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PL-10-19-2500 \��1���'`�t���l,\,��\\\�����\���1�\���\ �l\��\�,1;� �`et�i;S��°,�\�\���\��,i�£�.��s �`� �����:�it\�;�1 p� ;x���'i '�a�t��\\���t� ���\`\ � \ � � \ Z F �� �1 �����i� �.\,���`\l��l�\�.''���� �)����\1\�.\ �\�1\'��\��\����'� `\�����'�����' 1'� c�' n• ��� �j� �\���>»�\�y\��tiz�\�� �� k1�5 �\�', Zc�� z\Z�v����'\��s���:.1�ti�\� tz1 �i��l , 1�>>lt�1l' 1» .�\1 4 \ \L ti k t{ �. ���� � � 2 \z \� � t'* t+e�CTtl ��'1QCE5�B�'��� � � �t�,� w� ;�\� �...` �\ tt��\ �� � ���� L� �,� � �> �. �,' ':� �\ � \ 1 � �t1ll\��\ i ' ��i� \���\�� { �\\4�ti\ .� ����i�� � � � 10{I5C1NE2AV8 � \ �\ 1����\�\O ����t����`��g�. ti�' � `� `� �� ' Z,, #� MlaRll$hQfE'S F���1�� �� \� � \�� � \� l�t �\`i�Z» ��?� � �°�c,,, ..����' \ ��>>�� Z;. \ t �� ��� �� s� � � ..'ti1�\`, �:'�\4��,, v,����� s \` ��.. � 3Q5-795-22Q4 }\�1\`��ti l��\�� � �:�3��� ����\� �sz\ ��\ � �\1 `�4 �� ��i \ ���� .. � \�i\�L,\\� �����\ . � \� �\ \�>>��� L � #}l� �� � s � 't' r� .,._C.�" � \, � \ ��'i k �.Zl�ti � \` t��\�l,`a�.., '}� \,..ti � �,, { ,i�.o,.;�� �+i��4s3� �� � A', � A � 15 � � \ �ti � ��62�i�� ����z������z�l� ���� � \� \' � �� �� \ t t.. Z .��, .�. �< ����,t� A V �L�� � ���;���`����,�, �`����� �� �, �xp`tr�tlot1: 10f�.1�2�a1 ,.ti15��3����\�}, ..�\�a,,�`\,�..��:5`�����..�\1w�,t�,��<;3 Lac�tic�r�Addr�ss Parcel Numb�r � ��..� ��� .�._�.,�M ��.�� �...��.�.,�.�.���,�,���� �_ aay.��a..�,��e�,r a..�...����..,����.,�._. ��,�,_. � 19t1 Pd�1ifi 971�F�ST,Mi�reti ShAreS,FL 33150 113l010250QS0 � Contacts �...�..��m�� �.��m�������_�._��� ��m���,:._�,__� ������_��ar.����.n�dm���m�,��.�.���_,�a,��.M���� �� .�a�a.���,�,.� � Perey�alpartida Qwn�r BUI�C�IM11G SEftVECETEKS L�C ��rttract�r f 19Q(VW 97 S�",�iami Shares,F�.33250 1�St�S�AR(�IE(�T� � 5323 MICC€N1A!A#CES B�VD,QR�ANDO,�L 32839 ' �usiness:3Q59�62217 � �� tns �ets�n R� uesfis � ��scriptiQn�KITCH�N ARlD BATHRQOMS RENC�VRTlC?Ri � � Val�atie�r�: $ 3,3Q0.00 � , ` � � e ,, � { � ,`�\� � �is �y��L ° �3 �� �: � ' Total Sq Feet: QAQ � o,t "\�`..���ti � �l�� � l� � FE.'@S Aft1QUR9t Fa}JCT&�CttS L1�L@ P�ICI ARtt P�PCI Applicatian Fee-Oth�r $SQ.00 Tota!Fees $12�.59 CCF $2.a0 Credit C�rd 04j09J2Q2S $12�.59 DBPR Fee S2.Q0 DCA Fe� $2.OQ �mount Due: $4.40 Education Surchar�e $0.8Q Permit Fee $65�5{7 Seanning Fea $3.00 Technology Fee $2.8� Total: $128.59 uil in e a ent a y In c�nsideration vf th� issu�nce to m� of this permit, f agr�e to perform Yhe wark cov�red hereunder in compliance w+ith all ardinances and regulations p�rtaining ther�to and in strict canformity with the plans, drawings, stat�ments or specifications submitted to the prop�r autt�orities of Miami ahores Viliage. In accepting Ehi� permit I as�ume r�spon�ibility for all vrork dc�ne by�ither myself, my ag�nt, servants, or employe�. 1 understand that separate permits ar�required for EL�CTRICAL, 1'�.Utr��IN�,MECNANICAL,WINDQWi, DC?C7FtS, F20C�FfN�and SWlMMEN�POOL work. � CIWNERS AFFIC3RttIT: I certify th�t aEf the f�reg�ing information i accurat and tha ai ork will be done in compiiance with aIl �ppiieable law� regulaFing�Qnstruction and zoning. Futh�rms�r�, E�uEhoriz�th�ab�v n c t d e work st�ted. r` s k ,4uthori�ed Signatur�;Owner 1 Applicant t C�ntract�r 1 Ag�nt�� � Ckat� April€�9,2021 Pa�e 2 af 2 i i r s i[I ������������������ � � il � � r t �� � � s.OQSCI tU.E.2r�d�uen�a�,1Vliatni�F�c�res,F?orida��1'H ^ -�� �r��;{�������-zz�����:����)���-�s�� ���ff � ��s������a������������n����a���s����a�sa� ��..��.,�� � � � ����r P�rr��t�c�. R�� 1�-` "��� � � � �c�b P�rr�i� ��. ���a6�,�E�c � �����-��� � �c�c����� � ����s�c�� � �x-r��s�c�� �����v��� �����n���� � ��c.����c�� ��u���c����s c����� c�� � e��c��.���Ec�� � �r��� �c��v�-������ ��r�v����s ��������ss; � r,w�� s� City; _ ��iam[Sh�res �o��� firliami C?ade Z�; Fe����a�P����1#. �"E�;3�C}1-C?�5-��E� � ��th���aaldie��i�€�r����ly���i���fi�d;Yes I�C} � C�ccupancy T�jpe: }��� lo�d: �_�______��nstr��ic�ion Ty�e: ��S _�Flo�ad Zesr��._� ��F: �f���FF�: ��7� C���ERe �aer��{Feesirr�pleTit4ehe�lder}:,F'��GY ����2TEC}� f���EE111FEE� CUC�l�I� Phc�r�e#�: ����3�- 7Cl �idcir�ss: �C`�. SVt� %�CT City; C},�1l�lE __m__� ___� ____ �ta��:��- � ��,_ �,p; 33��4 �___-___ Tenart�JE.ess���la���; C�`�A - -- __��_ _�_ e .Phane#: �f�' ___ E�r�aiE: �/� �—_ ______._ --- �c3��'�.AC`�C�RcCarr2p�ny�van�e: €�UI��i�C'� ��F�'111�;�� ��E�� ��C 3�-��F3�-2�-�7 ___ . �,____—___�_._______.__----�'�one#:_ �dcir-ss. ?:32� �E_E_�lill�-1 L�lKES �a'�.tlC�. S�BTE __ _ �_ _ __ __ _ __._ C iey: C��2��1�C�� _____p�--�-�—g�-���ati�:�.��_�-_ —__ __�'�' _32�3� _m__.__.� Q.Uc`3IF�'�P(�k3FYiP1 ��`-'lJ� ....._.,.�V�� �P'1� IU�! � __._ ..___..._____,___.�_ _.._.�._...._P�1C�tl��:..,,.,._.._._...��. G.G"`t i St�te Certi�catian c�r R��isteaeic�n�. C;F�1���3� �Certifieat�af Cornp�t���cy#:_____ �.__�_,_�_ t���t����t;�archit�ct/En�;i«eer: FT�i���` �1tA�F'�,F2TIGI�Q f��..9��� �__ __.._._.�......�.�hc�r�e�r ��a"i��3�-�ICC� Ac�dress.��SUV ����" ���_� eity; G��1V1� 5��t�:��-�z��,�: :�3��d_.�. �f�iu����c�rtc f�r�hi�P�rr�at:$ _ St�c����JLira��r F�cat����f�c+rk. _.______ Typ����ea�k: � �1clditic�n � �leeratio�� [� �euv �� Repair�JR�pf�ce � [�errrolitic�re #��sc�i��i�r��f��rk:_K6��FIE� ��C? ��T6�€�C}CC���2F�C�tI�TIQ� �RIC} ��1�GAP2F'�FtT FIV��_C��E�I�E .����ify��I���f��f��t�r�� t�l�: s�� ���������_�_.._ �.���������� __ � ����� __.._� ��/�c� s������������.�. �.����������� ����� �.�������� .��__� T��hr��lcz��r F���.�.�__._�m����.� Tr�irs�r��°Ed�s���i�a�F���_ ___-__�c��ab��F��$ S�r���er�l R������� �� � .� �r����.��e���r�����,�� � (�e����a�2lan�zo�a� E3c�t�diE7�Car�p�€�y's€4arz��{if applic�ble} �c�ndin�Ccar�p�ny's�ddress___ �itY ___.�___._�..�___ SC�t� � - _�� �� _ �1cr�����L�n��r'��am�{if applicak�Ee) !1�1c�rt�ag��en��r`s�,ddres� Ctty �.____. S�a��_ ..��_m__ �EP__.� �� ___�_. d�pplic�tic�n is h�reby m�de ta abt�in � p�r�it tc�d�fiF�e wo,k�r�d ir�stalla�i�r�s as ir7c�;cated. € c�rtify t��at nQ work or ir�st�llatic�n i�as c�me�enced pricar tea �h� issu�nce c�� a perrnst �n�# tE�at a11 �rc�rk will t�e per��c�rrr3�d te� ���t �he st�r�c��rds of a(( l��v� r����l�tirt� co��structita�� ir� this ju€�iadicticn. I ur�c�ers�ar�d t��t � sep�r��e pern�it r�ust t�e secrx��d fc�r ElECTR�C, PLLJ�Bi�lf�, SiE��3S, �C?{�ESx FURt�,�CES, BC�kI.�l2S, FI�ATERS,7�E�KS,A(R C�t�DITPC���R��ETC,.,.. ���E�i�S �FFI���1�": I c�rtiFy that a!P the fcare�r�?��� infarr��a�ior� is �c:cu�-ate a�-�c� th�E a]1 vvc�ek uvikl b� dc�n� ir� ce�t�plianc� u��ieh all applic��f�I�v�s r���l�tin�cc�nstructiQn�r7d zoni��. r� � ��� � � ���o � � � ����� � ������ � � ���� � � � �� ��� ��` ����,� � � � � �� � � ��� � � � �� � �� � � � � � ��w �� � � { �� � ��� �� � �� �� �� ���� '�� � �� � � �� �� � �� � � � ���� � � � �� � ��aa �1c��ice eca A�a�lic�nt; �ts a eorct�t�iar� t€��f�e fsst�c�r���af�b�rffd�r�g g��rrni��a.�iti� crr� estimca[�d v�lc��exce�d�`nc��25f�(� t�a��a���icca���rraus� prc�e��i�e ir� gac?d faif9t thcrf a cr�py cz�th� r�e�[ice o�ce�rr7r�t�r�e�n�er�P c�rrc�cor�sfr-uctF�ar� lien tavu k�r�ach+���� �r�l��de�it�er�r1 tc� �f�����rsc�rt wf�c�se property r`s subject�a attcre�rrtent. .Also,a cerei�ed cr�py c��`Ptre recc�rcfee�r�eatic�eaf c,�rrtrraeracerr�e�rt rr�usc be pos�ed at the�c�b sr�c� �`ar the first ins�ecticarr �rhich r�ceup�s sev�n �7) r�a}rs a,�ter £h� k�crrt€�rrtg p�rrrtit is issu�d. tn t6t� crbs�rrce a�suc�t �dst�t� racatic�, thc lnspec�ron�uilf ne�t be cr�aprc�ve��rad ce r�in�p�c ' rr,fee snr�Pt be c�crrgec�. Signat��re � ,�'` °"°� � __._.�.._� Si natu .�` t�UV�ER or��{{aE!V� �QC�TRfiCTC�R Th�fe�re�oin�instrG�m�nt was acknc�wEed��d�ae�ore r��e�his lh�fure�gin�irts�r��n� n��as ae.knourled�ed ia�fQre m�t�is ��. � �__ `" � �ciay of � ��� �. ����. , iay ���___ ��y c�t '�""����c�� ,2C1 `� � , �Y � � � �. _ ---- p �� ._._. -` -���� � �°.����; �� � �ona ly knc��rn ec� .� �- �`�� � �. � �:�C�',�rho is p�rsc�na�i nc�w�t tc� �� ���,. m�or u�?he�has�ar uc�d___�_�____ __ �s ;�r�rar�vha has prt��iuced_._ __���s ic�entifica�ic�n a�e!v,!hc�e1ic9 t�ke art c��th. icl�ntific�tion and kvho dic�tak�ar��aath. ��1�A�t�t Pi3��.� ; ���'�F��Pt���,l�; ���� ��� }+ ��� � �, �' ` �_b Sig�: _ � - y,�t S����: � --___ �- ---� , _ _._,_...� ____� F; x �' ft Pt�it1�: �'. i.`...r �.-- ._.__._.. e._ �.._P�I��: �&"Y't\.����`t _"��y'� �Ec�t: 'y� �9���0`���. � ��'c`3�; �S?�'�� �9��I$f�#t�Tl���'{�A$E}�QN � � . t��tary Publie State o€Ft�iri�a �.�"' �-: �otary PaaDlie-&t�����Flo�fda �� Gamtrrlssi�r��ifH�7t394 ;� � °�'°' Cctm�niss on�GG 12T245 '�;�, �� �'`� � �}=C�mm_ExpieesJuk23, 1 �<.���� �Ay Cor��a.E�9resD�93,202� �'' ,���� .�� d�d thr�� h Hatt�n�l,��E� �ssn. ,tcr��,.� �,rdedthro �!a' � �Y ���R�&4��##��� � �� �' ������a����#��#X��:k��h������a���X�k#�� . . . �#��k�k;� t�PPRO�tEC3�Y �_�� PEans Ex�r�iner � __ 7ranin� �.�_ Str�uctural Reuieu� � f�lerk {ReuisedO2l2�12014} ��, .��.���� ��. � f< ���` �� t� ��° �'�; �.,,�� ���"`�� '� ��� . �' ... ������� '� �� �����$S ���� ���� �lr����"���1� �f�����}a ����.,_� �`��„��.i��,�; ��, v._������"��� �.�� �����, ��: � �� '+ , } � ��a�, r � r� �� � � �����'s �������A ������ °,�. , � � � xi�< <� RK " a ,� 3, j.,�r� , � D. .... .t.. . .. bmt§ 7=....� ��Cta44. .. . wFGf.,86� . � �r &�� ��aroT��g�....N `.���,F �� f�! �°. . . .. . . . . .... .. . . . . � . . . . . . � � r x „i.�< ��� ���r��ss ����r� ���� �� ����� ������ � z� ���� �..����. � � � : .s � �ity: �� � ���r�� �����. ������� �i� ��a��: ��� �� � un��� �* „����� � �� �� ��.. ���s������rT�� ���������� N�r��� ����� : �� f A j ���r���. �, u� ������` ��� �� ��`' � ��. j F � . � � � :` � � �� �� �' �����; ���.��.� �� ��� �€���; � �. a ����i����'� ��r�� � � ;`� � `�.�.p�.. �..��s ��r����¢ � � � # �.., �@ ' �� £ . ,�����i����� �r��ir���� �����:��c� �����. � � � ` . �,�.u�'�m„�h , ,� � ����� �� � �;m . �� � �;� �� s �������e �:� �� _, $ ��. �_� � � �.itY� � _�.� ��`� �..�.... � � �t���. ��f�. � ��� ����a �° ����� ��""�'������ .�a�# �"�t { `�E .�...€ �r€,. i„ g�f`��� �.:�,,,i�.�i 4 ���'..&�.,�8�*.,.�.,$t�l° �,,,¢0..»t� ' �a�, .,,2 4,.,�„.���,�"�,....o�,� � ��,��*,.�.�...F,� a . �.t. . , `s �. � } ��.+ 2.i . ... . �� . . . . .. . ..,.. . . . ... .. � .=m � ,., ,a � �����y ������������� ���� ��� ���� � ������� �� ,���������������r���������� �� ������ �r�� ����� ���� ������� ��������� � �� ��� ��� �� ������ ��� � � ��a ��� ��� ���� ����1 �� �� ������� � ; ��� �i r������ � .°� �� �t� � n. � � � �..� ;,� ��� � � � _� _� r�..�...� �w_��A�, � ��������,� �� � ����� �3 ���������` ����t���� ��� ��€������� �r���r�����t��� �� �v������� T��� ����a�������� ����������r����� �k����������i � ������ �� ����� �� �f � ����'�, �� ������ �� ��i� c��� �� � � :�� , �� � ����r������ � ��,�.�� _ � '� �rs�� �, ��°� ���a�� �� �� ����� ���s ��°��t���� � ��r� �� �� ����c� ��� ��������� �� ��������i���t���. �s i���r�°���������a�. � �fi� � �l� ���� '� ���� � � � �� � ����� �� �� ���� ���������t� � �a��,��s���c��z � . ,+�"��s� R�SE��N YUKfN ��� Not�r��eakdtc�-Stat�t�Fic��c#a �1� ��P� ����� � � Y P��S#��e�0 FI�r6da ��' ��� ����; �§� �< ; c.��r�is���t��s5 ,� , ��,,,. � � y G �3.��piret 3t�t?3.202i ��.__,��� � ����°�s, � � �sn u��u��� ����� r��pot��" �{1ftt�Qt��PIf�fU��1��E�Q1131�013ry�$.Rti. � iam� hor�s ill e �� `� � ��� � : . �aildir�g �partment �� � � � ����� ,-�}� 10050 N.E.2nd Avenue, E�liami Shr�res, Florida 33238 �R� r�i:t3�s)��s-zzo�Fax:(�as�7s�-ss�2 INSPECTION CINE PHQNE NUMBER:(3Q5}762-4949 F�G 2Q�`� ��-� ��� � Master Permit No.��� '� �� ��� ""��� � PE�MIT APP�ICATIQN Sub Permit Na. ����"���-��.=�.�`C�� ��ue����G � ��ECT�Ec � �a�aF�N� � ��visEory ❑ Ex�-��s�ary �����wal I.UMBING � MECHANICAL �PU�LIC WQRKS [� CHANGE OF � CANCELLATION (� SHQP CONTRA�TOR QRAWPNGS .� �oB a�o��ss: t�i � ` C��,`� Citv: Miami Shores Countv: Miami Qade Zi� FcalioJParcal#: [ t � �� �( '" ���''"`�� � Is the B,uilding Historically Designated:Yes NQ t�ccupancy Typ�: Laad: Construetion Type: Flood Zone: BFE: FFE: owNER: Name(Fee simple Titleholder): � � �' �� �~.��`° Phone#: ��.������.��' Address: � �..�r"�} �C� �� � �-�'�`�'` City: State: Zip: ��d � Tenant/�essee Na Phone#: Email: �'�� � � �m� �a t . �� C�NTRACTOkt:Company Narne:�f'� ''��-�.' --�t � � � � �''��% �1'�`�� Phone#; �� � �� � -���� ����"�`f��� Address: � �' ��.. �G� t,.�� ,.�`"�. x City: ����� � ,�,� State: (""`�_ Zip: .��� `�� d. Qualifier Name:���`°� �� l.������� Phone#:\�� �d� J`��� «;�"'! State Certificatian or Re�istration#: ����� � t"�° Certifieate o�Competency#: D�S1GtVER:Arck�iteetJ�ngineer: Phone#: Address: City: State: Zip: Valu�af Wark f�r this Permit: � E � �� SquarejCrnear Faatage of Warka Type of Work: ❑ Addrtion ❑ Alterati�n [� New Repairjfteplace ❑ [?emolition Description of Work. �-*.�,�� � �'� `� �� �'°� �'�� `�' �- ��..,�� � � � �-�- �`� � .� S'pecify cvlor c�f color thru tile: Submittal F�e$ Peemit Fee$ CCF$ COjCC$ Scanning Fee$ Radon Fee$ QBPR$ Notary$ Teehncal�gy Fee$ Trainingf Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revi5ed02/24J2Q14) Bonding Campany`s Name(if applieable) Bonding Campany's Address _ City State Zip Mort�age lender's Name{if applicabie) Mortgage Lender's Address City State Zip Applicatian is hereby made to obtain a permit to do the work and instailations as indicated. I certify that na work or installatian has commenced priar to the issuance o# a permit and that all work will be performed to meet the standards of all laws regula�ing construction in this jurisdiction. I underst�nd that a separate permit must be secured for ELECTRIC, PLUM�ING, SIGNS, PQOE.S, FURhiACES, BOILEftS, HEATERS,TANKS,AIR CONDITIaNERS, ETC..... OWPIER'S .4FFtDAViT: 1 certify that all the fore�oing infarmation is accurate and that all work will be done in camplianee with alt applicable laws re�ulating canstruction and zoning. "WARNING TC? QWNER: YOUR FAILURE TO RECOR[� A NC?TICE OF CQMMENCEMENT M,AY RESULT IN YC}UR PAYIRIG TWICE FQR IMPRQVEEII�ENTS TQ Yt�UR RROPERTY. IF YQt1 INTEND TQ t�BTA1N FINANCING, CONSUIT WITH YQUR LENQER OR AN ATTORNEY BEFORE RECURDINC; YQUR NOTICE QF COMMENCEMENT." Notice to,4pplicant: ,4s a eondition to the fssuance of a 6uilding permit with an estimated value exceedfng$2500, the applicant�must promise in good faith that a copy of the notice o�commencement and c�nstruetion tien law brochure wil!be delivered to the person whose property is subject to attachment. Alsa, a certified copy of the reeorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7J days after the building permit is issued. in the absence of such posted notice, the inspeetion wIN nat be approved and a rernspection fee wil!be charged. � � � �"�� � Si�n r �' Signatur � �.-'� "�- � � OUJ'I�R�or AGENT CONTRACTOR The oi� ' strument wras aeknowledged befare m�this The fore�oing instrum t was acknowledged befiore n�e this � day of � �� 2Q � � , by � °� day of � . t 20 � by ���� ���� €��-,�ho is persanally known to ���� ���°���Ei,��`��ha is persanally known ta me or who has produced ��# �'��` as me ar who has produced � ��%�� as identification and who did take an oath. identification and who did take an oath. NOTRRY PUBLIC: � NOTARY PUB�IC: � fi", ; x ��������4��§�tEBtgs�p�F�������k �' �� �40§$ ` 9�d,e= .� ��, � � ^�, �Pf �.' ...--�� � t�� r�`,� r y,`yli� � �`��y' . Sign: r°' ..-'°"`� °��, ��;�Sign: �° '� � V �� �o�� Q .. f n. '`•�'`� Print: �-� � �rint: �.�, � � �c� _ -��-�- � s,----�� s � -� Seal: _ `a ` c. �eal: ' � "~ � �� , � .. ,� e ����a„ � �� ,�� a ��n '�' ' u �,, r `, � "� ,1������ �,� c � ` � �"° ****�*�*���**�*x���**���z�*��x��***��**�*�*��C`#,��?��#��m�����**���:#*��**���x***�:�z�*�***���C*��Sx��*���a��**a�+�„��x��x���:� -��fir,��,:. ;�f .tt,. Y t°`�� ,,/� � dki����i�Y °54�..�, APPROVEQ BY �' m~ �"�t` � ���° Plans Examiner Zoning Structural Review Clerk (Revised02j24j2014j ������� l 1 �1�I"�S IrC � .... ����.� � � ��� ����� 1Q05Q N.�.2r�d Auer��� �� �,�t�,'C�P� �li�r�i �h�r�s, Fl�rid� 3313� T�1: {305} 795.2204 Fa�o (305} ?56.�972 fii t r � r r ' �i 1 r � �i �'�,s�'��?'��:�ti. }l, ��z}� � � �6 ��? . �.� 1,.�c� �;��{ ) a,�, .� � ;`�.i\�,�} r � `�� ��' } �. ��`i� ixit4�tti:���,1� � �torida Law cequir�5 ��'orkers' C;'c�m��l��atian iz�suraslc_e eotrera�e �xnd�r C11a�ge�� �4� �f tt�e Florida Statutes. Fla. Stat. � �4(�.U� I I ; �Ilc��s tor��?r�te o�ti��rs in tl�e�e�c�st�u��i�et izzdus�s-�=tc� �xem��t thenls�l�es fra�z1 tl�zs�•ec�uire�nent fc�r arty �oc�str�setic>n pe•oject prioc to � ; obtainir�g a bui#c�in�p�r��Zit. I'ursuant to t���Floric�� �}i�isic�l�pf��u`arkr�rs' �c��s��ens�tiQn�tnplc�yer F�cts Broc}�uz-e: i C !�n �rt�}�loyer in the construction ind�Estr}r who �iz��loys one or �nore �art-tim� o�• full-time � I e�nplo}�ees, ir�cluc�it����he o���r,n�ust abt�ir�w�orkers'com�er��atiai�cQvet��;e. C`ar�oeate c�ffc�rs � ��t� r�ie�l�be1•s of� iimitec� iiabiIit�� cc���paz�y (LL�I in the c_allstruciion ind��s�r�r n1���� elect to 6e exern�t if: ' i ! � l. T[a�aftice�-c��vz�s �t [�ast 10 p�r�;e7�t c�f t[�e st�ek of tile ca1•poration, or in the c�se c�f � � ar�L.LC,a statement att�stiE��to tl�e minimur�� 10 per�ent c���z�ership, 2. The ofFic�r is listed as an o�io�r of the �;ar�orati�an in �he reeareEs of the E lQrid� j � Depar�n�e��t o�FState, Divisian c�f C:az-��ratic�ns; �ncl � u. Tl�e cor-���r�tion is r��istei�ed a��d listed as �i�ti��� �vitt� t�11e Florida Department c�f : � �tate. Di��isi�n of Corpc�ratioris. ' i ; �o m«re than tl�ree cor�or�te officers ��r cax•por�tion t�r Iiinited lia�ilitv cc�r���aanv Enembers �z•c ' allotived t�� E�e �xe�npt. �`austru�tic?n exezlaptions �r� valicl f��- a period of t�uo years or until a � ��at�zz�tar�°re�°ocation is fi[�d or Eh�exeu�ptic�n is revoked 1?y tl�e I�ivisian, { 1 !I �°`our eontrac_tor is t•�c�Ga�stinff a pernlit under tt�is�n=�rk�rs'cc�nl�ens�ti<a���x�n�ptzon aild}ras acknawl�d�e tl�at}�e or she��+=ill not us� � � day 1aE�ar,pax-t-time ernp[t�ve�s ar subcozatractors"or y�our pre�ject.The co��tractor has�r�avided an affidavit static��that he c�r she wili I � b�the anl}� persan al[c���ed tc?�u�rk oz���c�t�r project. Ic�th�se circu�nstanees, ��tian7i Shores�1i1(aa�dc��s not requir-e��erificatic�n of � �arc�rkers' �a�npel�satian i��sur�nc�cot�era�e fro�r�the cc�n�raetc�r's ca�npan�r for�ay Eabc�r,�at�t-ti�ne ez���lo}ees o�•s�bcc�r�t�-�ctc�t�s. i }3�` 5IC?\(\G E3EL�}ti1 �'QU :�CK�C)WLED(xI: TI-I<aT 5'OI� ��r11 E 12E.�L' TNIS \C?TIC'E; ,�tiL} E-�DEF2ST<��I� 1 FS i � C(�tiTEtiTS. ' ( � . i � �,�'"��-_�� a I i �14?i1a�UP��..— "=�",�-' {� -- � i � �,�^'�° (�6 I � ' i �t��te of Fl«ri <� i ; i �OU �t111-L)ZC�� � Tl1e fore�c�i�1g��as ackno4��l�ti�e before r�1e this � ___���3' of _'_�''��----'��-�_�-' 1 ; Bti � �� � �'�� -----uiho is p�rsor�all�kno��n ta me ar I�i�s pro�uced � � ._ _---��_�---- � � �� as i ` teatic�n. j _ _ -- ------__ �����a��`�'���,����� � \ot��ti: ���� � � '��e.��, , _._.___ __ __ ` �"� "�`�° � ,.�- .�^' «�,.✓ �� � ��:�'..�5`�� . .. m, -,. ( �� I i ��<�L: v �ra: " ;:��. � � � �' 1 i � �i r���. ,r x �'a ,„ ��������{���ti�6id�614����1�������� �T � � ..,,.���:� =�3 � � � � ENCTINF:F;I:F;I�SY`,iTI:M��C?I.LJ"I'IC)ieS I.I.C: 7352 S�4t Street;4�Siaza�i FL.331SS I'h 3E�5-909-4t37I F�)S�-€;7I-68f�� F�f1T�': Qe.f��ae�1.�, ?�19 State af Floric�a Cc>uittv af I3��cie I,7est�s Caef���nate, u=iI1 be th�e���ly pers����orkin�c>t�t��e praject�t: l�(}N`W 97"' Str�et,�L�iami Shores FL a315Q 5`ncer ly, -�"� _ �`°. ���,� " i�a� ture � � t����� � ���� e ��x���t��n� s�����t�rtQ���� C oi�nty of Ntiami-Dade .� ,�, Llefor�rzz�,this �� d�y of� ��.�� _,_��,persan�lly appearec� ��`.��,..� �-� ��"�°"$iZe_��„r+� ��c�.�.� �erl�c��xee.�ated the fc�A-egoin�instx-urr�er�t,a��ci acknc�wled�ed befc�re ine ttr��satz����s exectrted fc�r the;pur�c�ses thereit��x��ressecl. �,"�.- ty���,`�`�,�-�� �-�_. --�,..� {S�:AZ.) � � ���������t��#�d���S���n�lly I�n��u�k ar 1'rc� ��"_.._ �� � Idctl�ticati< �,�°�°°�o`��-'a� ,�, � �' r' ^,=`�� ��`'� `�� "" w"^�z w .« � Si�n i>f Notar��PuE�lic � '` �� �« ; , ,.. �����'�f��bs�#ddk t1�1��=��#���'.