Loading...
PL-12-16-3424 � �?����` �� �� � � ���'�'���c�,� Miami�hores Villag� 1 ��� ; ���I�'l�I�������I�����E� f�� a „ � � 1Q054 N.E.2nd Avenue NE � , . � \>', �+'" ���, �����,��'���+E'� ������'�1�:. ' " � ""'�' Miami�hares,Fl.33138-Od00 � � w , � �. :; � Y�t��`+�����.,?�������'. '�� '��" Phon�_ �3Q5�79�-220� � � � ��' ' � '"����t"��,, � ��� �� � t � �X 1Catlt}Ct: ��J������� ` �� �����t� ������`: [� Project Address Parcei Naamber Applicant __ _� : W�.� �ea,�. , .�r.,�..W�w�.W.n.. . �.n.....�_ _,�� �.._.�..,�.�����d�� � . ��. _ .,__e�, .,,... �N , «r AM_. . .�n,. . � ..v...w.P... .s.., �„_�_�., ' 1270 N E 97 .�a�1'�@fi '�9 32Q50090560 . E �AMILQ�VI��`�f21I�VIL���,45 � Mi�mi Shor�s, FL. 33�3�-256Q �ioc�c. �ot: i:'\:�:aCw`3S�:Y'�2"�`.S':�A3.'v�R'klY�Xi{5.�+'a�`�i`1."Y�*,`%"..T,'�&�'S'AR."s"��'�,"�'�ii4"tiK't�.��Y6,'�3�.a"S�YI"S%.URA'1.`S`k:,,�;;,.�1��i5'�t`Xe't°�a'xS.`Y�'�S`,`U"�+,Y�2L.�-�Y:b.Yd`.�\loh3�`�%k.C�,C�.'a4�C3�}K.�.".,'n,b�:YfriEd.�a"iCYE".'5,.�.N'..l�:G:o�l'�`a&l`„u�'a4lif:..\\�\"a�`.�.�'.'.;u.*i4`m`�2.���k'd:�3S2�;.'�TY.};`�.2?"a.°�A�..\i�ll'e.??�`,S`l':,'?.�C:':°\":."kbi`:,b�C�`,'R\�'a.tik3fS"z��..'�':::a`k>.�"�5.�\V�+�.bh'v^=,'i,��tiU;)t�.ii.`3Yk\Y)Rtiti'#a#a.tii.l.�Sa\f� Qwner tnfarmat3on Address Phone Ceti x�� �.�.. �� ��u.�,v..�....� �r.. ��...x.. �.,.�,. �,� ,., ,..nn. . ,. �,. ., �P� � ���. �e�...._ .....�... _,�e. �,__.., ,. ._...uw � CA�IIILtJ S�VICTOF2IA VILt���A� 1270 N�97�treet � �tflANll SFiC��ES FL 33138- � �x2'€a`::hitirkY£`:�.,�.�YRacai'#�Y.�S,v.kktR9n�.`�.4?7i. -.. . �vr�A;.�&�`�;:�yr�az�;a\'��&c3,�l,�kYzti3Aa:.�."aAAd�i�a.l+,tiv�.f�.m�""x.`�.. ���€:�ct�n�i:.\�":C.Yllu;zY,rs:�txvXrva`al"�.\\za��.,..A�i2,"Ma?�',`�t.titi4'tti.sh'�RYeI..`l�'Sa'�v'4.�1s�a`*taY:Sh`�Y�.4ia�:.��3:�3}iYC4;a�uil`.":t?�ssatla;a"�..\�*S��`iix':;i:`hX�`"aNt�.°�.�`�:�>t;�`.c1:t.',t.ctib:�1`.s�`3:.`:'�?.#i1t`."��„`+��.:'.)`.A'�`� 127f}h1�97�"agCG�t NIIAMI SN�R�S F�3313�- Contractor(s} Phon� Celi Phone �������w���������� _,___ n_,__- _a�.w u�����E�n: � �,saa oo � A&� PLIJM�ING SP�CtALISTS L�C (95�}274-8915 _ E Tcatal Sq F�efi. p � , '���������������������,������>t�������� Type of Wc�rk:ADD�REP�ACE FIXTURES Availabie(nspections; Type of Piping: Inspecfiion Type: �� Addition�l Infa:,0.DD&REP�ACE FIXTUR�S Finai Bond Retum : Water Service Classification:Re�idential Scanning: 1 Rough Top C7ut Under�ground Review Plumbing Review Plumk�ing F2eview Piumbing �ees C)!ue Amount Pay Date Pay Type Amt Paid Amt C}cae CCF $1.2Q InvoiGe# PL-1 2-1 6-6241 9 Change of Cantraetor�ee �11Q.00 12f2112016 Cash $ 60.00 $260.70 Ghange pf GontraeEor Fee �76.00 DBPR Fee $225 C�2106(2017 Credit Card $26Q.7(3 $OAO DCfi Fee $2.25 Educatian Surcharge �Q`�0 IrtYOiC�# P�.-3�1�-669�9 Peemlt Fee $150.00 03f291201& Gredit C�rd $ 110.04 $a.0€} Sc�nning Fee $3.00 7echnoiogy Fee $1.60 Work withaut Permit Fee $150.Q0 'C1VAtC�� P�-�-�7a64061 Tatal: $495.T0 o�rz31zo77 cn�ck#:z2�� � 7�.ao �o.o� In consideratie�n of the issuance to me of this peemit, E agree Ea per€orm th� work covered hereund�r in eompfia�ce with a!f ordinances and regulations � pertaining thereta and in strict conf�rmity wifh the plans,dr�wings, sfatements ar specific�tions submitfed to the proper authprities af Miami Shor��Village. in accepting this permit ( assume resp�nsibility for aIi work done hy �ither myself, my ager�t, servanis, ar employes. I understand fhat separate permtts are � required for E�ECTRICAL,P�U(t�BING, ME�HANlCAL,WENDOWS,DC)QRS,ROQFING and SWIMMING PflQ�work. �,,.,-�m__� OWN�RS AFF! AV(T: I cer�ify tha�F���"the fi��regoing informaEion is aecurate �nd that ai! work will b� dane irr comp(iance with al! applicabie laws r�gulating � constructian an zQning��h��t�s�;'�f au ��irize the�ove-nam��l eo actor to do th�work stated. � March 29R 2Q18 � ��c��� �� ��� � Authoriz S" wner / Applicant ! Gontractor ( Agsnt Date t�l l� 11'1 ��� G�'1'� � fiHarch 29> 249� 1 i i h r s iII� $ � t�£ ���� ��w.�,� ��� _. �il�ir� e rt r�� �� � � �. � 1, yy� � ._� 1 1��,1 1Q05Q N.E.2nd Avenue, Miami Shores, Florida 33538 r °r�i:��os}7�s-22aa FaX:(3os)7s�-ss7z ����' .w. � INSPEC�CION LtNE PHONE 4VUMBER:(3Q5�762-4949 -� '�: ��� �t,� ��. � Ma�t�r Perm�t No. ,� -� �� �" � E� IT PLIC 1'I su�P�rmit No. �� -� � ,.��`-`�.. �Bl11GC�ING � ELECTRIC � RC)QFING � REVISI�N � EXTENSION �RENEWAL [�PLUMBIIVG ❑ MECNANICAC �PUBLIC WC�RKS [� CHANGE OF � CA(UCELLATION � SHC?P ; CONTRACT{�R �RAWINGS �` � � �'`�":� JQB A�DRESS: J�', � ,�� �- r� � �a�j��<M�� City: Miami Shores Gount� (Vliami[7ade Zip: FaliajP�rcel#: Is the Building Histc�rically�esignated:Yes NO Occupancy Type: Cc�ad: Construetian Type:_ Floc�d Zane: BFE: FFE: e �.,__.f� OWNER: tdame(Fe�Simple Titleholder}: � �i:��`��°""�' "� ,�t``�'� �'?� Phone#: � Address: ,�r� � ��.' ��; . � ���� �°;�_������,.:�� f # � �itY: '� �t� 2�t� ��G��Ca`"<` $t�tE': �..� R ZI�.I: Tenant�essee Name: Phane#: Email: ce���r�r�c-ro�:e��,�a�����,�. ������ ���� ����`� t.�� �n��e�; ���°�� ��' ����.� a�a�-e��: ���� �. �-���� � ��� � �� � � City; ��� �� �`�� ��_ � State: `��- Zip; ��`�� �� qualifier Name: ���� G`�_„�?{�-e-��f..� Phone#: �,��~� �✓ �`� �•�� State C�rtification or Registration#: ��- M �„� � Certifiicate caf Campetency##: t1�SltaNE�:ArchiteetJEngineer. Phone#: Address; City: State: Zip: � �� Val�e of Wc�rk for this Permit:$ � ���..�� � Squarejtinear FooT���of Work: Type of Wark: ❑ Addit�on�� [� Alteration . � tV�w ❑ Repair/Replace ❑ Demolition Deseriptian ofi Work:� �E��� �t�'�. ��� '� 6� °�� ': � d � ��.,, , , ���.��.r: ,��. ,�,� � �. "�� .Specify ec�lor of color thru �it�: � �..���; �� Sub►nit�al Fee$ � � P�rmit Fee$ � � __ CGF$ � CQ�GC$�� �_� Seannin�Fee$ Radon Fee$ DBPR$ ��c��`���� , t"� Technalo�y Fee$ Training/Educatia�Fe�$ Daubl�Fe�$ t � Structural Reviews$ _ �ond$ TC?TAC FEE NfJ�W E}l1€��,� .����� ��� � (�e�isedo2l��fzo1�� Bonding Company's Name(if applicable} Bonding Company's Address _ City State Zip Mortgage lender's Name(if applicable} Mortgage Lender's Address City Stat� 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 ta the issuar�ce of a permit and that all work will b� performed to meet the standards of a!I laws regulating canstruction in this jurisdiction. I understarrd that a separate permit must be secured far ELECTRlC, PLUM�ING, SIGNS, FOOCS, �UftNACES, B01l.ERS, HEATEftS,TANKS,AIR CUN�IT10NEftS, ETC,_... �V1fNER'S ,4FFIDAVIT: 1 certify that all the fore$ain� inFormation is aceurate �nd that all �rc�rk will be dgne in camplianc� with all applieak�le laws regulating eonstruction and zoning, "WARNING TQ OWNER: YQUR F�ILURE TO R�G(�RD A NOTICE OF CG1M(YiENCEMENT MAY RESUCT IRI YAt�R PAYING TWICE FC�R I PROV�MENTS TCl YAUR PRt�PER . IF YOU INTEND �'� QBTAIN FINANCING, CONSULT WITH YOUR LEIVCIER QR AN ATTt�RNEY �EFORE RE��RDING Y�UR NC)TICE �F C�MMENCE ENT." Noti�e to Applieunt: ,4s a condr`tion to ihe rssuanee af�building permit�rr`th an estr`mated vatue exceeding$2500 il�e apptican€ must promise in good fcrith that a cQpy of the notic� af cc�mmeneemerrt and canstructrvn /ien (crw brachuee witt be delivered tQ the person whose property is su6ject to attachrrrent. A1so,a c�rtified eopy of the recorded notice of commencement must be posted at th�°job site far tfre first inspection which accurs seven (7) days after the buitc�ing permif is issued. !n the absence of such pasted ncatice, the inspectian wi11 nat be ap}aroued and a reinspeetion fee witl be char�ea`. ,� `,�;"� � �� + � ��;; � �.� ���`� Signature � �� �'� � �` u �° ' Si�nature °'�,,,��` .� _ f3WNER or AGENT C��ITR CTQR The foregQing instrument was acknowled�ed befcare �this The foregc�ing instrument was acknowied�ed before me fihis �� day of,,���'� , %r"" ,2Q by � day of ���'��`�'`�� .;� 20 by ��C�.��"� � �`i E..�..� `�� who is personally known to ����� �"���e�' ��,�, ,who is personally known ta nme or who has praduced �� ��� as me or who has produced as identi€ieation and who did take an aath. identification�nd wha did take an oath. NOTARY PUBLIC: NQTARY Pt�BltC: � �, �r .�� +�` � ^�� :{� ✓ 4kdbH..6 $I�Ci �%^'���&�-a � � �I�Ct: ° �"'� 'e '(P,R� o�,' Print# � ��tf� ��`` Print: �' �p�^� '�,� f �}, c �"�� l`�� � c d�t�,Q 0.p00R P Y�� ���� e �ie ,7�aI. J���. "'I&ilBS .,.�y��t�� �'a+ d ��.� ��� b'}��,n�,� �f,Q��d��'�� eeaa�eaa � e+°Av � �4�h` ��d��.� 04$��'� ��+ H���} F3�^Si�E��9 FIO(8d� �9p e� = � G e E cs Ap��2�PQ�� ���:��*� ��;� � �� � fi�'!'F �� �»_�*��*�x:��:�z�**�*����*�x�s��*���z*»���*��*��*���*��*�����:*�*�*�m���� � ��`k�'>;�eeeae$*o`� ,� �t}��gqY. � .. � n�.� x ARPROVE[�� � �� � �� � ���R�ans Examiner Zoning �� ��� � � Structural Review Glerk (Rev�sedoajza/zola) 4 ���������� � � � �� � � +s°� �'�`�, � `�° � t � � � °�"� � � � �� °� �� �� �1��"E� t���1��FF�� ������1 C� ����C} ����} ��7�°�39� �+`&�������& 2��1 � �F� ��"� � F���� . �°�� F#�1���� �t� �239��Q��3 �t�������. ����� ���tt� ����� �J���� 23C���ti��'�C�� C�� t�ICaF��"Fl�tl�� ��Ih�T FL 33��4 ��r�gs��sx����r��! Y�it��h��ti ���yca� �s°��ear��€aF�t��r���r�� c�r��r��#1" �1�ri�6�s��1� r���cf by t9������ �nt caf�a��ir�����r�c� 6�r�f���ic���1 F��g�€�t€ear�_ E�c�c p �� s�r������c�bca�i��� �r�r�g� ���� �1"�`f��F �C.�Ft��?� frc�et�� �t���tc�y� #�ar��c�r�,�rcr��ac���r��c�t�� �a� -�-~�"; ��F��F� �tat�"�� ����E�����t�� ������r�s�t�,�raci�h�y k����Ec�ria��'���c�e���y�trcara�. ��C�����IC�tV�t�����1LP4T�C�h� ���€y ef�y���car�tc�'sr�a�r�a��t��a����e dt�bcr�ir����ar�c�r�c��:r ������T��� ����.l��: �$6�1�2�16 �c���rsa�y #��ft��e ��sr is��c�rrra�t��rs� �csa�r ic ,PI� � �c��c��#�s e��fl��°���t����t��a�� . �[`t��r�y r�fir�d�c�r� t����`i���C�F��k���i����f�`t`€2���'�#� ir�f ��#i�ts��c���€�r di���is�r����sc�Ft►�r�g��tica��tt�����g��t ��9f���Ft#�. F'�T'�� y�aa�.���a�c�a''s6�tc�d���ft�a�€�t�����t� ��r�f€�:� rra ����st [3���t�E����'��E� ��f3 ��C3���c� � e�8`��sa���t� � �. t��r�i��s�ra����a��?��rfs��r����: �.i��r�����€��€aF1�. ���,a���� ���rly. ��i��a�fy�trE��t��� �yc�u i��r��th�f�e�c���� ���a�c�cs�tt� �-�. T����Syc�c�fc�rcl�r��b�a�i�e����r�1� ��, �� ���rs���€� �,���r �n� ����,�;e��,s c�a ct� ��� �� s"�9����CS�B'�$YI���E�bF't�CPiY��€C F���1'�F �9'6 � E�ks;nt,-u���.�ta FtE3f3"' �pi� �.,�"�3i :�3�� �����..o� �'�#��� � �iCs4�F.a�&Sa�d �0.7B.f�&�#SR°�6d� 6\�8�t„r^}6�a�i.�,a���r4B,�68'4€t.i ���8���6"���l��ffi ����� . �g5����^ &"' ��°�F����$��Q9�$&�ffi�' 9�'"`g�g�����5�������� ��0.�8� ��&��B ��E��� @� ��#� i E..����� ��. � :� � ��.. �„ � � x���a� �F��d2r� �'< ���< �� �,, �=��': �Bt� ��.€���I�t��(���€`���`f�� ;�`� � �A. tS#��c���1������fZT`9FE�� ���. �J���r��r� �a�c��i�i�r���f�h�p��r���� ��. ���a�r�t��s� c����: �a[�� 31. 2��� �tJ����1�r ��T'�� � � E�F��(h� ������2 ���A�� 23���'1�`T�aC3� {�� � 1�1�F��FfE�E,��� F�C}�h37' �I�33�64 � � ���t��e� ��r���2��� C�I�F��.�'��� �2��tJ���� �� E��� ��t�� �.������ ��� � � 11� �� �dr�������g �rr�. ��-1 g �t, ��� ����¢ �� �ffi�� �-� ��� � �1 �'� 1$ T` � ��8 � � � �������-�����z es�i� � ��� �r� �� ��� t�C� �� �� !z� �� ��d1��a . �, � ira �T'� a f �° �� ���� �� �r �rt��a����� �€�����z� , e���� ���� a��,���/�t��� ir� �, #i��a 3��� � ��r�� � ��� ##3�� � t�l �tt ! d��°�������6 ��a�� t3 � �� �t��t������ i� �'��r��: � � � �a0�� �Iti � �� �� � � ��g ���Ey � ���# �I�s tf� �r��7'Yp�a I`�� �aa��� 'f�� F � �§��� E� � €�� r 1'��t� �cs �a� �`����'�� ��.0 C� CI.t3 C� �?.�� Cd a€9 f1 G.t7� QB.C�C& a�.C�� � ��� �� � � � � � � � � ��� � ��� � � �� � � � '�F#t����� ���`F ������'T �'tti� ����' f itt�p,€�a�c��g�c�f d¢���bcr�# °���t�� r�� ����r��i� €� is�r��trsr�. 1�csr� �� #��1� �ty �� ` `��€€�iy�r��' �t����i���"��� �r�c��c�r��a� ��s�� u �ra#�a 'T`F�a������ �' � i��� te� f�r��c!� �� t� ' ��� 's� . b��` �� e���� t� ��rt y�cc t� �k�� ba��� t' .���� ��t t i�� ����#€�� ' ���� �� �t��t �t a��r� �°e�E�� �at��t����r� 1� �r� �����ars�, �it�tt���� �a ���` �CT����I� ������� ����—:LS—�����3�� 3�{3� � � � �-I�F� #3�1 �C}�i� C� � ��� �I� 33f3�� ���� ���Ct`T,���3�6 ��a{�E� � � � m � � r�vv�� �2f���2�3�� �� ����°��s���r� �� r �r�� � �� ���a� t�� ��°rtt�� e��r.�r���cc������ r�c� ����r� � � ������ �� �a��aa �� ��������a ��t��r����� ���€.�c���� �� �.�����r�� �� ��, �����c�� �����c������� ;� �������€��. ���� ���r��o�� � �a����� �� � �� ��°t��r� � ��ra �� � ���€ ��� �t�� r��!u���t�?� .�� ���� �� �� ����� c��au�����t�� �� °� t���: �a. 1A� �tTAE�7'. If eh� rti ���h �r i� an,� �T°F��t�E.EJN�t����,2, ra � �� }�a t E� . �f�tf�Ft� T�f3i«E���f�f�+'�t"�,��a ` t� #� ��t's� �ca fi€ r�E �cy, C is� " ' est�y t�i ��e�w� ,a��s�k. 4 �rtt df�i��� ' � ' !����a�ta� ��rt�fic P�ca# �ra Ii�ca eaf ��a a . � �, ar�c��a�;��� CQ��� ��'f�F�V�S I��EJ�t�;�i�i���T�F� '�'��"u`r �f�dt��*���� 5���a G(����_�€�3t;�� C��d�� �ar���.�� ��-. �V�#2� ._�_ ��x 3� 17>�- ��:..�{�.�W� :�c�c��e�:�� �Ft �C}t�.�E��9 C�F�A� ���I�Et,��>FL 33f��ta W __. m-- m__ ��as�.�������c�€zc��rs:c c�v��z�t�� ���c� —�_.___ ___.� �. __�_m� __...._--�--___��___ �.��a��aa; ��t�`�7"SL����ft��UFt�l��'� � _._____._ _ � rr�,a�a£c €� �€.� F'�C?C�sF��aS14�`�_�. __. __— _ _____�__ [}h���t�a�'�F�'t1�,�C} � �_ � _�.� �_ _� � .__ ����rs���z c. 3�Ci7 t�?.F�C}�F�A�!-�If;�t-t�J�Y�339 {���;����, l T_�_���_�`� F�C?F�P`��t?���G�l, F� 33f�4 _�.�__�..� �M.� _��_ s� u���; ,__--, � —�-.. _____. _� �t�1�fdA��� ,��u��s��, _� ��Fi"f`lF��,�T� tdU���#t: ���{���C?P+i �tl�E3��. TNl�#i l't�CER7'tFY T T � Lt�t��C?F#P�SE! :d��� t�t�7�i?��Lt�1+Y V� F���td t��t1E(?�`Q TF4� iPi�t,i#TEGt E#�}�1 �t'�FC�R'C�i� E�tCY`�'ESt� t�t?4 T�l�. ��3 7NST�PfCJIP�t�fO�Y f2�E2i,tt�f€ Pd�", T�RR9 CtR �C)f�G3f�'K3�I{�F€tPdY Ct�Id'� CT G�2 C}"f��FFi CJ Ef NT `�kf F�ESF'��T FCt!niti€�fi�i T�lS5 CERTIFE�AT� Y E#� f t1�C) t��Y F'�£�2TAlYd, T�IE E�SC# Fd�E R�F�#�f}�� �Y TNE �J{�lES �3���Ft6��L� FQ�Cv�t6�1 iS SCf}3JEG"f�Tf�Al�L Tt�dE T�R EX�LUSlC)d��f��3C3�C?N�T#t?�!S{�F S ti F'4�L6�6E�.�t#�€TS StlE}V�1P��MC? �`FEAV��E�t�Fi�[3t3��9��Y PfitE[3 G Et��. ' tNSR 4"� ` � � �_ ..�"""�" _...�.�____�m_ ...n......_-�_�____ LTF? TYPE t?�it^d�i132A�htL.:F � 3l�#SCe p FC?CtGY Pdt��� Eit �.�� Y EFG Y P . ��� t. � ����� t .�# :.Y '" .. - ,..... �._..__ __. � �97�� �� 6#� f�1� � �il�l�#2't 7 �ncr�t��v �€�.� � ��,€���k � X �e��an���c€���������.a�t��.rry �'� �_� � � E e�EdEe,��as�s t��erc�urs�en�e�t y 5t?,��}. �..,�c�atA�S�#��&�E ��t7c�ca� � � � �TrP��cP{�:,x�s�p�st,r�� s �..�� �._.�.�� i a _ ���a,�s�.�a��?v,au�zr (�� � ��,QQC� � � ��_ � � � � � ..._� � c������,��c�c����r� � 1 C�£�,i�Cl€3 ��r,�,a���s���r��r����€��t�s r��� � ��at��aiae rs-�ca��tca�*�c�c � 1 a �c� � �c�c ` _� �mm_ ���c� ,. �� � _ _ �� ��rr�� ���a.e;��r.rs~v --�-----�-._.n�__�__.__�.� a._ s � ���`�Tfi�6�,}-Q `�f25f2��6 �1��12{}�7 t��a�,��� � � �__ � 3 i � ,ae,��,��r�ca E �5t3�#�t� n�;����� � s�,��t�u�.�c ( �a€�€�rie�a���v���r��rac��,� � ___ _,____.�___.__ A���� , � �4�3 V§��£7 t ' ` 3?�l�FNJiJid'x'gF'�r aca.: 2� � h�%S3E[�AUT�,� � �k1S'f� � ; � � .{7�c-���ceat���Y�.������' ..—__:. � �'--�° s ? � t . . a � f u.....� _.a ..�_ .---_..,......�.�.,�. ^ ' ._._.,..... �... ...�.... � ��.'�{� ���� . ""' ...,___ _......�,_ .,.�,...,,......r . .,.�..,.._..--..,......�_ .._._._.--�.�._. ...... Q.{�i�� � � '�"c�+���s4.����� �....... . . �.4.._ ... . .�'.��e�.J+A ' . ��#�a�'!"��� � � iI � _�,_.-�.�. -�.r. �................. ...�.R. . � " -.�.�,..... � t i � 3�4�a�Sf�1��Y���` �,..._ �—'_ b..�..._ �.�,_.....,.__.�......_.�.».. ,,.... �_�L� h2�TEk��`f��§� [ _... � . . _,,,_„„� Ft��&�� ��5,� � - -.___.__..______�____�_�__.___-__ � � . �.� �APS[5��.$€>l.C3Y�R���.3,� iYY v t� �. . ,.�.._--,-_....._.�,,..._.-�._.... --�—�; ��'E,f_ �. ... _.......�.,...m �,�...._. q��d'Y�F:C,+Ff��ETt���R?RtER�'t�f:ClTttv� �"' ( ��'-�---^-�-� E�}FF6£=��if3tE�Fv�C�R EkC1..C7DEtJ? ���IlA. � �L.��HACrG€L3E�ds $ . ���s.t�ss�.^.s irc�61j s � � m-�.. ��. C7�S�A`..^E-�Pa E�flk>CCIYFE.�� .. .,._..__._�.,,,_.___Mn„___ � .�...�„m... "�,SiF2E3�TlGk� -�t)P�F2r1A�C}."*€�'a .-�.---.. __._.__ _�, e..., .�.._.�..,�.. ,�a° �. . ___�o_........_. ��C.GFS�A„�'s�..P�S[.t�YLlP�RIT � �'� � -'l�"' -"--- -.a._._ ._. } I _i,.____�� �. _� �._..�_m_____ CJ��'SGFitPtTC1I4 f)��E�ATItJ�t.z f i..fSGRTICi�YFS I VEEflC1..ES{�t[srGBS�(:-C3RY�1i}i,�aie�#tAlt81 R�STt�f€c�SC2t��Ril�.t�„ ^_��'�'�. .. . . . . s�e�c�ks r�c�qr�E�tk). . _ . ._____ . -�.........--_.. �r��'�����i��� ���.�}�� . . . .. .. . . . . . �s.����:��..����� .. .. . . . . . . . . . . . e3� �,.�a������.������.�: a��. � ���} .�.����il���'".:��{�s���,.��}��� �.� p�pPp�p � �+ (�p-� �p}{�^y�p�a }{ p}^��qp.}�}� �. � � � �'��� ���� ����� -� ����m� ;�..{.. �� ���,..������ �� tVfdl'S&��a.T�1lR���ViL..3...'�R�x..7+F't�tJ 6..V��iV�t��9 ���« ��s.� � ..�...� . . �y.�{�fi��,... �� .. E��d!CV�G#Y.B.f 1"'Y�Y�c. p''��i A��ls�[�Fft)���, �L 3�13$ Rur ���s��� a� �'�� � �����25 2�'i6f�� �498#�-�€�1Q�� ��C��P T7�1�. ,4}P ri�h� �. � } `C ,R��}���aarne�nd �re �St� martt��af��C)�[? � .� ��� � � ����� � �� �1'� �� ��� ��� � �i �i��,� �i � �� F �� � ��"�� �� �'TI ��� °fi� ��°� � ��'TI�t� � � FL. � ��� �° �� �� �`1"�li�lml��l��lT��'��' � ��� �� rti` �s�' ' �s�3�i���d h �t ������c�rt�� F��ri�� k�s�°� �i�rr 6��, �� � T'�s 4B'� ��� �i "f�� 'C�. �ft 1� F�����{�s L �C �C��I� ��F�. ��1� � � � ����� � �: "i`�C3�1 �.�t��`� �€��LE?���< ���. 3 � �� �1��� �� �� � � � �� l� � �� o l.l�����[?���� � �C��`§` �1"t?� , �a�a�c t� .e���p.�.�, �� ��� � � , � , . � � �a . ��j,��„ ��� �� ,_ � �R� . � �n�.�., � �� � . 4ca 8� � ' � �;� c� � �� ' �� . �� � [iF�-�2- «2�2���`�9 �L.�� ��"{?�� F°1"� C) 1� ��'f� �"?d $4i3�1 ���������� � ���r ���,� i�r�i �eare� i�l��� �.�;� _;������ a Q �'���`� ��o�c� �.�.��,� �,V��,�� � t�i�r�i Shc�re�s, Flc�r�da 33138 TeE. (30�) 79�.22Q4 F��: �30 a}756.�972 �� � C � C �" ' �1 � t" � �1 Flerxid� La�v reguires Warkers Cozn�ez�satiaz� insuranc� covezage under �l�apter 44Q c�f t]ae �'larida Stat�t�s. FIa_ Stat. y� 440�OS �Ile,ws corpora2�c�ffieers in the constructzon industry eo exeznpt themse2ves fct�m this rec�uireme�a�for ar�y cc�nstructian prcaject prior�o olatainin�a buildina perzrait. Pursuant tc�Che Florida Div�sibr��a�'�'c�rk�rs' �Qmpensation En�ptayer Facts�rc�eh��re: Az� employer in ihe coz�strucCian industry who err�piays one or rz�Qre part-tzzne oa� fs�Il-tarne ern�aloyees,znc2udin�t�ze ou��er,�z�ust abtazn�vorkers' carnpensation covez�a��. Corporate of�icers ar members of a limi�ed �zability co�npany {LLC} in the canstructian inciustry may elect to be exeznpt if: I. The offzc�r owr�s at I�ast 1 Q percent of the stock of the carpor�tioz�, or ir�the c�se of an L�LC,a statement�ttestin�to tlae mzuiz�uxn 10�erc�aat a�vnerstaip; 2. The offic�r i� �zsted �s an off'zcer af the corporatiarz zn the recozds of th� Flarida I)ep�rtment of Stace,T7ivaszon af Corporatio�3�;axld 3. Th� cc�rporat�on is regzstered a�ad iisted as active with the �lc�x•ida L}epa e�t of Sta�e,L�ivision of�c�rpc�xatiaz�s. No more thatz three corpc�z•at� officers per corporation c�r lu�aited liability coznpaz�y members are allc��=ed to be exer�apt. �vnstructzan excz��ticarss are vaiid for a period af�tuo y�ars or��ntii � volunt revocation is�iled car t�z�exen�p�ac�n is revol��d by the Division. �'`c�ur contractor is requestzag a��r�nit under thi�workers' c�rz�p�nsat�oz��xet�zption and has ackno�rled�e that he or she w�ll zzot czse day labor,part-tzrrze�mplt�yees or subcoxztractars f4r your projeet.l�i�con�ractor has prouzded an afFic�avit stating that lXe ar she wzll be the oziJy person aIlcawed to wozk or�yo«r prc�je�.t.In tlz�se cireurnstai�ces,M�ami Shoras Village daes ngt z�equia�e verificativn of tivorkers' c�mpensatian ins�zrance coverage frc�zn t}�e contracto�'s cQrrzpany for day Iabcrr,paz•t-time eznplayees car subcontracGor�. BY SIGNING F3ELC}�% YC}U r1CKNC�W�,FI�GE T�IA� �'(�U �I;�VE ,� T�TIS NC�TICE : E�S�" ITS CO�TEN S. ' ", { � �, Sz�?natus�e: ,u (�?�vnez- State of Flarida County of Miami-Dael� The foregaing w°as acknowled�e befc�re me this � d�v c�f mm .,��.� �- ,2C} � i � �____.._ . By��t�� #� �vhc�is personatly knawn to zne or has produced � � i �-- � t�'"'---`;���'.� �` ��I` �s identifzcatio�. � , � Nat�� � �.�_.�_� � � s���.: � 1�; �������a��.�� ����z���� ��� t b�`�n�i���t!�i°�"att�6t ��T'�. °����� '�'���t�'+o-�.Q 4� � � ''�.�"�`�°„��J`� . Ck..r'�:r;;�..:�gt�1�t*�;")+.�SPrlG°S � a • a • 1 �. 1 �. I. oa./o�/�o�� ���r'��. ������� c�u�,ty Be�are �e this day of persar�aily �ppeared P�ter��r�ekis v,rha, be�r�� d�6y suvcarr�, d�pa�ses �rtd says: Th�t h�c�r she,will be th�c�a�ty perscsn �ark�n�„at tlle prc�jec�located at M�aza�i Shores i�illa��s Buildira� [�epartm�r�t. � c��n to�c�r af�i�ned}b�fore rr�e�his c�f � ��t ,2� , (�y � _ �� �. � f �,� 4 gi4iii 4 t FkkF F � f���'/ �'��'P �,�,.- _�_���� ���a��u� �IC�tc"�=�'� �. t�,°�t�l��' :�:��RCO�`�'tdiS5I��FFp0074I �;��r•_ �'���XXPIRES�M4R.25,2QT7 c�.�.,,a _:.,,, WiYW,rSftCNNOP�RKccm ����i'�'.2tit`�E:�CIS