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CHANGE OF CONTRACTOR (4) 1,��..���t�`.... `.`„1��.��;a�4��5 `z�a+��it�eSst�,lg.`",�`�� �.,�,,�k,,,�. U�..� � � � ���\� �n�§��. `� fi;. `�s�b�<c�Z� \� i�t��'� �t�> 'i� ` ot?t.tt"�`, �� \ �������5����`�����>3��.�?�.j���c���3 i�s�\����'��.a���\��� l,�t 's���, ,:���`,.Z'`� '� c,�`�.o.,���.�.� ,�,�`�t`�„�`�.t��:�,�,�,1�`a'��*. i��is\��'������;,�'�y��. . a. � C��E� ��,��s�������������c���3���;�,\��������\�t��ti 4���������� . �� �.� �' ��� a��l����?�ij;����t���1�`����1<r; l n�k f�t�.�Z�Sti�s�r�;���� ����t'l� �� �: u `��; t . )4�k. +�"�''' �`'�a�" I�tt"1i Sr�tOC�S VlII� � �l �� ����������'�',��Z���?�i��������a �����tsn���`��'�•��t\, ��a �� �.�,"����s;��h 1 4��. � � 1� q ,?z� �� � �� � �����}S�� ,�5�i���i�� � � � 3 �: � 3 � � j � �', 10050 hIE 2 AVe , 1. ° �` \� ��\ ��� �ii ���z2�����04 k��'� �'�:� ,`�°`�1�'�����'����}��v�`����'� ' ��� `���4 ` � \ � :;� ���1�� ���\�� �� �' Z � ���������`t����. ��� ��: �� f�✓tiami Shores FL 3313& �� h `a��� � � ���, 3, ,3s� 1� Z� ��ti1���f�����ic`��� � x�����`��'�t� `1�}`��`�t\�� �.��'`� ��`l i��i�`�� �,�`t�`,���\,��1�.i'Zc:.�� sx��, 3����1 ti`���;'�,��t\lx��� ��""a`^i?,� w 3d5-795-22Q4 �����;�������}��``�,Zr�tt��ti�������`��`�'��,���F�������lt�������,��s,1 .��3��r ; 3 ���,� ",;�U� ~�� ��5,�'��4`�����?��: `�i�ti�,.� ������;������\a������t�<�����\ ; "�;t<�Eri s ',� `�� ���c�.�\�`�1 �4L�o�i����s�i ���3`fi�{�`i�, '\`� �,�� ���y�7�� , ` , ? r pt�C9� �`�}`1i�i?�� �`�i�SlS���\�.�.��a a ��\1 i�.: �ti�� ���oti �tt��:,,���s;�,���`\.\ti�i`,.t�,.�.,"����.u,s.?�,���,:`�c.r:.m�?.`h�..a�„s, �@��*��� 4,�t��,��1����iZ��������v����t������c� �z�`��i�oa�zt '.�' l�2'��z��`�1`�4;����lti���� � � ,.� �Zt m.�� �3,y?y x � � ' �XprlC�tlOtt: Q�f������� e�,,ti,l ��,����;,t,����.. �� ., ,,� ���S} ;.1 U 1� 1 C1 � � Cl'� Q � In cansideration of th� issuane� tc� me �f fhis permit, 1 agree t� perform tt�e w�rk covered hereunder in complianc�with aIl ardinances and regulations pertaining th�reto and in striet c�nformity with the plans, drawir�g�, statement� �r �pecifications submitt�d to th� proper authoeiti�s of Miami Shares Village. In acc�ptinq this permit I assume ee�pansibility for a!1 work dane by either mys�lf, my agent, servants, or�mployes. f understand that separat� permits are r�quir�d for ELEGTRIGAL, PLUNi�ING,NIEGHARtiC,�L,WINDCIWS, DOC�F2S, RO�FINC�and SWiN1M11NG Pt�t�L w�rk. �WNERS AFFIDAIfIT: I eertify t�tat all the foeegQing infcrrmafi�n is accueate and that a!1 work wilP be don� in campliance wifh �IC applic�bl� Iaws regulating constru�tion�nei zoning_ �uthermore, 1 authsrize the above n�rrr�d contractor to da the w�rk stated. .�-------- .�°"^�' Ruthorized Signature:C?wner I Applicant t Contractrar 1 Agent Date M�rch 0&,2019 Page 4 af 4 � , � �:����� �:� I 1 1�� � � � �� �w��� I I � �� t� .�.F�.�� .�,.,....x. � � 1QQ50 N.E.2r�d�uenue, t�fliami Shares, Florida 3313� "" ��w: (�os��s�-2z�n F��,(3�s} a��-���2 ��sPE��E���f�E�a����������:��o�}Tsz����� ����� � �� m.,� � � � � � �st�r P�rrr�it fV�. ���' ��'~ �-� -� �.� ������ �������1���� Sub P��rrao� fVea. ��u������ � ���c-r�ic � R�c���n�� � R�v�s�o� � �x-rE�sic�� �����wa� ���u����� � �Ec����c�l ❑�u���e�rcaR�ts c�a��� �F � c��c����-r�ory � s�ac�� �ONTft��TC�R C�RAWf�6t�S 1CtB A�DFtESS: �� � {�'��"� ���� � C City� IVfiarr�i Shar�s Counev� Miar�i [Jade Zip• � � � ,�� �� � Fealio�Pareel#: ts th�6uilding t�ist�ric�lly[?esi�rs�t�ti:Yes NQ {�ecupancy Type: laad. Construetior�Type: Flaod Zan�: �FE: FFE. .. � - C1l�fP�E�: Name(F��SimpleTi�lehQlder): ���"�'� � �,� I �.�.�� "�� Phonet#: � � ����;� �� ,1��;= � ���:- ����_ � �� � _ : � �d����s: �..y � ���� c� . � �a � � r � _ �� �t.� City: e ��`1 :� State: � Zip:� � � � _ � Tenar�tJLessee Name: Phor�e#: E �. a �.� —n.._, E��a�l; ��' % � � � �� �:�-�' '�'� F �,' � �t3�ITft��T��e CQmpany(��rne: �" �`�k.�`' � � `"� �� � f,. . �_ �.,, ._. ,.4.-�`"°2. ���� �'� "��—��_1 � ��'�� ��� y � � Address: i..) G�,; "��� '~ �`� �'�: City:�—�� /� �-� � f� St�te: � ZiP� � =� � � ��� .�._ Qualifier�ame: � ( �-�c � � ���� ; t� � �_ Phone#�:_�����`��,��i�� State Certifica�ian or Registratio��#: gT? C� Certificate af Competency#: i?�SO�IVER;Architeet/Eng€neer: Phone#: Address: City: Stat�: Zip: �9�1u��f W�rk for this Perenit:$ Squaref L'ene�r Fo�tag��f i�ic�r�e Type af tlVark: ❑ .0.ddiCion ❑ Alteration ❑ New Repa�rJReplace ❑ Demoli�ian C3es�riptior�e�f U�csrk: � � ���.. � �� ���� A --�, ,��a�cifje c����r c�f�c�lor thr°u �ilee 5t�bmitta6 F�e� P�rmit Fee$ CCF$ � C�j��� Scar�nira�Fe�$ �aden�ee$ ��PR$ PVotary$ Te�he�ol�gy F�e$ Tr�i�a6r��f Edtacat6c�n Fee$ Daubl�Fee$ Str�ctur�l Revievas� ��nd$ TCSTAC F�E NC}4�t C�tSE$� �- � � �- (�e4�s�aoz�z4/z�sa} , , � Bonding�ompany`s Name(if applicable} _ �onding Car�pany's Address _ City Stat� Zip �elarEgage Lender's N���e(if ap�a}icable} Mort�age �ender's Address �i�y S�ate Zip �pplication is hereby made te� obtair� a perm€t to dQ the wtark and installations as ir�dicated. 1 certify that no worK or inst�lla�ion has c€�mmenced prior to �k�e issuance of a permi� ar�d that a�l wc�rk will be perforr�ted to meet the standards of alf laws regulating construction in this jurisdictio��. I understand that a s�parate permit must be secured for E�ECTRIC, PLU(ViBIt�G, S!G{�S, POQIS, FURNACES, BC}IIERS, NEATERS,Tt�NKS,�ER Gt?N(?ITIt��ERS, ETC..... E?WNER'S AFF��A�tl�': I certify that a!I the foregaing infarmation is accurate and that all work wi!( be dane in compliar�ce with all applicabfe laws regul�ting construetion and zoning. " AR 1 G T t� E o `f UR FAI�t! E T E� A tVQTIGE F C E CE E T �0.Y EStJLT 1 l� R P�YI T iCE F � P 4'E EI�TS 1` 1( U PR PE� � IF Y U � 1`E � T TA([V FI A CI G, C NSULT tTkt �Qt�� �E ER R A(� A R EY EF E RE�� I Y tJ� TICE F C E GE E T4►' NoClce to App�ieant.• As a condii�iar�te�fhe issuar�ce of a building permit with an estimated value exceeding.$2SQQ, the appficant must promrse in good farth Yh�t a copy af the natice af commer�eemenP and construetltan lien laau brochure will be delivered tQ the perse�n whe�se procaerty is sub�ect t�a�at��ehmenc. Rtso, a eertified copy c�f the recor�ed nc�cice of cc�mmencernent must be pc�ste�at the jc�b site �or the fiest inspeeiion,avhi��" occurs seven (7) citrys after the building permif is is�ued. In the absenee of sueh posfed nc�ticet the inspec�ian wi{1 n�c bex�epR�'oved and a relr�spection fee witl be eharged. � � �, >° �. �5����, 1 ' � ,.�i � -.°.a..�� . ,�.�,. Signa�ure °' �'"� = Signature______�� � t..�.�----���7I�' R�r fiGER1T��� � � CQNTRACTCIR The foregoing instrument w�s acknowledged b�far�me�his Th�foregoin�instrument was acknawledged beforc me this '`� day of r... �� , �� � , bY �� day of�da,�'`,r'�"t-.`'� '.��`�`��1�a� , 2Q �.'� by F��� � i�,d���,�.��. �" ,who is persor�ally knawn to ' � �s'-; L.��- ,who is personaliy kr�own to . � - � r��e c�r w�ha has produced as me or who has produced r�'� ��,�t%'--��°� �`��vp r,l�:� as identifieation ar�d who did take an oath, identificatian and who did take an o�th. N�TARY PUBI.I�: N��'A�Y Pk�BL�C:=���' `,� 1 �� t� � � t � � �..... Sign: � F� Sign:_ � r� �7 . { �t _. � P�_�._ ��;�� _ `��C� � �' Print: _ ._ _ _. �� ,� ���L�t t7�"��i'�. , � .� ` t,�, �,� ;:�, Seal: Seal; ' � � `, �+�up�k�����C�i�����o5�a ';� � �`$�?Y�,�?tS,�'���;�v�C>+"uu��� � * E,X�,� � +�a��t? �'�i � �; EkP;� 5 P4��� 2���i � �.a'` ev�'�a�u !?v+�t�3ty ', u«���� G�n��"h�4� ' i.' Gi3a`4� ��'.+ �����x*x����m�����m�m������:*�x:�m� m� �ra �*��*����*�*�*���x������**�mma�*:�z�*����*��w�������**��*���t���ra*����*�����w � � APPRC}VED BV � � � � Plans Examiner Zoning Struc��ral Review C[erk {RevisedQ2J24f2014} `�, t ��e s � ���ss�'�* � ����'� 1� t h�l"�S 1��� � ��x� ���� e —. �. �� � � : �� +�',������ I(�t35f� N,E.2nd Av�nu� f�iiar�i Sh�r�s> Fi�r�da 3313� "T�1: (3�5} 795.22�4 F : (345) 756.�972 1 1 �r� it �,`� � ��� ���� t,�wr�er's Nam� (F� � Simpl�T�tl�1°�lolder}:Victc�ria y C�milc�Vi11�g�s Rf�on�#�: C�wn�*r's Addr��s: 1270 NE 97>treet �€ty, Mi�mi Shor�s Sta�� : Florid� �ip G�d�;3313� ��b Addr�ss {C�f vvher�w�rk is b�in,�dcarre): 127Q N�97 Stre�t Cit�y: i� i ��t�res St�t�.�Flc�r�d� �ip �od�:331�� ��nt ct�r's Ccarr�pany P*E�m�: ��dern [���ign �li�mi Phc�ne#a 7862�1476& Addr�ss, �596 NW 72 Au� City: (��dley SLat�:Fl�ricl� �ip ��d�=331�f> C�ua4ifier's Nam� : Jo���C�cyu�la �ie. P�4umb�r: GfaG't5�583t Ar�l�Et��t! E��ir� r�f���or�d t��m�: PF��n�#�4 �4ddr��ss: �ity: St.�t�: �ip Ccad�� ����i�� ��ka t` � � �1 � � � t" �'1 �Qft^ � � �C E"� t"� i� �� Es un�bl�e �r� un in� tc� ccampl��� t�� c�r�tr�,��. 1 hcald �h� �ui�dir�� t3�ei�1 �r�d th+� y,�� � � �� �e, �.� i i or�s ar les� �f�11 I� rnv�lv� � .�;f� .� i nat�r� ` Si�r�atu�� �' �"`�� �? er or c�,,.„�M-~�""" �r Arcniceectt Th�f�r���a6n�instru '�as aknc��l�d��d b�f�re me The fc�r ii u w�s�knowledg�d befc�r� me this�d�r c�f ��"a`�`� ,20�'�',bY ._.�_.._ this � day of .����Z���,'Z,� 20��by k, Whca is p�rsonally lcnc�wr�tc� e c�r uvha has prc�duced wha is perssanaily known Qr v�ho h cadue�d as ir�dentifieation. a�indentifcati�n. c��� f'u�.�. 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L7FS-F2-C�WG-252�ERl"iFICFeT�OF EL��TEC?N T'C}��EX��fPT F��VISED 08-�3 f�UEST'fQNS7(B50}At3-16Q9 ���� °�� �� � �! h�r�� ill � ..�� �,'.'� � �uildir�g D�p�rtn���� °:�. nr� '" _ �����. �oc��o �.�.2�� �v���� �� ���' i�i�r�i �h�r��, �I�r�d� 3313� �`�i: (305) 795.2204 �'��: (3Q5} 756.�972 �� � C C ' �1 � �' �1 ��,.1:\£ ;<S•..s .l S`, :t 1....ti' t. .\: � .�� l ,.�F �F a, ,\ �,�� t .:.tt.z `.�:. � .<`�.�.., , '.5.� 1 t a-� ".�., t< �, 3 � .��� �\." ,u,t. a„� �.� � .V\ l>.l n. \, 2...'� i 1,�: .�.. L„� .�:`i� .,1 ��., t� s\`� �\ . il } �� `Sn' ""�i� 2�. ,'�, „�l. ,?.. '.��.� �`�' ,.� �', 1' }�.,. . ,��`, r.i..�. }. .,,i `.1. .. ti� .l .t�t� , l \.� � . .,.�. �"� \';;,. �„ \, t ..2 l � �\�> i.*,'.. �%,. . ) �l. � . .� ..� `., �. �, � .� .C;i �'l. . \,. l`5..�u . 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P�zrsuar�t to tl�e�=1Qr-icla Di��isi�r��f��v'orkers' f�c�Fnpensation Er�2plo���r Facts F3rochc��•e: � � � ,�r� �m�lc�}�er in tl�e canstru�tiar� indl��t1�}� v�=ha ea��plQys ane c�r n��re part-ti���e �r full-tin�e � erz����yees,in�[Ltdin��he o���n�r, must Qbtain ti�=or�:ers' c;<ar���eP�satic�n co��e�•a�e� Cc�rp�rate�fficers � c�r n�ernbers �f a Iii��ited li�bilitv� carripac�}� {L_LC} in elze cc�l�st��u�tion ss�clustr�r 1na�� elect to be � ��ernpt if: � � � I. T}�e officee ol+�t�� at least IQ perc�l�t c�f the:;t�ek af tl�� corporatic�f�, ar in tl�e case c�f � �n I.I,C,�staternent attestin�to th�minimc�n� 10 pet-ce��t c��v�s�ershi�; ; ( 2. T1�e c�fticer is Pisted as �n c�f'fi�er c�f t1�e eotporatic�r7 in the recorcis r�f tl�e Floric3a � C�e�artment of State,Divis���n of Cc�rpof-atia��s;and � 1 3. T}�e GQr�oratian is re�is�e��ed ���ci listed as a�ti�e u�iti� tl�� Fior•ida C?e�arime�lt af � � St�te. L)ivisic?n taf C'c�r���r�tic>r�s. I ( _ ?�� mcre th�n t]7r�e cae•por•�te affcers per� ce�i•�oration c�r li�nitec] lia�ility eQm�any ���en�bers are ' a[ic��vec� to �e ex�rri�st. �ons�rlac�ion �xcc����tians ar� valid fot• a ��eiod af tw=a ��ars �r urt�il � i ��ol�sntarv�revoc�tic�s�is filed o�•the ete�n��tion is revoke�!�y t}�e Di�zisio�2, � Your c�t�tr�etQr is r�questi��g� �ert��€t�nder this ti�����kers' c�z��}�er�sation e��n�ption aT�� has�ckna���l�d�.�e tl�at he or sh��=ill i�ot use � � day l�b�r,�art-time en2�aloyees c�r su�acontraetar�s for}°aur peaject.The cor�tr�ctor I1a��e•o��ided a�1 a�fidaGit stati��g that he or sl�r��ill j � E�e�i�e anl���ersor7 al}c�wed to�vc�rk an��aur prc?ject.lr�th�se cir�;u���star�c_�s,'�'Eia�ni Sl��aces�'iliag�does��Qt P-�c���i��e titerificatio��c�f ���arke�s"cot��pens�ei�r� inse�rae�c�ct�e�ra��fra���t}�e coi�tr�ctrar's co�n��n�•� for da}�i�t�c�r,part-1im�en��alc����es���suhe��z�tractors. � ( B1 SIC,'\[�� F��;IwC���% l"C)t_' �t�lti'tiQ��'LF;I�CrF T�3.�1 I't?t� F�.��� RE.1L? `Tl-1IS �t�'1,ICA[: ,��f� L"�I3ER�T,�?�I? 1T� ' i �Q\"T'E;�TS. i � � �.•� t1} � � _ � � - , ; � _-_.. ; . ,. . �_� - � ; Sl�natuPe: '; i `� ; _._ _ _ �:-�___.� .� � Oe�n�r � i � � j Stat�of F1Urida 1 ; i Coutiil c�f R1i�n3i4l�ade � ' ` �.�..-- �-� I The fore�c�i«g w<�s acki7oenrled�.r�l�efore r�1e tt�is_��_day'c�f� - ���-� ���" �E7��_' , � � � ��- � `� ������`��=-�''���`` �y � �Y��_� ,. `'��_��„. '�������~`�r������`� ...-''ti��o is�4rso�lalie ���c���r�tc�i��e<>r E�as producEcl , � . i � _� -� � �_�:�? �.��=����=.____ ��,������,����<>�,. � � 'tiat�r�': - -- � � ��— � ' i SE.�L: � SIP�'}I��.I�A�E� a,�,�., � `�°�'''���'�: �tl'CC3MAd1SSIt�N�GG 23II273 :�. #RE�,S� t�� 3.2Q2� � o-`a':����;�,�'p �d Ths�No Fu ' es Fl�ar�d� c�ildir�� C�r�s�. �r�c 19Q w 12 st.Apt 19 Fiialeah, FI-3341£? Gic No:CBC 125QSQS �ic IVc�:CPC 1457C}59 ...:� ,-� r���.�.=; [�ate: „��� ��� ��. ; St3te C}f: F!��'.��. County of: �����!��_ a�.,����,� c;�s Tt7 ,'� ��i.1���'� �efore n7e this day person�Cly appeared --_. � �d�,��J ` � who,kaeing duly sworn, D€�poses and says; Tnat he or sh�will be only persc�n�vaeking an t �r�ro�ect located at: / r{� � �h� �� � ��� � � � � �- Sv . :��(or Affirmed)�nd subseribed`pefc�re rn�ihis ��� cia of �'"� �'.� . '0 � ; Person�lly Know ' {�r Froduc�d Id�ntificatic�ri �-�, Type af ldentification Producec�� ;�,"'� t�~�' �-�.�-�_�=`��f' ,� � ; � q�;��+tl`P�'` Sii��t�4 A��tt�y � 4 :«� _�; d�Y C�d��1tSSt�td#��23�273 � '*' ,��;�.` E3fFlRE3:S� E�rrt 30 20 ? '�'������„ 9ar�de�TP��a P fl�e 22 ��`' � � #�rs r�.�� �,� ��rin�,Typ�or 5tamp Rl�erte of IVotary. f,t i r' ��� l�`���\h� \ � \'� �\ �`t�� � Z � �ZZ ` t� �. � ��tii zti\ \1�s ti�t� � �\���\ \ � t \�� y;����� '�`� ���� ��,�S��\\���� 1�.� �1�} �.� \ � ". s\�c �: t� � �.1 � �1 � ,✓�r"Ci�t�� �\j�y�l����at��� Z�C.��'``.�, ll ����£\� \\ ������l\� �� i ���� j"i` zaE�t" �^ip� �lst[!tI JfEQC@S 1/is�84,]@ �� \\ *; � �1� ���` ti `' 1\ , � , " � � 1� ,:i n 1 i� � � l �� � 10Q50 N.E.2nd Avenue NE t �� 1 t a� �� ' �\� � �� ,�� ` �l � � t���� t� � � �� � �, ��� � ���' : �metx�.� e�eea�.. t a���`�' � �'�� Y��S '�1t � �i ��� \\ \�� � l � l, l;, Miami Shares,FL 3313&OQ00 ti �3�Z`�� �� �l� >� �s��,� �, * `�,�� z �� z �� ',1� � � '�� ��..��ti�`f���{���li�\�iU�i�`�������S��l�1�t���j�',�}�� ����1 2 \ �,: . ��F �1.>� 1::� � M���^'x'm�sv+�� �f10Ci�: fnJ�}CJ���rJ-2��� �\�:-i\f"�114t���.. i.lD��\��1�t�\�'\���\��� ���.1\�����\a 2,`.�-� s.ti......t`:��.,ci ,,..:,, `�...,<,�:..�.,�.,�...� ,. � .. �'C�k�'ll"�y�. � ����� �"�A\��i�\� �\'����y t�V�� �` .��� . ������\�� l��Z���� ZV� ���l��u i� � t �tt V\ � 1� �� � � ��� � ��'� �X�dICc��IOCI: � ������� \ll�����\ ��`� �..z ���0 �����\ �} � � �` a,�.,}\�,\, l �,\.�`til��\D 1,�, � �\ � �Z<<:��.,,.,, Peoject Address ��rcel Nur�ber AppEica�nt v.�n.�.w.�,.m.�.����_��R�,e�.�..�.,�v.��...,�sw�..�.�..��.n,��,r���.��n....�.��.�,�,,..�.,.�.,�m�x�,.��.,.��.�.m....�.u.� ... �.�.x,s.�..�_���,..�rn« , w. __.. �27� N� 97 �fire�t ��s2o�oo�o�sQ � C�0.MIE.Q�V{CTC�RlA VILL�GA�� ' IVli�mi �hc�r��, F1� 3313�-256Q ���c�c: �ot: kn��.� �������.�����,����,����;������������r���� 4wner Informatien Addres� Pfiane CeIE �,,M �.�_�....p�a.�..�������..,����.���.��,��>u�m..,�wm�w�,���.���.�=��.�e,4���.��.�..�,. av�. �.,� ��,,.w.,..w��.�..�... . LLe,w..,,..w C�MILCi�VICT'�RIA VILLECAS �27Q N�9?Str�et � MI�4MI SN�RES ��33'f38� � a�� �,�a � � a ����������� ������:�����������.����,:���,� �27�N�97�tr�et MIAMI SHORES FL 33138- ��n..���a�����.�._�._.��.��������,,,�.......�.�..��,..ti.��_.� Contractor(�} Phan� ��II Ph�ne � Valuation= � 32,543.�6 MQC?�RN C?Est�N MAIMI, cQRP {786}281-4766 (T�6}2$1-4766 „ _,,,. ,. � Total�q Fe�t: 3QQ ���.. � Appraved: in FZevl�w Availatal�Insp�ctians: Comments: Insp�cfie�n Type: D�te Approu�d: : In�eview Fill C�EIs�alumns �ate Denied: Final F'�Certificatian Type of Constructior�: INTERIOR REMOQE�.IfVG QF RESIC Oceupancy: Vt/indaw Daor Attachment Stories: Exterior; �raming Frant Setback: R�ar S�tback: Insulation ��ft Setback: Right Sefback: arywall Screw B�draems: �athroams: Window and C?oar�uek Plans Submifited:Yes G�rtificat�Sta4us: Revi�w Planning Cerfificat�Date: Addifiion�l lnfo: Revi�w Structural Review�I�ctric�l Bond R�t�arn; Glassific�ti�n: Resid�ntiai Review�i�ctrical Fee� �u� Amotant Pay Dat� Pa�r T�rp_e �mt Paid Amt Due Review E��etric�i Review�I�cfrical GCF $19.80 fi1VOIC�� ('��-2-1$-663?9 Change of Contractor Fes $11o.00 F2�view Pl�nning GO1CG Fee $54.00 0211 5/20 1 8 Cr�dit Card $ 110.00 �O.OQ R�ui�w Buiiding D�PR F�e ��4.6� l�evie4v�uilding DGA Fe� �14.65 (nvc��c�� i2�-6-16-60346 i�evi�w�uilding Edueatian Surcharge �6.60 06l27i2Q16 �r�dit Card $20Q40 $2,111.74 Revi�w�uilding Permit Fee �976.32 02/06t�617 Credit Card $ 1,911.74 $20Q.00 Review�uilding Preliminary Plan Review $200.00 Reuiew(�eGh�itiCa) Scanning Fae �,27.po 08105t2016 Credit Card � 'aQ.�Q $�.�� Review Mech�nicaE Technology Fee �26.4o FZ�view(�ectranicai Work withaut Permit Fee �s76.32 F2evi�w Plumbing Tc�tal: $2,421.74 In consideratic�n aP the i�suance Eo me o€ this permit, I agre� ta p�rfarm the work covered hereunder in campliance with alI ordinane�s and regulations p�rtaining th�r�to and in striet eonformity with the plans,drawings, statements car sp�eifications submitted to th�proper authori4i�s of Miami Shares Viliage. In aecepking this permit I assume responsibility far ali w�rk d�ne by either myseif, my agent, servants, or employes. I understand that separate permits are requieed for�LECTRICAL, P�UMBING, MECHANICAL,WIPIDQWS, �OO�S, ROOF(NG and SWIMMING POOL work. OV�INERS AFFIDA�d'f: I certify t f alI th �egoin � ormatie�n is aocueat� and that a(i work wili be done in compliance with aIl applicable (aws regulating cor�struction�nd zo ing. Futhe ore, I�ze t �bove-named�c�ntractor to do th�work sfated. x����_.�,��,�,�-- February 15, ZA18 �utheariz�d i�naEur • _.Applicant i Canfract�r / Agent Date 1� 1�1 ,. '� �( February 15, 201� "� �� � � � � IE11 � � t !1 � � �� �r, , � ��ildir�� G��p�r�r��r��t _ � � � ��� � � � � ��� �� � ���� 2�{}50 �I.E.2nd Av�r�u�, �iarni Shor�s, Flc�rid� 3313� � �r��:(���}����22�����:(���)�s�A���2 ��s��c�r�t�� �t�E����E�u��E�:{�o���s2w��� � �st�r P�r�i� �. � � S�b P�rrr�it �. �������� �����r�E� ��a�a���� R�v�s��� � ��cr��s�ca� ���r��v�r�� R��r����� � n��c����c�� �����c we�R�s cr����E �� ���c�c.��€c�� � s��� c���€��c�o� ����i��s ��������ss. 1 � ��t : Miarni Sh�are� ��urrt : A�li�mi Dad� Zi : � F�I��JParc�l�. Is th��a��ld�r�g 6�ist�ri��[ly��s��r��t�d;Y�� NC� �ccupancy Typ�: l.o�d: �e�r�stru�ti�n Type: Fl��d Zon�: �FE: FFE: 9JVNI�E�: �1arr�e(F��Sirnpl�Titl�h�ld�r�: ' .'� � C k� � � �� Ph��n��#: .�ddr�ss: ����� � ci�y: t ��ate: t"'�P��f7 zip: ��'� ...�.,.�.�.�. T�n�ntjE��ss�e(��m�: Ft�on�#; Er°n�il: CC?�7' �1'��e�orr�p�ny��rr��;_ � � �� � Fh�n�#. � � � �ddr�ss: 1 `ity: �� t Sfia�e: c t ��p; "� Qualifi�r�I�m�: t.�. �� �. Pl�e�n�#: �.�. St�f���r�ific�tic�n car Re�is�ration�; � ��r�ifica��of�crrnp�t�r��y#: �ESl��E�:Architect/Er��in��r� Phc�n�#: J�ddress: �ity� St���: Zip: ��lue of Vit�rk F�r th°s��errni�;$ Sq�ar�Jlin��r Fo�t���aaf ttdl�rk. Typ���1hi�rk. �dditi�n � Al��r�tic�n ❑ (V�uv R�p�ir/R�pl�c� � (��m�litic�ra ��scrEpti�►a�f l�f€�rk: ��� � I � �� � c� ���� �� �'���; � � S�abrr�itt�1 F��$ P�rr�i�F��$ CCF� ? C��CC� S��rartin�F��� ��d�n F��� E���it$ �I�t�ry� T��hn�la�yy F��$ Tr��nin�f Edu��4i�n F��$ C3�ubC�F��$ Str�et�ar�l��v`s�ws$ ��rsd$ 1`C}T"A�!F EE�i t)�R�!!E�� � � 6�ndir��Comp�r�y°s N�rr��{�f�pplic�bl�} ��ndin���rrap�ny's Adde-ess City St�t� Zip ful�aet�a��L�r�der's Narn�{if�ppficabf�) Mc�rt����L�nd�r's�ddr��� �ity Sf��� Zip ,4pplic�tic�r� is h�r�by m�d�ta c�bt�in � p�rmi�te� d�th� wc�rk�nd inst�ll�ti�ns�s indie�ted. I ��rtify th�t nc� u�cark ar inst�llaticar� h�s cc�rr�m�nc�d prior to th� i�s�aar�c� c�f � p�r�rtit and that �!! work �+ill b� p�rFcarrra�d tcs ��:�t tt�� st�r�dards �f all I�ws r�gul�ti�t�, cc��structic�n ir� this jurisdicticsn. i underst�nd th�a� a ��p�rate permit mu�t b� s�cur�d f�r ELEC:fRI�, PLt1f�t�1t��, SI��15, PC3{��5, Ft1RNAGES, �C?II�ERS, NE��'ERS,1'A(�KS, �IR�C�N�ITfC�NERS, E`F�...., �t�l�E�'S �FFI�d���T: I ��rfiify th�t a(I �h� f�r���in� inf�rr�ation is accur�t� and th�t all �rc�rk wil6 b� dc�n� in campli�nc� �uith �II applieabie I��vs r��ulating construcfiion and zar�ir�g. ra t � . � �� � �� � � � L1' 1 � �I 1 1 T"S �° Y . IF Y 1 1' 1"� C?�T�111V Fl�1�4�t�1�+�, �fJ�Sl1LT'VU11`H ���1R LE�iE�E� C)1��I� �11`1`t7�R�E�' �EF�FtE FtE��t��IN� Y` Ti E F T`." . �C?�"FC4' $CJ��1p�7GfX17�': �.5 t7 COf1t.�tlFC3PP �'t? tt7�" fa�UCdF7�'�C1f fX �7UIfC�1P7��4�t'YYTt�Mi/tE'�t QI7 �S�ii7}��'�C�V��U�.'�XG�'�C3`fPt����Q�, f�1�C%��J�iCCiPI�'t71tf5f �rc�rr�fs�� in goe�d faith th�t ct c��ay e��the r�c�tiee Qf cc�rrrmencer��rri c�nd ccanstructicarr li�rt /crvu brc�c�hur� wifi 6� deliver�d t� �he�a�rscav� w�acss��ar�p�rty is subj�c��ca e��tac�arra�n�. .4ls�, �c�rti}`ied c�py e�f th�r°�c�rd�d raca�ic��f ccarr�mer���r��nt ma�st b�pv.st�d crt th�jr�b sr�e ,�car ti�e�rsfi insp�ctic�n hiefa c�ceurs s�uera (7) day� aft�r the 6u1ldln� g�rreait 1s isscr��. in th� crb�er�e� c�f such �sst�� rrc�t°ic�f the ir�s��trran�tt1 n�t b� �prr�t�ed anc�a r�insp�c€�iczn fe�wr'�l be charg�c{. r �� F,,� Sign��ur� Si�r��tur� C3VV�ER or A�ERlT C R���`�R Th�fore �irt�instrurrt�nt w��s�cknc�wied��d b�fc�r�m��has Th��s�re��in�er�strurn�n�was�ckncawl�d��d b�fc�r�r��this � d�y c�� �. � _, 20 by ��- d�y�a� 20 � by $i �. �rho is pers�nally known to wh�i�p�rso��lly known t� m�or wh�h�s praduc�d � R as rv�e�r�vho t�as pr�duced as id�ntificati�r��nd wh�did t ��� �t id�n�ificafifcan and wh�did t � �a�t� (V�1"���PCi�LIC: IV�T`�RY Rt1�GIC; S€�n: Sign: Prin�: �t� Print: .�a � �� S�al: �a ���f°�.� Y � �� se�l: ����������,� Y ����� COr�� # � 7fi� m� �� � �i5,2��9 '� �'� � � �t���2Q1� a � �'s"�i� �, �>°'�' �� '°'''"�,s��p�.•s�°"> � a:�����:����:���++e� ������a�������s����a������������x������:���������a����������`���s���������������w��������a����������� d� � �PPRC}1PEC}�Y ��� �` �� Pf�ns Ex�miner Z�nin� Structura�R�vr�w �lerk ����R�� �� � .�� �ami hcar�s illa�e E.YE iRE!!� � _ ��� U1� In �C't t1t '��t�Ri�� I OOSQ N.E,2nd Av�nu�; Miami Shares, Flc�rida 3313� T�1; {3Q5} 795.2244 � � : {305} 756.8972 CI-tANG� t�� �t�NTR.A.CTt'�I2 / AF�CHIT�CT F'ermit N. ��� '" �'�"� Qwner's Name (Fee Simple Ticle Nalder}: ������ �����.�f�� Phone#: Qwner's Address: � � � �ity: �' 4„- Stat� : $�` Zip Cade:� t�'__ �ob Address (Uf where wark is being don�); City: P°liami Shores State.�Flarida Zip Code: �antractor's Company Name: � y t� _ #; A��ress_ � ��, 1 City: � Sta�e: �'" �'�t �ip Code: �ualifier's Name : �Zyt.� ���� Lic. Number: Arehit��t! Engin�er of R�card Nam�; Phon�#: Address: City: State: Zip Code: D���ribe ork: I k�ereby �erti that the �rlc has be�n � andoned andler the contraetor/��ehitect �'� . is ur��.b[e or , Elli�g �a �o pl�t� t�e �ar��r�et. f hald tMe uilc�in �ci�.� �nd th�� �� ���`� M'r��. i S -�s harmless of all lega� involvemer��< �,�^°�� fi�,' #� . ` ,,�� .'��'` � S�gnature -� �`' ...—m---- �i�n�ture � Owner Contraetor�r Architect The foregoing ins�trument was aknow(edged before me The foregoing instrument was aknowledged before me �"", '" �, this,�day of �s°,� ,2Q��,bY�<¢� ���� i������� this �� ��'��day af ��r"� � 2d��g'by ��`�� ����t„�� Who is persanally knawn to me or wh� has produeed �` , f� '�'����� who is personally known tc� me or who has prc�duced ��C,� � � � �� �� 1�.:�s �,`��Yi�`���r��� �� as indentificatian. �� ��,�?- ���� ��~a�'.�~�� as indentification. �.f Ngtary�� ublic: ,�`� � �� �` Natary Pubfir. � - � . �- ---m f .��.� _.�_�M. Sign: """�_" ` �_`"`� Sign� `�� W � � � r, _ ,� Seal: Seal: � � �` �.*'�:" E3R�N��h 9UCKaeY a Ntat�ry Put�li�S4�t�ctf Fi�cid� ' �,�`• 4�`.�;,- - NataryPublie-Statec+fFEori�� ;� II��Fd�IF�lt� :`, � ��L� : �� Cammiss�on«GG t 22»55 �X Gommi�icsn G�16�3t MyComrnExp:eesa�l�.2��1 ��,�,� �%pir��11t14f202t ...-,.. 5�r�de�thr^uch ka@crai tvetery,�ssn. . �5���'�� �,.� Miami Sh�r�s Yillage � ��* �uildin� �ep�rt ent �" �`� 10050 N.E. 2►�p Av�nue ..'. #•#r.� Miami Shor�s, Flarida 33[3� � � � � Tel: (305) 795.22�4 ��'�� � ;��°�� � ; E�os� �s�,a9,2 `��o�tt��' �hang� a�f Contractor/Architect ar En,�ine�r A change caf eontraetor, arehitect ar engineer must be done under a permit number. There is a $75.00 charge for a chang� caf eontractor. The owner will submit a �han�e of Cantractar Farm campleted with natarized signatures. If th� signature of the previaus contractor cannot be obtained the owner must send a certified letter/return r�ceipt natifying the previaus cantract�r, arehitect or engineer the reason far the cha�ge, The owner must allow 10 business days for the contractor, architect �r �ngine�r to respond. A permit applieation must a.ccc�mpany the change of contractor form, with the information ar�d signature of the new cantractt�r. Th� new contractor must be registered with the Village or must submit the required docum�nts tQ regist�r with the Village. � � � � 6. Change of Cor�tractc�r form c�mpleted, signed and notari�ed. 2. Permit applicatian by r�ew contraetor. 3. Requir�d fees. 4. C�py of ariginal letter sent via certified mail along with the r�turned receipt. In additian to th� r�quirements abave the architect or engin��r af rec�rd must auth�rized the new architect or en�ine�r tc� repraduee his documents. The auth�rizati�n must b� in writin��nd must be signed and s�aled. lVl�Af1�l� JA�UARY 1�, 2�2� S�rs iVll��ll SN�RES �lJf��I�IC� �EPARTi�E�lT WITN �fHl5 �E ER 1 ELEASE C,4MiL�AND VI�TC}RIA VILLE��S FRC}� A(�Y CC?MPR�M�SE C}F PAY�dIE(�1"AI�� ����R FRQ�11 Tf�E Ct�TRAC`�1�VE SIGN�� IN�TNE VVC}RK �F�"NEIR Ht�I�SE IN 127� t�E 97 STREE�C�F to�i�tt�l SH�RES. SfNCEREL.Y � � � SIXT� MtJN�Z , � e ��� � i hc�r � �II ���� e���� � � ���� ����� �,�.�t1C� ���5�4�� �'�� � C�i�r�i �ttc�r��, F4€�rid� 33�3� �`��a {3Q5� 7��.2204 F��: {3��} 756.�9?� 1 � C ' 1 { 1 kFlc��ida L.a��= re��ur�a ��rk�rs' C:crrnp���atic�rl 'sr1�t�° � c� ca��r�n„;� tz��c��r G:.h�pt€;z• �44} of t��� I�f�rid� �tat�zte�. Fla� �tat. § �f}.0� atic���c:«r�orat�c�f�i�ers irl tt�e�c�F��truc�iaz�u�du�t�f tc����znpt th�zrx��i����frc�s��T��i��eqcairer�c�n�fQr�z�s�c��c�stszzctiGr��%��e�g�riar tc � e�bt��z�in�a Eruildfr��p�;r�t�it, F"urs���t te�t���I�Ic�r�da I�ivision c>f Vr'c�rkers'Cc�i���r�sat�c�n�rnploy=�r I��ct�I3r��f�ure: �n e�plcr���r izz t��� con.�tru�tic�n ir�dusiry ��ho e�iploys c�ne c�x� mc�r� par�-tis��e c�r full-time �zng�lc���e�,inuluding tl��c����r��r,must c��t�iin�,s�ork�;rs' com�ec���tic�n cc���e�a�;�. �c�rr�ac�r�t�c���cers ar r��sl�b�rs af a I"rn�ited Ii��i]it�= co�t��sany {LLC� irz the constnzcticar� indu�try zn�y elect tcr �e exs:mpt it; I. I`h�of�"i��r c���as at le�st ��p�rc�n��f`the stc�c�c�fth�cc��-�ac�ration,or iz�tZ���ase c�f �r�I.L.�`,�st�ten��n��tfiestin�;ta t�a�mis�im�ua� i�p�rc�nt o��n��hi�> '?. 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