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L�eat�c�n�,ddr��s Parcel Nur�ber ��,A.�.�.m,� �.��.�.� ,o� ����,� �,��. ���_ �.,��aA ����,� ��.�.a � 1�D IVW 9�`CFi 5T',Ittli�mi 5Focar�s,FL 331,St� 2231010�SOt�10 � � �� ��ntaets �,�. � _ �� �� �w ��,��,��.�P�� .�..��_e�.�.������ � Percy IVialpartida A�rner BUfLDBNG SERVICE TEKS l.lC Contractor � 19Q NW 97 ST,f�tliami Shores,F�33250 JESUS CARMENATE IVlokaile:3Q59�62217 promax4 c:yahero.com i ��..,m.....�„_.�..m....._.,._�..............n�.�_,_....,�.._....�._..,_....,......__a,....�..,_ �,�m�.._..„.... . :,�..__....._..m_,_.....,..,_m........�._�......,...,..„,�,...�. M...,_,m...,.,,_.,,.�_.:,.........._._. . .e....�.....�.,.......w.n.m..�..m.m.....,....,.....,.,_,.. ,. .a.,. .... � � � �t1S �C�`i0[t�@ UES�S � B�scriptior�:AC I�iSTAILATlQN (2}3 TQN,(l�1.5 TQN � Valaatian; $6,9QQ.�Q ��������� �� �� � � � � �� � �`. � � �� ��1�- �� � ' T4t�l Sq Feet: U.00 ���� t`� � 1 s��� � , �� � ��� „ � ���� :,1���� �.,,z�� ��.A. :�,��� .��.lti �' .����'�� Fees Am�unt Payments Date Paid A�t Fa�ei Applieation Fee-C}ther $54.00 T"�tdl Fees $8b.6fY CCF $4.2d Credit Card Q4f09j2C�21 $$6,6Q D�PR Fee $2.Q0 DCA F�;e $2.Q0 Amount Due, �0.00 Education Surcharge $1.4Q Scanning Fee $27.40 Total; §86.60 �uilding C?�partment �opY In consid�r�fian of th� issuanee to me of fMis p�:rmit, I agree to perfarm the work eover�d h�r�und�r in campliance with all oedinances and regul�ti�ns pertaining thereto and in strict confarmity with the plans, drawings, skatements or specificatians submitted to fhe prop�r auth�rities of �liami Shar�s Village. In acc�pting thi� permit 4 assume respansibility for ail work done by�ith�r myself, my agenf, �ervants, or employe�. 1 und�rstand that s�parate permits are requir�d foe�L.�CTRIGAL,PL.UM�lNG,MECHANIGAL,WkN[?�WS, DOC7RS,RC?C}�ING�nd SWIMMlNG PQ��wark. t�VliN�i�S AFFIE7AV(T: ! cerfify fhat aIf YP�� for�going information is �ccur�te anci a � I work wilE be don� in camplianc� �ith al( applie�al� I�ws regulating eon�truc2ion and ze�ning. Futheer�aea, 1 authorize the ab�ve n� d r� , cta to �, th�weork stated. i � �. Authc�rized Signatur�:C7wn�r ! Applic�nE t Gontraetar t Rgent � Dat� ��r�R os,xaz� ����z�f a i i r i�� �������:����������� �� � r� t �Q�SQ�d.�.2nd�ue€icaeF�11i�mi Shc�r�s,Florida 3313� ���.{�������-���� ���a{��s����-���� ���a��t �.�. �..x�.� k�.�� ��s��cc�r���������c���������;{��s}x�z���s � � � �st�� ��rr�it�cs. ��- ��-2�4� � � � Sc�b P�r it ��. ��u���f�� �} ���cr�ic � Rc�c��i�� � ��v�s�c�� � �x-r��s��a� ������r��. 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N,.�� g � � 3. � y�q� � ����������� ��������r�� ������� ��r���: $�d�qj��'q�¢ ` ,$�.� t �v...t"� �� �5�rvm�i..ny�l. .,+�; R 6§&t°98bw¢ t lx ;t' \ F�af���`���a y�� �� <�J. �° � � .�. � , � � ��� �� ,� , �.�.���� �. ���..��.� � � �a � � r. .,... , � . �C3E��: � , s, � C����: � �n � ����:�s ��� �' �"�`� TM. �.,xi��,�„�..�.,�.�.�,.,�._�„�� ,�, �"'� ��..�.��,�,�. � � � , � < F *. .������.�� . .���� :'�"`., � ,.�.,�:�.�r�� �,..F �',�. �.,: Fs e y,.vt i°;�S,. `t..��t��� ,,,.. �4<�^�� �.....r`��.�s F �HI�;,��� �°�;<.�, ¢..� 1..,:�����..,.'�� ,.F�`��� e...', .. ,;t<<.t„�. � � 1 ������������������� ���� ��� ���� ���� �c�� ���� �°������������r��r�������� �s €��� �� ���� ����� ���� 1������ ���t�� � � ��� ���� ��� �� ���� �� ��� �� ��� ��� ��� ���� ����� �� �� ����#�� � { �� n� ��������� _. �;, S� ��� ������ � �, ������ ���������� ��������� �"�� ��r���i�� s������������ ��s� ������� �����������a��� ��;���h������r�� ��� ��������������f � ����r� ��� t��� ��� �� ��� F �� ����r� �� ���� c���t �� ��� �,�� � �y � i� ������� � ¢ � �� ����� �;� ����t� �� r�� �r��� ���� ��������� ��r� �� r�P, �r��v�� ���� �r������ �� �r����t������i��n �� ���������������a �t�ry ������� . ��� � �t�� ;y+; ,�����s��cs��z ; ,a ��� �€ €� �r�� ����g , � ��t ��������—s�������� � � � ��� �Y���EN � t"�� � °: i,����ais�` ����z(��a � �� �� �� �������; :�,� . . ��t� '� � C��t��sEsMt��6G �27295 �� � .��E"'� ��t��ar�����t��� � *8 � � u� ��' �,�.����r�.;��P����123,2Q�9 ,. �.e� ����oc�;��� ����ed�ro�ou�n�ati��a}�do4ar��sS�. , .�., i� i h�r�s i�l e ,��� uildi� epartmer�t �'�: �. � � ���� F,�6'� �'�� 1005Q N�E.2nd Avenue, Ntiami Shores, Fiorida 33138 ���� � '��� Tel:(305)795-2244 Fax:(305j 756-8972 lNSPECTIQN LINE PHONE NUMBER:(305�762-4949 ��� F � 20�:� ��� (��7i Master P�rmit Na � � � ���.� ���� �� � �� ��� PE�MIT APPLICATIC)N sut� Permit �va. �� �� �. ������°� �� ����� ��IJILDING � ELECTRIC � RE�QFING � REVISION � EXTENSIQN �RENEWAL �PLUMBENG �MECHANICA� ❑PU��IC WORKS � CHANGE C}F (� CANCELLATION � SHOP CQNTRACTOR DRAWENGS ac��a�aaR�ssE � �`�`� �� �"��` µ Gity: Miami Shores County: Miami Dade Zip: FaliojParcel#: ���` ���� ��� `��!� Is the Building Historically Desi�nated:Yes NO Qecupaney Type: �o�d: Construction Type: Flaod Zone: BFE: FFE: OWNER: Name(Fee Simple Tieleholder}: ���' �� ��°�° Phone#: ����� � ���� Address: � ��� �� ��� � � ��" City: State: Zip: Tenant/Lessee Name: Phone#: �,�� � �� � �� � ��§� ��:.�� Email: � � r` COtVTRACTOR:Campany Name: �'�"� C `� �,���� � ���a��.� �-�, Phone#:���?� ������� Address: �7,���. ��..�5 �� �,{ City: �� t� State: �� Zip: `� ��-�� 4ualifier Name: -��� �� � ��� ���� �� Phone#: State Certification or ftegistratian#:��`����-� ���`'� Certificate of Competeney#: �ESIGNER:Architect/Engineer; --�"'°��������-�� Fhone#: �ddress: City: State: Zip: C � � Valu�e�f Worb�for tf�is ermit:$���� quar�/tinear F�utage�f Work: Type of Work: ❑ A 'tion ❑ Alteration � New °�J RepairJReplaee ❑ Demolition Deseriptian of Work: `� �' � �� � �� ��,�� � �>� °� � S ��"`� Sp�cify color of color thru tile: su��,E�cat Fee S �e��Et Fee S ecF� co/cc� Se�nning Fee$ Radon�ee$ DBPR$ Not�ry$ Technology Fee$ Tra'rning/Education Fee$ �ouble Fee$ Str�aetural Reviews$ �ond$ � TOTAI FEE NOW DUE$ (RevisedQ21��/2014) Banding Company's Name(if applicable} Bonding Campany's Address _ City State Zip Mortgage Lender's Name(if applicable) Mort�a�e Lender's Address City State 2ip Applicati�n is hereby made to abtain a permit to da the weark and installations as indicated. I certify that no work or installation has commenced prior to the iss�aance of a permit and that all work will be performed to meet the standards of all laws regulating construetion in this jurisdiction. i understand that a separate permit must be secured for EIECTRIC, PLUMBING, SIGNS, POOCS, FURNACES, BOILERS, HERTERS,TANKS,AIR CONDITICINER�, ETC..... QWNER'S AFFIDAVIT: I certify that all the foregaing information is �ccurate and that all work will be done in complianee with all applicable laws regulating construction and zoning. '°WARNiNG TO AWNER: Y�UR FAlLURE TO 12ECORD A NaTICE C?F CaMMENCEMERIT M,4Y RESUI.T IN Y()UR RAYIIVG TWICE FQft IMRRC}1/EMENTS TC} YQUR PRQPERTY. IF YQU INTERIQ TO QBTAIN FINAIVCING, CC}NSULT WITH YOUR LENDER QR AN ATTORNEY BEFORE RECORDING YQUR NQTICE QF CC)MMENCE�/IENT." tVotiee to�tppticant: As a conditran to the rssuance of a building permit with an estimated vt�lue exceeding$2SQ(1, the appticant must promise in good farth that a copy of fih�notice of ccammencement and construction lien law broehure wilt be delrvered to the person whose property is subject ta attachment. Rtso, a certified copy of the recorded notice of corrtmencement must be posted at the job site for the first inspection which occurs sev�n (7) days after the buitding permit is issued. ln the absence of such posted notice, the inspection wif!not be a�aproved and a reinspectron fee wrt!be charged. ,-�"n" � �� ��' .`�.� . �.m_. F�°`�Signature Signature ���� � G`� f t� � Q R or AGENT ��'� CONTftACT R fare ' g instrument wras acknowledged before me this The faregoing instrumerit was acknowledged l�efore me this � �~ ..� �, °� �1 � .�'� ���� day of �� °`°�.v.� � 20 � " , �Y � � day of ��?�..w��� ,20 � bY �t����� �""`�'� 1���°"��� �,who is personaily known to ��,.���,� ( �"�'.�.�'"�"��'��-~,who is persanally known to ,��� ����� �, me e�r who has produced �`" �� f..��_�*����..-� as me or who has produeed � � °E���-��-��,.E ���'� as identifieation and who did take an�ath�����������,�� identifieation and who did take ar�aath. �,¢, ������ ��'����'_�� ���` � � NQTARY PUBLK: � �;; ' � �`�°�,,� NOTARY PUBUC: � {�� "�mM%° � n 9. �.�;..;,�°� ' .F .,,�,.�.� �' �� �� � i, � 1"'- � ����$�p�,�[��s���:��� .. � `"' '�` � �. ``:r' }.�� � '��� `li �.,t`�,t1"�x¢f " „�� ` ��. r' q ,.� � : «� 7� �,__ �yaaa .i a 4.,. � Sign; ` _�, �' ` � � � �,_.�, � Sign:� ��'^� �.'��gq��`��'"� � _ � �� � �• ��� �� q�.r.,.�,,� a� t��, Print; � � � �� �� � Print: �c�e ,� �'�. � � `,, ,� �. �+.� ;_' ,, Seal: �` �'�; , , �� Seal: � „ � ;„ t ����,� �� ' � ��, w c, �� �: ¢:�3��4�;� ,.� ,� �, �#f' 4 � ;� ° n ; � � 1�� ' ����.��� �*�*��**�**�***���*���** **�:� * *�*� �** **��*�� �*���**m*��**�*����`�k�x����:`��ti���**���m���***���m�mm� � �n ����x� . � ���aaa�t4�4� APPROVED BY � Plans Examiner Zoning Structural Revi�w Clerk (RevisedQ2f�a(2o14) � t`l$zi�t�ii��5���� � �_ �����1ti1'�;��` �� ��� ���� t��s��i�{1 '� . . �#�.."�ea�::.. ..,`ro` b �j I.i�(,INF:�E;RI;D SYfi"FI3h�fS�t�L.U`FIC�NS I.[.,C 7352 St�'�1 Street ivliaini I�L'33155 i'h 305-909-4$71 k��954-671-6865 L?f#TE: �c�aker I5. ZC?I g �t�te oE�Flc�rid� Cc,unty of T?ade I,Tesus Car�nenate,�=iil be tlie or�Iy��er�oY����rkir��o��the�rc�j�ct af: 190�,�W 97��'Stre�t,�1iGtFni Sl�c}res F'I,3.i I SQ �ISICt;Ely, . .. � . .�v �. �3�,llF llt.' ����� �R ������ Print'�I�z�e --� State of k lorida Count�of��iamiaT?�cle ��� �t �� � �3�:f����e n�e,thi4 ' � dc:v c�f' � $,.�::� . � � >p�r�c>n�l1y r�p�ear�d ����€�°� � ,�..��.���'�.�.¢��..��°� ��lo cxeeuteci tll�;�cr�going islstrur��ent,az7d aekns���s>Ied��d b�fore aae ttiat same was executed fc>r tfie�ur�sosc4 tEl4rein�x�ressed. � �1gt4464�aP€ttlf�� �. ������A� (��AI�.) ����a��� {,� �'��,,. �'Grsonally Kg��wn � or Pr�duaed Icicfit�ticF�tio ;��`�,,`� � ,� �� ��'�,°;.�, .� � '.�� ,� �`� ���� ���.� �,.,r �s� �s��� �i�tiatti cr af?�t�tar5`I��e;p � h�' e�;�� .. ` C7 „?'P,a�F7"` c �:�>=,. .;�`3 k� 7j* ` ��. 2 s w �, ;� �>,,, �`''d" .� c.S,a � "b , y, y�a t �«�� �4,, �, {����'�rd1�tl�l�t1�0'ai`�°�•.. �'����`� � � ��►� iarr�i h�r�� il�ag� ..`.� ���`� ..".� �uild�r�g D�partr��n� .� ��.��~ ..���,�� �oo�o �.�.��,� a���,u� ���R.1t�P+� Miami Shores, Florid� 33138 1"�6e (305) 795.2204 Faxo (305) 756.8972 ti� t n r � r r ' � � ti In� r�r�� x� ta ��t��,5�� ` v5 'b �,;� @ ����. < � x,� Lt ������ t1�;8t�,�� tt �� §. f ����.ti. ��� ��,,��������}� ��$t°,���,tY}i;���i`���a��';�a; °c�< � ;`,'�� #�, i� �" .�>����,s,�, � .� 3 �,� � s � 1 � Florida La�� requires tiG'ork�rs' Compensation insuE-ance cover•age und�c Chaptar 4�0 of th� F�aric�a Stat�zt�s. Fla. Stat. � ��O.Q3 t ; allo�vs corporate afficers €n the construction iazdustry to exem�t themselves t�-c�m this requiremezlt for anv uanstz-uctioc� pec�ject prior to ; 3 obYainin�a buiLc�ing permi�. Fuz�suant to rhe Flc�i•ieta Division«�G�o��ker5' Cam�etl�a�ion Flnpiey�r Faet4 F�eoe�t�r�: �1n e��1plQy�r in the con�truction incllastr� r�zho employs c�ne ar more }�art-tirne or full-tirs�z en�plcsyees, incl�tdina the awner_must obtain��arkers' compens�tion ca��erage, ��rparate officei�s �r mer116ers of a Iimited liability coinpany (LLC`) in the c�n�tz•uctzon indlistiy ��1ay elect ta be i exempt if: � i � 1. The officer owns at le�st 10 pei•cec�t of the stock of thc cor}�araCial�, �r in the case�f � � ar�I�LC,a s�atemei�t�tt�stin�ta t�le inir�im�un 10��re�ent o��nersh�p; ` 4 2. TEle offtcer is tisted as �n officer c�E the eorpor�tian in the records of rhe Florida ' De�artmzl�t of State, Divisi�t� of C�rporations,atsci 3. Th� corporatian is re�istered �nd listed as active ��ith the Flarida Departrnent of State, Division of Corpora�ions. i i �ti`°o more than three cc�rporate o�ftcers }�er corparation or limit�d liability� company me�ttbers are �lio��eci to be exenap�. Coast�•��ctian �xemptions are vaIid f�r a period of t��o }=eaz�s or ur�til a � voluntary r�vocation is fi[ed or tlze exemptic�n is rav��ked�y the Divisian. � = Your ccP�ti•actor is i•�c�uestizl�a peri2lit uitder this�c�l�kers' co�npen�ation exemption ane�11�s ackno��led�e that he or she G��i11 not use � day Iaboz•, pa1�t-ttlne employ�c,s or s�bec�ntractors for yc�ur proj�ct.The cc�ntractor has prc�vid�d an affida�,�it stattug that he or she��iEl � ; be t11�onIy persolz alfoti��ed tc�wc�rk on y°o�xY��roje�-t. In these circumstances, �rtiami Shares 1�ill��e does nc�t rec�ui�-e verifieatian of 1 workers' compens�tion insurance cavera�e frozr�the�antractor's com�aany tor dav labor,part-time empioyees or s��bcontraetors. i E3Y SIG�I�C'i BELC}��' 1``t}L .�,CK\Q�t'LEDGE TI-IA'T Y�t; 1-1.•�ti`E R�aaD TIIIS \QT(CE A\l� L;�I�ERST.��L? ITS ' � � ; CC3�TEtiTS. ; � �° r ' : i Si`�t1 x ; ,. . . — { _._..�_. � ,,,�„` 'lk�e � St�te o� 'c a Count� c�f 1liami-L��c(e �° F ' Ti�e fc�regoin�was ackno�ledge bef�re mc tl-�is �� _da� vf =�...�� .2� � � � � � �� ��„ � � ���� � l�� � is persc�naliti l�na�Nn to me or has produced � � � — - -- �������e�z€ `€t������;�r� ����.. ��.-e� �._�°�. �a�����i����€��a`�r�`��� _— ,,,, �' �', r,�f" "`�. �.' � "�� �� �.,-t�, � ;t&x �Otat`4�: r1 —j ,�. �� �f° �.r — - — � --- - T � <" , � .. � � �. �� �� e�r, �,.... � S E.a 1,. -'', �'�� ,x,�„ � `"���° `�' �`>� � �„-�,° <$a� ��o m �,�b �°�^f a`�� �`� i � �-,.. ��. �da,���BJa�t�4#4�t�`�e�����