sy tT1�{�2 C9��?��ltl l �7�FCT14��C� t����1@ 1NQf���IC� 'tP1S�e3����EQflS c3S IPIi�ICc�$�C�. � G�'f'�1���1�� f�G?lAf�i�C f71°It1S$3�f3�IUt1 �4�5 cc�rnm�nced pricar tc� �h� issuanc� �� a permit and �hat �{I w�rk �vill b� p�rfc�rr��d to m��t the st�r�d�rds csf al! lav�s r��uE�tin� ccanstru�ti�n in fihis jurisciictl�n. ( und�rst�nd th�t a s�p�rat� p�r�it must b� secur�d foe ECECTRlC, Pl�U�Eiltdf�, SIf�RSS, FQC�LS, FURN�CES,�OII.ERS,F�EATERS,T�IVKS,,0.IR C�t4DfTl�NERS, ETC..... OV��IER°S�FFE�AV13: I c�rii�y that a(I tP�e foreg�irrg ir�€carrz�ation is �ecurate �nd that a!! w�rk will b� de�n� in c�rrrplianc� wrP�h all applic�b[e ia�nrs r��ulatin�constructior�and zr�nin�. ra ' � � � � � ��. � 'T � ��� � � � � � � � �� �� � � �� ��� � � � � � e �� � � �� I ! � f"'i . iwE d � ���E IT � � �. � �T . �� � iw. i � . �d . �� i�Sa� � 6a . C. 4a� � !.dt �t�a�i�e£ca,4�rplTc�n�; As�craradiE�t'€�n t�th�issurar+ee crf cr bt�ifding�aerrrtlt wit}a ae��st�rrrest�d vr�tca��x�e�dirrg�2SC3C3� the applicar�t�raust �arcrarstse in geaod fcar't�� tfiat�z ce��ry of�`h�not�c�c�f�e�rr�rr�encern�nt�nd cara.structr`�ra lien Ic�w b��ch�rre �tal!!b�deliv�rer�tea th���rscan Yd�tt?SG pCiJJ?�Y�y 7S StJ�FJ�G�fft CF4tfSC}PtT3�Pt�. ,4lSA, C7 C�Y�tft�C{G0�?y 4J`E�3�f�CtJt`��e�P7��'fC�Of CQFYdPfi?EPfC�Pt?EYk�tT1U.5��?��dC1St�'C/t7�C�Y�Jf1�k St�B fe�r the �ie-st insp�ct{c�n +�rhich occt�rs seuera (7) dcays �ft�r the kauilditag �rerrrait �s issu�d. Ira the abs�nc� c�f stactt �€asted rttaft��; gf�� Jnsp�cti�an �il!not be capprov�d and a r�ins�a�cPion fe��nril(b�cd�arg�d. � �? � NpA�� ��,. Ch � �;. gF' � . <..,.. � '4� .�r .��' ,P`�!��^� �� 3 � �.. 2�� � � ���' e'�� "' � g"�s�• Sigr��ture �"a� � � °<�� , �i�nat�ar� �� � t'�iht{��R or,4GENT � `�Ct'�M1ITRACTC)R Th�fear�$c�ing instrument ur�s�cknow9�dged b�for�me�his 1"t�e f�r�g�ing irrstrumen��as aekn�wledg�d before me this °� .�� .. .�e °'t t `� ���d�y Of �`�."��,� �L.��g„,��,,�..:20 ��,.._= by � ..,,�, r,``��y 6f � �` �f".�.�'����''�� �.2C3 E.�>� b�d ` � � �` �..� . � � �.� �_ ��:�� t, � � � ��t��'`���'� wnc��i �r�rs�analEy kr�o�n ts� ��� �'� � �,��-„"'� �-����,v�+hc��s ers�nail�k�rae��tc� �.�....n� �� � �� �.._ me�r udh�has produc�d "�"� as m��r wr�i� has prod�eed ' � �s ide�tifieation and who did tak�an��th, iden��ficatian and wh�did t�k�an oath. (��T°,��Y P11�l.6G: RI�T'��'f Pt1�LIG: �� ..�n� � � � � �� �� ������ Si �n: k ,r�_�... Si n: ` � � �`" .�.� � � � Print: �� �' N���� " .A .� ,,.. T �m. �.�. .., r� ..�. `". � Print: �-� t �-`��`��� ' �"�_` � Seal: ,���'�''"`�;°: �i.�R1�,�.R�E�UE2 Se�l; �r�„*,,�,# C�S�AA, `F2t��f� , p�# biY C�AdISS1C�!�h�t�S�232 � ,w h#�t�t�#s����!'�d��'�32 `° S �Ia � �.� �` IP�S: �Om 2A2� "�*�'���"<�$a ±."�a ��A � o��;, ����*�� ����������xr�»�����*���� ���������������������r� �� � ������� �PPRC7�ED�Y ~''. � � Rl�ns Exarv�iner �oni�� Structural R�view Clerk {Re�;sedaaf z�t2o��a) . - n► ., � • � ��� , }� ;,�� � ��ti �� �� �� �� •M" f � • `l� :�� \'cti,�� \ n�l � ���a �iS� e,�'�'' __ `'.i '�i��. >��� 3��� � �z� ���'`, � • i ���1 �r �� � a�s� 'k1'���'. i � S� � y`��� \� � � a� '1` �� - i�z��'ti 3�\\ ���'� .,.� -E � � F�, �„� ,�� 4 2� v , . ., � �� � �'i � �g � �� �; � � , '�.s r a •�♦ `� � � °`� ' � � � �,. ��. ��. � � � ��� �� � �'. ` ���`�� � ��.�' ��� � �� V���� �t. f� : , 1 tl� � � �'�Y �1 � ���} � S � � 1 t � , �Si � ���s � � 3���� � t � � � � � i ?��i p � 1� � ��'s"i 4 � fi��s .`���,� � �,K*� �t � r �� �yl`�;.��� � ��`;�a �'`�, � �� .� . � � ��y§�`�� � - Z i; o�` ��� t.. �. . d � . ara � ' � :`; �z. .�., 1 i 4� � � `� � . * � � � ' � �� "� , « �� _� . �� � � �1`1 `� i r��` �1 � � + 1! 11i � � � z���1s� � �'s� ��.. � � � �ti at\l`�;` �� �. �' � v�.1� 1 � �i i � a � �i �; '1 � `ky, �� S q � i > l ��� 2�Z".+3 .� ,u": .: l� � �t '��,�' :,l ���,��t�� � �� ��� ��� � �\��� � A ��"� �? � .. ���';�.4 S � �.""` f�� 1 'Y�`��\ S2�s,`�1.`� *s � '�`�,i' '�� �l�'�.t� ���' `�casl.�t,� a'���. .`� t � ti�\ �� '� g��� "� � 4 � � �� � ��ca`,��� ;�, ZSCv'�n`u���'� t�,.ta �";.A�\�t�����..i� � � '�, `� � � �``x htS tt �� � � � � �� � � ��� ��� � � L � � t ,� �� � � $ w,,� ry y ... . 3 � i�� ��, ii {i,.�,\� � ��'a��` .i '� l� � �Z'. 4� ��j�`�'1 fi �' � `�: ,.��.�,�:.%}�.�:: .,.�,��".�ai� `` �. ..g,�,.ta�.t., «ta.�."`�33��.� + • . � i .s�� •.. :��: ,� � , , :'� � . . y rr • • i 1 ! . s s ♦ � ; . r 1 1� • 1 ♦ • � . •* � * �x «r. � + �i i 1� 1 i� s � � i .+ I t «.: „ ,.+ � * 1 � 1 _� . ,� a. � �.; «.+ • . ' •' • 1! 1 i 1 ' �« � 1• i� , . � � , . », � ,� :r ' w� •��. .♦.;��. • - a - w 1� i : iM ' . , � � � � . . '..� . r� . . �ri � r M� . .. ; . . �� � ���� .� ��� - ��- � - + . . . , . . .. .� . ., , . __. � ••: . �� * � . .. �- . . i :. .-.... ��• 1 � �". � '� � ,.. " • . � ' . : ` � �.. �� f. � : t• • ! � �a. � .. . . � � �� •' � M . . i � •• i tii i i I '�a • • • « + '� • • � Prc�perty �earch App�ieatiox� - Mia�ni-I��de Cc��znt}r P��e � o�� .�� , � htt�s:/l��=w.mi�n�id�de.�;c�vlAppslP�/prop�l`ty searclll 12I�1/202t} 4 ° C�r�� Sl�ayt�r, C�wn�r ca�s����i����i. �.�c. _ 97Q-379-973Q SI�y��r�c�n�tr�etie�nC�.c�rrs�il.�c�m I��t�: �-����'`�� � st�t� of � �C>✓`��� C��ar��y �f � -�• � � � � � � �efc�re m�th�s d��per°sc���ll��pp�ared �� � '�� ����'����` hoR b�ir��dui�r��vc��n, ,., � d�p�as�s�r�d�ay��: �. Th�t�� c� sh� wi��be the o�1y perstar� �nrc�r�in��r� th� prc�j�ct Ioc�t�d �t. �� � �" �.,� ��- � � �':� � � � � �ca�t�°actc�r Si�n��ur� � � S �rn to or���'irm�d� �rad ��abs�r°ib�d ��f�ar� �this ! � d�y c��� ��r�' �`�.. 20�� .by ��.�..`�.; ��.�..0 `�=m.�'`__. �'�rscaz��lly�nt�� �r Fr�c�d�e�d �dez�ti�ca�ie�� 'Typ� caf Identific�tic�� P�°e�du��d *,����:�Fi s�����i,u �.� , :�: :�_ ��e���a�s�s����z��1� _.� :Qr� ���s:s��� �,��� '°°�;������;. � Prin Typ� csr St�rnp i�� e c�f Nca�ary Llcen.s�c��r�c�Irr�ur�d 4 �MIF^���L� � � iami har�s illage ..�. s��.�� u1��IC1� �G����'1�11� �� �ao�o N.�.��,a ave��e � ��tJ�R�tT>�'' � Miami Shar�s, Fl�rid� 3313� -r��: �sa�} ���.��o� ���: ��o�� ��s.��7� N+�fiice t0 wner — orker�' �om �nsation In�urance E�een� t�or� t:.��,.�,. .: �,�- ,s�i.ti..`.,w, .. �...y},.i. }, �,3, � > .r i' �i�":.£i� 'c ` .,'.:c';,:�,� ' ,,,a`, .�.1`�..'.t. `\'� .��" >.\"�:\.., 2 �t� ""i�rl.�> .�. >.`.. >,Y; �.+,.. ,'ds,�,.�tZ t„`��,.�: 3 ;. � �,�:'1�.,� .. �>� . , 1,:. ;z>'��, . � . �S.�i3� � t:S;.�. t�3;;a� .�.:',. e.�����;�,�.,i�,�;.ist��,,;�..1 \,�,t�f�1. �`,�. �„�*..� t�»�rr,. ,i,�`�,�. »\. , ,\,��,`, ��.,Ral �� .,��.... z ,� 3ti�',-. �. -.�� w.. . �'-��.tE�.`�'{2��. ..i � \ ,1..., �.,. y.1:v�?r �, ���.., }1 lt�;�t . . �.�,�,1 i 1.�:.., Z�..,.�.t..� ,.�yti17i.�t�`.�,�:ti, `. �z\�z���`', ?.fi`.,�,`���`Zl ��'��,�.`\r��.S4,\j��.��t�..$.�3��`,,�'ll �`�Z`�"�`�,i,�. ��',1���`+�`�.�„�..�,.\,�„�`,��,i.l?�a�R���„�T�,'1i.�.,.1.,`,��`�.� „`,;,`?.�1�5�.�`��,�,`���..���"c�;��,�`��.t�t,��>4Ls `�,`,�\:�.��f��`\�;:,�...t�.. .l.�ts., � Florida La�u r�qt�ires ��v=orkers �`c�mpcnsation insurance c��•erage uncler Cilapter �4Q af thc Florida Stattates. F[a. �tat. � 4�O.OS allows cc�rpar�te afficers it�the cat�struction industry to exe���pt thers�selves fz•om this requireinent fc�r a�1y cc�nstruction project prior ta Q1�taining a buiidin�permit. Pursuar��to the Florida Divisiot�af V4'orkers'Cc�inpensatio��Employ=er Facts�3rc�chure: An en�player il� the constructic��l industry ��=11c� empJoys one or ��ia3•e �a�t-�ime or full-time � en�playees, inclt�ding the a�hner,�nust o�tain�orkers' compensation co�•era�;e. (;or•porate officers or �netnbers Qf a limited li�br`lit��� catnpany (LLC) it� the canstructian i��d�stry mav eleet tc� be exe���p�if: l. TI��afficer owns at 1�ast I 0 ��ercent af the stock af tl�e carporation. aF• in tl�e case af an I.LC,a staten�eitt attestir��to tl�e tnir�ilnu�it 10 pe�•e�nE o�us�ership; � 2. Tl�e offieer zs listecf as an offieer of the corpc�ration in tl�e reccards of tlxe Flarida � Depart�nent af State9 Div�isior�of Corparatians;and 3. �Ihe corpQratian is re�ister�d and Iisted as acti��e witl� the Florida Depart»�ent of State,Division af�or�Qratio��s. NQ more than tl�ree corpt�r�te c�fficers per corporation or lin�ited liability cotnpany� fnembers a��e � allo�ed to t�e exempt. Canstructian exemptia��s are valid far a periad of twc� yeai-s or c���til � �=c�lt�ntary revacation is�led or tl�e exensptio��is re��aked bv the Llivision. � Your cQr�tractor is rec�uestin�a�er�i��it under this��c�rkers'cc�mpensation��e�i�ptiol�and has ackno���led�e that I�e c�r sl�e th�ili not��se ' j day° lab�r,part-time�mployees�r subcantraetors fc�r your projeet.The c-antractor l�as pro�°id�d an affrdati=it st�tin�that l�e or she�vill 1 be the o��1��persor�allo�ued to�rork an your pr�jeet, In these circE��nstances,��1ian�i Shc�r�s��illag�c�aes rlot req«ire verification c�f � t��orkers'con�p�r�sation i�lsarance covera�e frc����th�cor�tractor's cornpa�l�t for day`labar,part-tii�ie emplQyees or su�contractors= Sl' SI�?�I?v� F3ELC)W` Yt�L .�C`K'tiQ��'LEDGE `TH�T Yt�� I-lA�'E: REtli� TIIIS i\07ICE A�I� L"�L�ERST;-1�D ITS ; � C(��1TENTS. � �� �.� q �_V� �� ` � �� .� � Sl�t}ATUP�: ( � --� C�W'itCC � ( State of Flc�ricla C`aunty ofMiami-Dad� i The fore�oin��as ackf�owledge befare n�e this_ � da}�c�f ' � ?0 ' � ��,_ — . I �~ ' B}_�� � �3 w�}Zo is persor�ally� kno���n to me ar has�rc�duced �. � _ as ic�entification. .��� � Natary:_ _ .<�Y� �SE�DA j ——_ �� �',: MY�CJAR�i1SSIQN#�971705 SE�L: =��;, �'Q`.� EaCPiRES: ctr 22,2024 ''�'�o��y"•' P6a l! 'ta�ts <.: �a 4\� ,..`s � �l�,} yt��t{�ctS� ��e� �t�it,`�''l�'t�������`}'i§�l?}`���'"�h�'1`�, '}�\\ �u�,��c� a �g � .. ` �,� � i i L�i �����3� ��� �.�� � * t i S � � � �� � � � \ t 'e' r ����� t 1�; l '� ���� t : �.1 � 1 � � ��s � � � � � �� . „ ti 1 ti �s i 1�� ? U`�a Ar sl s��, ,+ � �' � t � � 1 � � v i \4 } �Y`z'� t U v V ... ti � � ti \1 � .Ai ��..� 1\�;� h g c � .��� 1 *? . � : t t `` "� t.A ������.,. � x�.' �� �' :>`�i\r�\\\,"`"Z 1 `�t���i�V`���'�'��S l?,,lii.,���'���'�1#�\+"�1����,� �� � �. � ti�� ����� � ..: ,�a. .:;'... �<�..",.. ....�..�,... 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