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RC-10-21-2818 � I � ` � � �� � ��� ..��� �r� a •• ; : � �. �, ,� � �, ,» M � � k �r� � !� � " � i ,....�,. ... �. . ... . .. . .. .. . . . .. ...�_.._� �Qli '�t+QRiDq" F'ARC��.: 113245Q 18047Q �ER(i�ET ADC�Ft���. 1151 N�99TH ST Nliami Shores,FL 33138 10i29t2021 St�UAR�FEE1`: 34Q.00 pE�CR4P'1'IOPt:FtEMC��(E�XISTING TQ(L�T&REPLAGE,REM�V �pf'L.ICA,TIOh4 t�AT�: $7,000.04 EXISTING TILE&REPLACE, REPdlQVE WAt�L TIL�� �XF�BRd�TtC3N[�ATE: d4127(2022 1tAL.UATiOP!: REPLAGE. 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'.<dt�5t.i.t}:, ,`ti;' u:ttit .u—i' lt, ��i��i,i . .a;;ii t:#X �:5i .. �s SchEuter Sys4�rns{Gart�da� tne, • � ... .^�� ., u u ',`.� .Si.�., �� ,..��., ,.,._. _�.. ?>:..�� � fr �.' r:( � ;{a ... . . t� _ � ,,�<,,, . ,.:,b ��.�. � ... � , .,, ,rw . ;,,, , ,.F=�„� %�����°���'�'� ,�� ��� � � � � �: � � � � � � � � ��� ;�� ���"��� �� �� .. � � � �� �': . � � ¢�. .. �k .� � �, ..,.S��y��k, `.� ., . �P'p�'"i"�,+ib�� � `������°` � . . . . . .. .3f. .. . .. .. .. .. . . .,4f. t l�a 1 �, �a� � il .e. .� . ,.. .L. ..... .. . . . .. . . � . .�.. . . ` ��F��I"f��t�����: 1151 N�99TH�T ��,����: 11320501$C3Q7d Miami Shores, FL 33138 �€��€�E��1"{C3h6 C��T�: 10129F2021 �C�t��Ft����T`e 30Q.QQ ���C€�IF'TIi��: REtVIC}VE�XISTING TC1lL�T�REPL�CE, ���1��aT§C�hS��1'�; 0�l1 Q12022 l��L.lJ�T�C��#: $7,004.007 R�(V1G�VE�XISTIPVG T(�E&R�PL�IGE, �EtutOV�WALL TIE��&REPLACE. �C3I�T��T'� ���� ��'1�F'�PJY �I��f���� Applscant t�isseth�mil A�Property Services 1 gd0 PIW 33 5T, 12 Pompano�each, FL 33Q64 �isseth Amil R(�F'roperty Senric�s 190Q NW 33rd St B�y 12 NW 33�T NW, 12 Pompano B��ch, FL 33Q64 Lis�eth Amil AM Property i�rvic�s 19pQ NW 33 ST NW, 12 Pompan�Be�ch, FL 33064 Lisseth Amii A�11 Praperty Services 1900 NW 33 ST NW, 12 Rompano Beach, FL 33064 �isseth�0.mi1 AM Prop�rty Seruices 1900 NW 33 ST, 12 Pampano Beach, FL 33Q64 lisseth Amil AM Property Servic�s 1904 R1W 33rd St Bay 12 NW 33 ST iVW, 12 Pompano Beach, FL 33064 Cantractor C}S�IE�P BLUE MAR�IN GONSTRUCTION 7674 SW 15��VE MIAfttCE,FL 33993 Owner ADAM GRFtRICO TRS 1151 N�99TN ST NI€ami Shores, FL 33138 � ,� ,., .. ��1d3�1�U IT'�� �T,��"U� R��II���F� 1. Building �equires IsmaeE Naranja email: bo a(.,,,?msvf(.gov Re-submit v.1 -Plot Resolved Correctican: Gen�ral C;camments: See Corrective Actian Corrective Action: 1. Prouide plans with details and�p�ciflcatians for th�repairs as required under�ecFian 107,4 of th�202C1 Fle�rid��uilding Gade. �, Ei�ctrical Approved Michael Q�Vaney�mail: Nu1125�m�vtl.gov v.1 -No Garrsction 3. Plumbing Approved lt�iguel Cabrera emaiC PLa�msvfl.gov v.1 -No Carrection 4. �tructurai �pproved tarlando Bianca errr�il: bz3 c�msvfl.gou v.1 -No Correetion April 25,2022 1005Q NE 2 Ave Miami Shar��FL 3313& F'ag�1 af 1 �� x � 11 � � � �� A� ��d�k���, � . � ��'��`��� �;� ������ v �� � ��,�� �Oliarv�i Shc�r�s 1i�1l�g� ������� ��������������� � �' �'�� ��� "`. � �tr G'� '� 1C}OSC1 NE 2 Ave �,� ,: ;. � ` �`�� s � � 1 .: �,.. . ' ����� � � �� Miami Shares F�33138 • �� _ �������������� � ��`� e� � � 1 � � k� ��� 3Q5-795-2204 `` � �������� `'�`Aa�;�� � , � �, � ����'���i ������ � � , , z � }��t���� ��������� EXpICatlOnr 05jQ4/2022 t��,.. > Le�cation Address Parcel Number ���.� �� ���� �.m,....r�__ �....�.�M__��.,�__ .. _,�� ,r_a� _ �._.��_.�� �,. w._ � _�_e �. � ` 115�.N�991'�t�`C,t�i�rni Shores�FI.3313� 2�320501�0070 � l. �.<<, ���� Conta�ts AE7AM CARRICC}TRS �?wner BLUE MARElN CQNSTRUCTION Contraetor ' 2151 NE 99TH S�,Miami Shores,FL 3313$ OSCIEi�PLAZ,0. = C?ther:415533�653 7674 SW 158 AVE,NIIAM(,FC 33193 z �usiness:7863997�27 oplaza@bluemarlinengineerin�.com _...�.................._...nm.�_�M�N,..��. _,.....,...._..._.,.,.._...___�..,..,......�,.�._.._.�.....,.,.,..,.._._..............�.,��..�w...,_....,____...___.,_._.._,_ �.._.,__...._..._.._._._._._.........�..�.....__........._...__...� �_..,._, j D�scription: REMOV�EXISTING TOILET�e R�F�ACE,ftEMOV€ i �� Ins ect�an Re u�sts Vaft�ati�n: $ ?,09�.OQ �� ����� " ` ; EXIS�fIN�TIL��c REPLACE, REMOVE WALI TILE&REPCACE. �? � �:'. ` Total Sq Feet: 300.E30 � � Fe�s Amaur�t P�yene�ts �ate Faid Amt Paid Application Fee-Other $SO.dO Tpta1 Fees $235.1Q CCF $4.2Q Credlt Cdrd 1Q/24/2Q21 $Sp.QC} DBPR Fee 53.15 Credit Card 21J04/2021 $1�5.10 DCA Fee $2.2Q Educatian Surcharge $2.4Q ��ac�nt Due: $4.40 Permit Fee $16(1-00 Scanning Fee $9.�� Technology Fee ���� Total: $235.19 li t 1 I C1 � @ n'� In conaideration ofi th� issuance to m� af Ehis p�rmit, I �grea to p�rfarm th�work covered hereunder in compliae�ce with �li ordinances and reguiafions pertaining tMereto snd in strict confe�rmity with the plans, drawings, s#atements �r specifications submitted ta the proper au4horiEi�s of Miami Shor�s ViIlage. In accepting this permit I assume responsibility for all work dcane by�ithee mys�Ef, my agent, servants, �r employ�s. I understand�hat separate permits are requie�d far��ECTRIGAl�, PLUM�ING, MECHAtVICAL,WINDC7WS, DOQRS, RQQFfN��nd iWIf�MWG POC}L work. C7WPI�RS AFFIQAVlT: ! certify that a(I the faregc�ing infarmation is accurate and that al( ! be d�ne in compiiance with all app(icable laws regulating construetian and zoning. Futhermore, E aufhoriz�fhe�boue ntract�r o th rk stated. ������,„�..�,.o �- f Authoriz�d Signature:Owner / App(icant t Contractor l Date Nauember 04,2Q21 Rage 2�f 2 ������°...` �����r`�����ew� .` ' 1 I �1C�r S 1 ��� � � . �� � � � � �� ��i I c�i n� [��p a rt r��r��t ���: ���� ���w_..�. 10Q50 E�.�.2nd,4venue, iirliami Shores, Florida 33138 ��,f"� #_ � T�i:(�05) 795-22Q4 Fax: (30S} 756-8972 ��sP����c�� ii�� ��r��� �uma��: (�os���2-�s�g �� � �� � �as��r �'�r��� t��a �`��� � �� � � R� � ��dll�' !4[�PL.I�I+�T'EE�� S�b P�r��� ��. �������� � ���c�€��c ❑ �Qo���� � ��v�sio�v � �x-r����o� �������� [��Lu��3c�� ❑ �Ec���►c�a� ��u����wc�RKs ❑ c����� c�� � ca�c����-rEo� � s�o� CQ�lTRACTaR DR�V�Ifi�taS ��a�������s, �� �� � �___���� — ��� : It���r�i Shor�s Coun� : Miam�i Dade Zi : � (�� �cs[�caf Parc�l#a �� � ��.f?�"�����""���� ` Is��Ze��ri�di�g�i�t€arde�t€y f��si�r�at�d;Y�s �� � Occ�pat�ey Type:��".�.�oacf: Ca�structi�n��€pe: � . �_.__Flc��d Zone: �FE: FF�: C9�1VE�; i�ame (F�e Sitr�ple iitfel�ofder}: �,��'�`t � Phone##: ,4dcfress: � �� City: � �- � ��°1t�� � State: � !,� Zi{a:� � � � Ter�a�t/L�ss��Na.me: Phane#: - �mail: � �� � t� � � �Yi�i �, . � � „�T� C��V���A��'��i� Gc�mpanyName. �� ��'�¢� �0� ��� Phor;e#:���`"��.��,.�� ��� Address: . �� � Gity: �'�� �s,�� Sta4e: ��,-- Zip:��� � T Q�alifier Name: (���e �� �" �� �� � Phare�t:�"t��°` ���p"°� ���� State Certification c�r R��istratior�#�: ��"'°� �� ���� � Certific�t�of Competen�y#: �E���&V€�:Architee�/En�ineer: �' Phone#: Address: City: State: Zip: t�� �ta3�o�of�tll�r3c f���his���rr�i�o$ ��� �� Sq�sa��/�.s`s�ear��cs g�ca��14fa�s�ke �������°�° � � � Alteration ❑ �1evv Repair/Re�facc 0 De oli�ion 1'y����vlf�rk. ❑ ada�t o ❑ � �e�er'spfie�ra �f V9l��kA ����� � �� "� � � �� � � � � �� S���i,f� ��l�� a�f�c��€�r'���'�t� �'�1��� � � �. s: � � �. Su�s,�i�ta( ���� ��P��mf�F���$ c�F $ ���'��� S���r��ai¢�g�ee� 8iad�� �e� � �8��2$ IV�tary$ 3'echrsczE�s�y F�� $ �'a��araiaagJEd�a�a�i�r� F�e� C9c�c��le Fe�$ `�r�aetura! ���wes�r�S ���d $ �-�a��� ����s���ts�s � �� , t��} i a �cnclin��c;�par:�:�'s N�m�(if���iica�l�) �ondtn�Company's Address CitY S�a�e �E� Mortgage �ender's�iame(if app€icabie) Uforfigage L.enclsr's�c�ress �fty �fi��� �j�} AppEicatEon is hereby r�ade to ob�ain � ��rm�t to ctQ the v,�os-k a�td irtstallatians as indfeated. i certi�y tha� no wark or ir�s�alE�t��r� has comm�ne�c� p��t�r �a th� iss���e� �f a perrn�t �nd tl�a� ��� �r(e uuil! be p�*��orri�ec� tc� r�eet the s��n€���€fs c�f �il (�c� e��t���t�rt� canstruction in this jurisdiction. I understand that a s�para�e permit musfi be secured for E�ECTRCC, PLUMBING, SIG�tS, POOLS, FURNACESF BQGk.��i5,�€EAT�RSr�Af��Sx�4E€��QE�C�(T�E����Sj ETC..... C?tt�'NER`S A�FE!?AViT: ( certify that all the foregos`n� information is accurate and that ali work wi(I be done in cam�aliance with a!I applieab��(aws ragu(at;r�g construction and zoning, f��f�'l��l�6� L i,! �����v 6��� ���' � t 4t �k.l.' ' � F1 F�EiJ��L� i.f'� 6.�1� G�:�I`Y`4 �� ������ ��$ ���� ���� ���' � ``.z ��,��: '��������� �� �5��`� r�`����.�: �, �� ��� '��i'��s� '�{� ������ ������� , ������.'����� �{��� �.�� ����� � � �'�f ������ �� � �'� � � � ���� � � � � � �,�� Ne��ice tQ App�icc�nt: �s a c€�r€di��on �c�tfae isscrartce af a b�e�t�fr�g perrr�it wit�a c��a e,�tima�ec/val�re�xce�d=�rrg�2.�(1t�, �he c�ppliecr���cr;�� promise in �oc�d.�aith t�hat a ��py crf the notice caf cor�trrrertce�aent ernd cerp�s�ruct�an lien faw brvcf�ure �vitt�e deliv�red te� ihe person �tnc��se prc�p�rc�r��scr�ject t�at�c€c�rrrrerr�. �S�sa,a eer��ffed copy c����re reeerrded r�e�t�ce�f eo�m�rre��en�rrrust�e�ras��d at thre�c�6 slte far €��e flrst inspecti�an �?hich a����s seve�r (7) �`a�s af�er t�e ��r�kdira� �rerrr�ifi is is,�ued. In th� abser�ce af�u�k� ��r.s��d r�a��ce, ��e tns�e�fiEon t�v�fl not�e��apro�ed€�r�d cr rciraspectrerrr�ee�nrr`fl b�ci�ar�ed. 5ignature S'rgnafiure� � � �� �� �--�; ��-- --- �����, ,. �� � �tN�{E�or�iGE�T ACTQR Th�i�����;���ir�sfis uf�«ni i�vas aei�ncs�nrEeci�ea ia�rc�r�r��thi� �he fQr��c?(ng i�?str�mPnt�n��s�ckno?�vledg�� �P���-e�,-�e�;hi� � � day�af � �C�t}�� t"' r�4� � �Y �� � day caf�` .� � _ F 2Ck � i � �y ����-'""'�.�..��r"'e,"�n;;�c�is�e,sanal�y�en�a�v��+to ����.t� � �����;�- , �v��is���s���liy knowr�io r�ne or who has produced ��`+�e"�"...+�'. �*t_��as me or wh�has produced as i��r�ti�ic��ior��n��vho did take�n oath. €d�r;tificatic��an�! ��rhQ di�tak�an aa�h. � ' IV��'�R� tP�i€.iC; F` �€t��` f��3���� ' ! � w;�....._�. �7 t r�. ,�'"" g""``e 4 r ta; r'"""`�,.. � , r` y ,r ) , �r : � �'` �,,.,......,.�....<.._,..-�m,. }, F � � � 1 �� ,... . .' � � 1 . �I�... ; �����¢°. �� � � �CICt�� �rFn4�; �..1 a ad �'Ut�k7R2{�S�9tt�����7�� gQ�,eawe�#f,�, ������������' Seal. �� �.� ��+te����agust9�2�2� Seal: � � �cz��l�et�a��G�2t1201 "������ ���o rr�� n���y �� ;��' ��plr��hugu��9,20� �'����'� �d a �#�������:���������*�����������������������������:�����������#�������������������������������������������:����� nF��o���s ��1 /I��'`�(�, �� t�, s cx�:��:�.. z�r�sr;� Struct«r�l F�ev'r�w r�I�*rk Pr-c�pertv ��arch Ap�licatioil � 11��aminDad� C�oLu�t}� P��� 1 c�f 2 �����k�� �� �3�� ��i�, ��� , ��rr�rnary F��p�rt ��„�f���a o�,: �or�srzo2l f�roperty Ir�form�tic�n ;r� �;t �� �� � ����o; ���-�a��-a�a-oo�o � ��' t ��_� n�_..��.._____ �__ i ____ ���__. � _� _ Property,4ddr��s: 11151 NE 99 ST iMiami Shares,FL 33138-264Q `"` � > �� � ��_ �.�._.._.� _. ._�._ �__�._.....�..��M��.____. .__...,._.. __.� .. j�� ����� EADAM�ARRICO TRS t?wner �CR62Ri�0 RN��ARGIA,�IVING TR ��ll��RTC?GARCIA TF�S ___.�_ �____��_ _. ___�-� ��.rm. �_ _.� ��` flflailing Addre�� C 1�51 NE 99 ST ,� � ` �t���.�y � �; ,�:,, ;MI�MI SHC?R�S, Fl.3313�USR ��.,.��� � _.�_...._.____.�..__�._..�___..._._._,,_,._ �. _w_..,_..��__.__�___ __.....�_....._.___ ....._... �. � PA Primary�ane 11QO SGL FAMELY-230�-250Q SQ � �_ �_____.�_____� � ' � �Q101 RESIDENTIAL.-SING�E~�^�^�T Primary Land U�� �FAMILY: 9 UNlT ���.�i. �.�e���.��.��an���.�_� B�ds i Baths!Half �_._�� ��/2 f 0 ��``;���M1� � r ._. �_.�.�_ _...r. .��,.�,_.�_� _�__, er, . s �m FIQC}t> 1 :� � � �� � � .����m �.______.� Living Units i 1 _______ _ .____.... _ ` _n___..____�.__�__.�m�_.___.___.______ _..__.___.__..._.._w_._..___ � � , �:�r Actuai Are� }2,OQ5 Sq.Ft . E�iving Area � ��1,765 Sq.Ft�����_____ ___ Taxa�(�t/�lu�lntc+rma�tion __m _� �_ ..��_���_��.� � .�__r_r� �___. Adjusted Area ;1,�57 Sq.Ft i 2021; 2020, 2fl19 � ��___�__m.�__�_�_�___ �_._�.��_e ��____ ___._ _�..�._m_�._,_w_��__�_m._____a._�_.�.�.____ �_ _._�._._,_� ���__._��._m___-_ �ot Size ��,925 Sq.Ft �aunty , _ � � ____�_ _._._.�______ . __.v�_.._..___E_____ ��______ __.___.__. __�_�__. . ...._____._____.�.. ..� ...__.,_.___, __w.._��___. .__.__......_..__ ..�____ Yaar Bu�OE ;Multiple(See Building info.} Exemption Vaiue ; �50,400, �5Q,000�������� $5Q,400 � __.__._---__� _..�_.___ _ __ ____�___ --_-_+-- _W Taxable Value ' �494,685I $4�7,165 $&75,088 ���essm�ntlnftarm�tion �---._.__ m__..____.__�_�__.____�___�__.____ ��__..__..____.� 8chao!��ard �.._. .___.� � _ ��._ . � Ye�r 3 2Q21 202Q� _ _.__2019 � , ---�--._�__ Ex�mption Value f �25,C}001 $25,09Q1 �25,OQ0 ....,..n. ..�.�.a.�.... ..}m.w.._...e..................e,.m..�...........m...._.n.,............_.......�.....,...,...g ...�...._.._.�..............�....�............--. .,.}�._.,...,...�. .�-,._.....�.—..�,. ......__..�.....m..m.�....,.-__...�....� �andYalue � $337,6�7 $337,fi87` $337,687 Tax�b(�Value � �519,685y �512,1�5� $5Q0,0��3 �._.�____._m �� __��_�__.�_ ���.�__.__„___ ..,_._.___�______....� _m_.. __n � _.��_�_.�___.___�,.m.�__._._ �.___� .�_._.�.__._.___�,�A. �� e__.w_M�._r Buildi�g 1l�tue i �311,976, �315,�76( �319,778 ���, _� �_�__��� �.�_��.� ..�� ---�-__ ._ � x�vaiu� ��,��a �����, �2,��a _._._�_ ____.._ � � _______. � ___. _. i EX��,�t�o�,v�Mu� � ��a,000� ��o,aoo ��o,00a �.���.�.�..��._ � �.� ._ �.!�._�����._ _ _.__._,��.______ _.�._.����___--_ -�-_� _._� MarkefVatu� � �652,273 �656,204� $66Q934 TaxabieV�(ue � ��49�b,6�5 �G87,165s� �475,488 __.� �______F.�__ - _........_ ...____,_.__ ........� ._.��._ . .._ ______...___ w____�___._. _. As�e�sed Valt�� � �544,685 �537,165�_��� D525,0�8 R€:gi���i __.__��_.N._______ ��_�____�______��_,,..�_.__._rt. �x�mption Value_.__ �50,OQQ� $50,OOQ€. �50,4flQ ��n�fit�inforrn�tio� _.___.._�_ __��..___��__��� � ____�__ � T�xabl�Value $494,6�5; $487,165 $475,08II Benefit ,Type � 2021 2020� 2019 _� �..��_._�__ ..__.�..__��._ __ _.;_.___�_..�_��_�_._.._..�.�. Save�ur Horn�s �Assessmen4 -�-..w.__._... �� � Sal�s tnforrnati�n Cap R�duction � �107;68�= �a119,039� �135,046 i �__��___.�___��_..._ __��_�.. _._._�__ ___ � _.__r_ Previous : OF2 Book Homestead �Exempfion � �25,004� �25 QQ0_ $25,000 S�E� ; Price ��g� Qualification Descript'son ; a._�_. _._ � .� _an��____._.__��.._ �___..�.__�_._�_.. � _ �_��,__ ___ ,_..__,��,_.__.____ � _�.._��.__ �_. __._.� S�eond�� i � � ! � �Carrective,tax ar QCD;min sExempfion � �25,606� $25,000� �25,000 Q8J12/2016 I $100E 30192-2348 i Homest�ad � � i 1 E �cansideration � �...�._���.���_�,m�e..���� ��� � _._. � �..__._�_�._.M.__.� �_�._____�__�_� __.____... Nate:Not�il b�n�fits are applicable t�all Taxab(a Values(i.�.County, 06l10l2Q16 �$7$5 OQO� 3Q113-0841 iQual by ex�m of deed l __._._ � m�_w��.._�_.� ��.���...�.._ __ � School Bc�ard,Gity,Regianai). _____�_....__� � 05l0612015 ?$46Q;QOQ 29607-3571 '=.Qual by exam of deed � _ .___�___________.._ ...___��_______...�_.� ._��____ �� __ Short(�ec�al���crip�i�n 1 0/1 91201 0 � �0� 2747�-0697 ��°����tive;tax or QGD;min � � consideratian 5 53 42 F�43-69 REV PL MIAMi�Hf3F�ES SEC� LC}T 18�LK 178 LOT SIZE 75.QOQ X 919 OR 9274 9fi4 The O�fice of the Prc�perty Appraiser is cc�nfinually�diting and updating fhe tax rolL This website may not reftect the mo�t current infarmation Qn record.The FroperEy Appraiser and Miami-Dade CountY assumes no Iaabiiity,see full disciaimer�nd Us�r Flqreement at htfp:ltwww.miamidade.qov/info(disclaimer.asp https./l� =.zTai�mid�ci�.gc�vl�}�psl�'A1prc���rtys��rch/ 1 Q/29/2021 �,��' � � Rcrn(�eSantis,Gbve�nr�r hi�lsey E3eshears��ecreta i 4��`�� � °�' � t�`` th� a�``. � �` t��<<: � �n�.rt �.: .� �t,..,�� � ���,,,����� �� ��� � �� � � ,� �,�� ���`�������� E � TMENT F US1NE�� AND F� �E5S1 l�L �GtJ 1'1 N �t�►NSTRIl�TION 11'�#L�U�TFt� �;I�ENSIN!� �Q►ARi� TNE �ENER�IL CQNTR��TQF2 Fi�F�E�N C� ��l�Tt�IEI� UNDER TNE PRC�VISIC.�N� CJF �1°�IAPTER 4�39, FLf�F211�A ST�T�,ITES ��.1���,�., ������. �������� C.7L.t„�� k�Fl"4tlI..IN F.=(V1.7�N�G»��lVL73 {�L6.+ S.LdG.L�'4iGQ���I.V. RL«f��S�t9��L?'.J..�. .. _. . ��,dCS6,..F"IEVVSJ �� ��&.m2�GJtd�.. t � �'L.��J���i�'{CBGR:�.:L.4�L.J:��16li°'tVC .. i ... , . , . .. ... . . . . .. .. „ �!1!'�R/^4 d I�JlV A✓H 1�: M6Jl.l4,d.2 1 w?�p�Lt.66e. �Iw�ys�erify[ic�ns�s on(ine at MyFloridaLicense.cczm � �''� �c�not�Iter this doc��m�nt in any forrr�. �� This is your license. It is unlawful for anyane c�ther than the licensee to use this daeument. ��� . a w.HV N.ta'�ftata�B'dtlT'a ���w� m namn Mm��n�1Pa& �mr��m Mo.aen e#YV a Va+e'w %w�v�vm�0a'e� �M8 B6Po� � 6%��� Y�45 0Ra%0.d @X . r �Q$�� . . � �tl��9 �� �{}i�i'!���b)6.� f63td E i,l�R 1 4.7C.IY6:. t�.lsi✓fV i C1P'9 �JV.VV 4 �9V11�8s4../Y CC � . piy��pEl'4�/y3�g�e}�/�pqa ��gS�}+.tryf�p� [" . 0.FJb+��t���R . RV�V yF'�1�'*1y^p.^q p�L,g��V7 i�?i�F !`71t� �dbnt.V/�V� i V lP11.6JV� �V.ItV 6{-Jy6�Ge tXpi�Ml[R�de,.g�6Ye�P�Blg��yl�I�!q�g��RR�IV19��0.r Cq"'ry�p (�4.dp�pp4�3��16i(��y�pyG�\t{[:pV^�P"6EV/}[.d� �iytJ.G��RRp���^y4�Vq6i�^�efV i�'�}pU/qySP��'J^�t! V�6P"Ft81d13 E-6�4.id4JV 942�Ft�h1�1�t� Rl���-iQ A-f?�L�thit�f_�,32�06 P�I�J: �3C1.0{i f?C}9�R0�99$�51 719512021 ��� ����� t' �� �t'i �� �"! � � � ll�Itl����� G�1 � 1��1 � 11C1 , F� !°I This Icac�l Busin T�f� ipt is in addifion to and no4 in iieu of a�y�ther t sai by lavd or reounicip�i ardin�n�.�usen��s�s�re subj�ct to e�gul�ti�n of acaninc�,h�aith�nd c��her �3 I�U CRh�#u�.�3�11IS 1��I�V�IIf�fTY7iTt Q�P'�£�1P't)Ut�h S@�?C�iYibBC 30 Cl�i8 t�k4�+&�C. ({Ct�it�PF��P4��i��������tg�C�. �Q�� # � ���ie�� �� `���}`�������� 1�01 C�RT G�N� L�C?PIT"RA $3Q.00? 1 ��IIPLC}`��� � � ����;�'��� �',�� , �„ � �`" ��`�� �''�r� �...__ �.,� �� �� ���;��� �c�T,��.� �30.0� � � ���� �`�� �, ���u�cau������� ��o.� �F �� � � � c������������a rc��r��.c�u� �o.�a � ����y � ;�� ', «� �� �-�'�'��� ��u������t����r��������.�c �oz������� ����-�o ���������';��1��� ���� ��e�sc����������o ��,��``` ���c�����v���a����� �-�a�tt���c���a�os c���r�c�c���.�z�os �AtCt: �30.0� Ot79&-0099�351 7/1512021 Thi�r ip�is oi�i�i�[wh�n vaEidated by th�T���ol(�ctor. 4range G€�unf�r Gcarie raquires this(c��f Busin�s�Tax��e�ipt to be di�play�d car�spicuc�usly at fihe pl�c�oP bu�ines�in public vi .It is subj�ct to€nspecfiior�by�(f duly authorized a�icer�of fhe Gounbj. ��������.��a� � ���������� ��� � �� � � �ca� t��r � I � 10J2�t�029 i --— --. ---- ----- - - —_ _ ------ ---- -- - --- - --- --- --_-- _ i °f�'!1����1'EFI�A`F�9�k��E3����Aa ����6PJ�����`�@����E�Y'�����t�IF������0�Fi1`�t1��t�f��1����°t"i�t��T`�@�P�L,���.�i^96� 1 ���'���@��1'�����E�1"�F��� 'Ffl�t��C2�td����6 `f�4����, �°�t�����t��"��`1°B������ ���F�C�������°T`�i���E��1�� i � ��t��i�a "fk�l�G��°TIF���4T'���9t��tJ����������T����1°9'Tti7'�A��P�"6°��T`��°f'���7'�i�i�t�t��H��t3���{�},�t11"t#��1��� ; I ��������'TA1'Et/���R���li���A�C?`Chl����"CIFB�� �f�L���a ; �_._ ____ _______ _------__. � — _____. __.----- _._ — ___ � ___ i i�R��FiTAlUT: Ot�h���atlR�t�h�Qc��r E����E�CaI7lC?FE�L I�at1Ft��,��p�4i��(i��)s�se�8 Ps�a AL?�9'Fif3R6l�i����t���t�pr�v���e���r���ea��r��. � �r�€���c����r����������,���� �c��n�t� �������a����wr�,�p�E��ya�� �n p���} r��y �� ������ ����. ��t�t� ��� ' �fs����r�#fl����d ���t��e�t�r rt�Pa���h���et1fl��t�h���ffir 9tr Q9�sa caf�a��Pa�e�s9� �ra��ra�{��. �. ____._...__.-------_. _ _. . - -- --- --- ; F��t�[7UG�� �� �'��'� �EAihAF���9C}�Z ' � �_� � --. - -- -- _ _ _i � C3ne�c��ar E€��ur�n �r�up,6rtc_ ; ����� (30S}261�211T -- - - ��--.�o� (3(}5}26�5-211� � 5752�l FI��i�t'�at �_����`.,_ on�scaurc.�.insue�nc�t�y�hoo.c�m .. , h�l�mi,FL 331�4 �rd�u��g�}���cs�� co�� ca� — --- � - E�� I (�h�r�� 3Q5 26�-2117 F 3C}5 261-219$ ����u����: F�4?�PCiPl�FEA����U�� GC���'�h9Y � — -{ }----_ _ -- -__ ______� }-- ------ i _ - - - -_ __ -- _ _-- - ; E�a�u��o i������� � , �- _ - — - �-- � - -; _._ - -- �Ll.��A�F�,L�1'�E�6�'al€����lP�6Ca,LL� ' t��u�i��e. __ _ __ � i _ _.. ---. 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I 1'F3���PE�2RT1��C$�i�1�F1�F2��Fy F��T6�� �L��C?�LttP���C$I� ����R63Aid��NY�Tt�T"�9�i�t)LI��ff�Ft�lff�3C7��. � I 10C1�4��2�EC?,4 h14.1� i � } -- __ ------� P+�i�te�l aFPC����,��..3393� ?��r�€ca�����w��s���r��� � ' ����t� .,.Ls� �_.__._ _._....., i ______. __..______ _._......... _-_-___ . ____A__ .... pggq ¢p� pq pRpq �eg�q�ggg ,��g� �...—�— —"��� �fn4d���ld4d�B�4d�F� &6�Atl�• �k4��._..__�� ��i$. A�4��2b{20t6103}�� 1°E������ ���� ��r�r��3��r � �f����� � � � �� � .� ����� JfMN1Y PATRON€S CHIEF FIN�iNGIA�C)FFICER $TAl`� OF �I�QRI�A �EPAR1" �t�T�F �1[VAN�tA�����f10E� �li�t�{ON ��t�/C?t�����' �C} ��N�ATIC?tV * * �EFt`TEFI�AT� t}� �t��GT1f'�h!T� �� EXE[Ull�T FF�t}M �LORIC}A�i�RFCE6��" �t�MP'�Rt�A`TEC}N I�Alltd* * G�N��'�11C`Tl�h! I L?t1�T�`f E}C��P`Fl�h! This certifies that th� inc4ividual listed belo�r has el�cted to be exempt fr�m Fl�rida Warkers' ��rr�pens�tic�n I�w. �FF�CTiV� �AT�: 612612020 EXP0�,41°6QN D,ATEe 6/2612022 �����N: C�SCI�� F P�AZA � AIL: {�P�A�A�E��U�MAf�l..INENGI��ERINC�.�QM F�tN: 272861650 �U�tN�SS Na� E Af�D ADD��SS: �LUE MARLIN ENCa(M11��RING, LE..G 1 C12 DRENNEN R�, �U�T� &10 �R�.ANDC), F�32$Q6 �G�P� C?F BU�IN��S�R TRAD�: Cantractor-Prpject iNanager, Gc�nstruction�xecutive, GonstruotiQn Man�t er or Ganstruc4ion Superintendent IMPQRTANT:Pursuant to subsection 44Q.05{14), F,S.,an officer c�€a carparation who eteets exemption troEn this chapier by Piling a certificat�of eEeetion under this seciion may nat recaver b�r�efits or corripensatian under this chapter.Pursuant to subsectiQn 44Q.05(12},F.S.,Gertificat�s of el�ction ta be exempt issued under subsaction(3}�h�II apply aniy to ihe ec�rpcarate otfiicer named on th�notice of elaction to be exempt and appiy oniy wifhin khe scope af the business or trade IisEed on the notiee of electios�to be ex�mpt.Rursuar�t to subsection 44Q,Q5(13},F.S.,notices of elecfion to be�xempt�nd certificates of�I�ctron to be exempt shall be subject ta r�vacation if,at any time after the filing of ihe natice or the issuance af the eertificate,!he persan named on the natice ar certificats na longer meets the requiremenfs of this sec�ion fae issuance of a c�rti(icat�.The d�parfinent shall revak�a certifica4e at ar�y time far failure of the person named on the certi#icate to meet fhe requiremenis of this s€�ction. DFS-F2-DWC-252 CERTIFICATE OF EL�CTION TC}BE �XEMPT REVISED 08-93 E011877�7 QUESTIONS?(850}413-1609 . r � ��v, ... .tv,�.;.. �,a����,�. � „ � �{: e` a A � _ � *a n ��� u a �ay�x#� i�.��. �4,.,�� ��� �"�. ��� �, � �,'&� CC.1\Z t b'.t 3C���t 7�Ci EiC�L.��' CCiC 1'sF(?-�C�2 C�tlt�: _Qt��_��-�--��"�-�---- St�t� c�f �t.. a �'o����t_y c�f � __��� �.,�° � '� ; . �3�fc�F-e ��z� o�i t1�is �ay ����sc�t�t�lly a{ape���eci i_J�a�.e�� _ ���� � ��r11o, laeiz��d��lly s��ozrr� c����c�ses �t�cl �;�ys: — That 1�� c�r s11e ��i11 lae t��e c�z�ly }����sc�t� ��orkit3� o�� t1�e ��rc�ject Ic�catecl G�t: ��`� �.���'____� �� _��°��� f:�6'��`�-� ����� �� ��� � ��� �g. C�`c�t�tt�actc�r �i�t��t�at`e ? S���oz-n to (or����ir d �ncl subscribed ��fore ine �I�tis�� �fa�� of__��--��.�� ---,20�-�- ���} �"��� �� _���,.� _ _ tj{t L�c��-sc�t�all�� �.�zc��`�� €�.�`"`� 0€4��rod��c�c� iclentifiec�t�c�t� �_._ r�.�-__� ,,' �z"� �� _ i�i` r F,,� r=� ; ` �m�--�.,.,_.e.—��ro�"�=:�°�t� �IER�tdIG,4 h#(2�'�S ��t, t� �C� �1'}' � « � Gamml�sl�n#G�2�12Q4 �a�.,.. ��,,� �� �� Expfr���upu�k��022 �'or�b�� sw�4ad Tt�u au�� �G�tS'e �x=2x•.`s�e�e,t �x,T�;:.P�.'lss*`xstE'e t,a�et>iai �� t.#} d'ts'�+:,rxaan+a �.c�a�f,4 fi.a�:'��h aa i!: �;� *.a3eax.r�re 3,s 4��,.<REst� � ���� ' � ��c.a��� j��, . ��h �" � � �� i�mi �c�r�s illage •�#R... � �YiiE� ��• � . ���7°��tW���� �OO�Q N.�.��1C� QV�tllJe '����t'��`' Mi�mi Shores, Fle�rida 3313� Tel: (305} 795.22Q4 F��. (3Q5} �56.8972 �ti�� t� wr� r � r r�' �r�satian ir�sur �� x t� n 1� t �:�,t \ :���ti i, 1 lti�� l \ ...iz ::` 1ti: \� t,: i� �Y Z � �� � k �r1�, ��'V�, � � � \,�ti�� ��. ti S� s �. ��\ 1 1 � ' titi ti�y� �� ti t � �;�A11� \ \ t ��y �,. , � �� �„ ,.l„ .�� �y, :„ � .ti„ .�A. �< ��,u�,,�„1„.1. t, :� � Flarida Law requir�s Workers' Cor��pensatic��� it�su�-ar�ce eo�erage under C1�apter 4�� of tbe Florida Statu€es� Fla. St�t. � 440.05 allaws car�orate offic�rs in t1�e constructio� industry to cxempt ther��seh=es frc�ln tl�is requirenle��t for a���=eot�structian �roject�arior ta ol�tairlin��l�uilding}�ernlit. Pursu���t tc�t}�e Florid� Divisior�af W'orkera' Co171pet�s�tion En�pla}=er Facts Broc��txre: ,�n employGr in thz co�lstructian inclustF-}% u110 etl�ploys o��e or tnore �art-time or• fixll-titne er��ploye�s, ineludit��e3�e o��rnes-,n�ust obtain t��a�•kers' co���}�e��sation eotiTer-�ge. C or�orate affice�•s c�r metnbers c�f a lirTiited lial�iltry eoanpany (LL�C) ii� tE�c constnzctia�� ind�tstry tna}� eteet tc� be exei��pt if: 1. T}�e afficer o��=��s at Ieast ]0 ��ercei�t of tI�� stock of tl�� cc�rporation, ��- in tl�e case af ar�LLC,� staterr�ent aet�stir��to t11e fnini�num I0��,rGent o�%ri�r�hi�; 2. The o���er is listed as ar� officer of tlze corpor�tic�n in the r�eof-ds of th� Flc?ris�� DeparEt��efzt of�tate, I�i�isian o"Cc��pc�z•atia�ls; and 3. Ti�e corpof•ation is re�ist�r�;d and listecl as aetive witlz tlle Florida �epa�•t�3�ent �f State.I�i��isio�� of Corpoeatia��s. No mor� than tl�ree eorporate officers per corporatiof� ot� limitec� li�z�ility can�par7y izzen�bel�s are allo�red t� �e exe�npt. Cc�t�struetion �x��n�tcons a�-c ���lic1 for � perioc� of riuo years or tantil a �=c�lta��tary rGvc�catit��� is �led or t��e exemption is i-evoked b��the I�i��isio��. Yaue cantractar•is i-equestin��t�ermit under tlais worke�•s' comp�nsatio��cxei��ptic�� and has ac�knou lec��e that l��or s}��w�il1 n€�t use d�}�laba��,part-tizne��nploy=ees Qt�sul�cor�tractc�rs faf�}�c�iir�aroj�ct_Tl�e car�tra�tor has pt�ot�ided a��affidavit statin�tl�at}�e ar sl�e ti��ill l�e tlle o«ly}�erson allo�ued tc���rark o��}our�r��ect. It1 tt2es�circtt�ns�ar�ces,Miazni Si�ores tifillag�does 2�at rec�taire Ger�����eior� c�f warkex-s'comper�sation insut-ance ca��c,�-age fro�l tl�e cont-�ctar's cc�mp�r�y for day labor,pa�•t-tin�e em�ioyees c�x-subcontr�aetors. �3�' SIGt�iI�G E3ELt�W �'C)C� ACI�N{�1,�'LEI)GE �[���AT l'QLi HAVE RE.1I� T�-3iS ?VC)TICE ,A'�T} UNI�ER;T.A�II3 1TS �'Q;�TEI�rS. Sigr�acure:__ — — --- t�wner State of Florida �'otzt�ty�f�1�Iiami-I�ade `I'}��far�boing�=as�ck�Q�vledge before tne tl�is_ day=of t°°"`�2Q � F� � ��t�,� ���ho is pez•�ar�ally kna���to nle or h�a prodi�ced � � � _�� '� .�,�°°""'���as identi�caeion. � � _ � —.. '�ot ��i � � n.,�` "� � 4�R��tiGl4 N�Y(�S S Et�L:���',� ••>,•� � �ar��r��GA 2�720! `� �,� ��p1r�s�u�t 9.�1422 '�+`'�r�.�^�`� e�t t�v s�ne�^y+�vmmE