1140 NE 100 St (6)PROPERTY OWNER
New Construction
Name
Alteration Exterior
�/ /6; ,# 4 , 4
Address / /r 7 tie- /x .5 -. 7 _
/17 A ' z 5/01'4. s �G
3
3/3,
Home Telephone 305 7 77 Psn
Demolish
Business Telephone 3 5 9d/ ,S}a,
Shell Only
Fax 3e45 91/ 590/
Foundation Only
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'I Detachment
Other
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
Step I.
Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted
along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
APPLICATION
Job Address:
/1V
Address
State
Folio Number escription of W ork .15�477YA0(2"—'
Lot Block
Subdivision PB PG Zoning Linear Feet
Current Use of Property Square Feet Units Floors
Proposed Use of Property k Value of Work r; 0 db Bldg Value
Tenant Information
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
/GO ✓T i Z7OM'r S.�/O/ r
Apt d City
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT
Name
License No.
Address
Telephone
Flood Zone
Master Permit No.
Subsidiary Permit No.
PERMIT APPLICATION :
•
Base Floor Elev.
33/3
Zip
.ea moo f G
Tax Assessed/Appraised Value
ENGINEER
Name
License No.
Address
Telephone
Fax
CONTRACTOR
Name
License No.
Address
Telephone Fax
Qualifier Name
Page 2
IMPORTANT NOTICES
1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department.
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE
Signat ' of Owner Signature of Contractor / Qualifier
SEAL.
Print Name
Sworn to and subscribed before me this da
gnature of otary ' b State of Florida Signature of Notary Public - State of Florida
It 1P PU Ai: ,ZiLA RA 13c1:.:4 SEAL:
O .r. g'a
n to's =oa
�tt Ay CC7 3G
>
Personally known IJF Produced Identification Personally known OR, Produced Identification
Type of Identification Produced:
Print Name
Swom to and subscribed before me this day of
PEtZMIT APPLICATION
Q-1 V Type of Identification Produced:
s
Page 4
OFFICE USE ONLY
CHECKLIST
❑ OWNER - BUILDER FORM
(Attach)
O FIRE DEPARTMENT
APPROVAL (Commercial /
multi- family)
❑ CONCURRENCY
(New Construction)
❑ OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
❑ PROOF OF OWNERSHIP
(Attach)
❑ HRS / DERM APPROVAL
(Septic / Sewer)
❑ IMPACT FEE
(New Construction)
❑ OTHER
(Specify & Attach)
$ -o&
$ L r P -o (sq.ft. = x/1000
x 0.60)
$ (¢.005 / sq.ft.)
$ (t.01 /sq.ft.)
REVIEWED AND PREPARED BY:
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
PERT ITT APPLICATION
❑ CONDO ASSOCIATION APPROVAL
(Attach)
❑ BPR APPROVAL (Restaurants)
❑ CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ .O c U 6
1
ISSUING OFFICIAL
DATE:
CONDITION OF APPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com
ELECTRICAL
TYPE
Minimum Fee
Q'I'V.
i'YI'E
Dryer
QTV.
TYPE
Outlet, Appliance
QTV.'
TYPE
Service Repair
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights •
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher ..
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TITE
Minimum Fee
()Ty.
TYPE;
Condensate Drain
()Ty.
Tv
Generator
Q•rY•
I
' TN PE
Refrigeration, Tons
(,Y1 N
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C WaWWin. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
'TYPE,
Drains, Roof
QTY.
'f \PI?
Miscellaneous Fixture
Q'I'v.'
T1 i;
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
PERMIT APPLICATION
INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below.
O
RECEIVED AND REVIEWED BY: DATE:
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed:4 /11/2002
Applicant: RAYMOND
Owner: MATEO
JOB ADDRESS: 1140 NE 100
Contractor
Local Phone:
Parcel # 1132050190430
Building Permit
Permit Number: BP2002 -745
MATEO
RAYMOND
ST
Contractor's Address:
Page 1 of 1
Legal Description: 5 53 42 MIAMI SHORES SEC 8 REV PB 43 -67 LOT 7
BLK 178 LOT SIZE
e e--06:Lut - \ QO 4 Od /yb,, j - S, o c a ��_�
Li-TO Total Fees: $thOO
C C Total Receipts: $0.00
Permit Status: Approved Permit Expiration: 10/8/2002 Construction Value: $8,000.00
Work: BATHROOM REMODELING
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances
pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the
proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon
which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work
covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees.
NSPECTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and In strict conformity with the
plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibiiity for all work done by either myself, my agent,
servants or employes.
Signed: (Contractor or Builder) BY:
STATE OF FLORIDA'`
COUNTY OF DADE:
2. Description of improvement:
■sv ..vim %el vvlYliiii IY1G1V 1
PERMIT NO15 I' ' 100 4 TAX FOLIO NO. (I 3.) 0 S D I 36
02R22834-7 2002 APR 12 15:11
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal descriptit of property ands t address:
3. Owner(s) name and address: 1
1 1 `t pJ loo)
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
5. Sure Pa p
Surety:( Payment bond required by owner from contractp
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the State of Florida designated by Owner upon who
by Section 713.13(1)(a)7., Florida Statutes,
Name and address:
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
different date is specified)
Sig ot Owner
Print Owners Name ReffI 4 W e) • •
Sworn to and■subscribed before me this la. day of � , IV W03.,
Notary Public
Zadafa C�il(�1i1
Print Notary's Name tu
My Commission Expires: (32V/06
3 cit '4 .t.
3— - vb ; '3P-1
)'YLiz�¢.D
F FLORIDA, COUNTY • DADE --"'""'--
ERTIFY Oat this is a tru
t the
j' olt a„I
r �
y�. o1c c oun, C. n
yr
notices or other documents may be served as provided
Prepared by:
p Barbara Fugazzi
• • My Commission D0083826
f Mn M
Expires March 29, 2006
if9 / mod
Address: //fl fke /do ST
S/' A-S
fG 33 137
Date di /2 0Z
• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204
Qualifier ON,)
State # eL'. Municipal #
Square Ft. 409
Sign
o ary
y Commission Expires
Job Address
and/or Condo President
FEES: PERMIT /4 0rlbe ' RADON
APPROVED:
/y.
o President
•
Legal Description Al Any J//O�F�f ..J fey PB y3 07 2o7 7 Historically Designated: Yes No
B,cact #'78
Owner/Lessee/Tenet T1 , ‘-t'A, Ale. d /)1,Q1. / ) I frrO Master Permit # 4' 0® a
Owner's Address //'y' A/.pn✓ /DO �rf�f > AX9i/vJyo j�s Phone >>/>•5.53 / , / 7 / 4 7 i
Contracting Co. ■,-,ti.uerr ELeoi , C - v.:2 vire tomo,V -Z./4 Address 90 arn/ 'S ./ V.9 1 -, / in!, % 1. .3. X38
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECT AI" PLUMBING \ MECHANICCAL RO
WORK DESCRIPTION: /9.�,i�oe/ a� ..65 / 9Mi /3M/� 6F.S 06),e,g_7Z C/> 1 /4(;0 vt VsYUiTi
i cho e ' /,v /f4 GQ %/; OO/h ,C3/t >A ,D ,0 2 SEE �rr dA57 2 /n F�
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in 'compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work stated.
re o owne
• i 4 'IN . John M Farquhar
* '* My Commission CC908801
'..,,,,S Expires March 27, 2004
D
Date
D. to
o
Folio ,/-3;n5 -oJ 9 - Oh' SZ'
SS# Phone _30.5, 759. /G G_5
Competency #
Estimated Cost (value) ADD, DD
C.C.F NOTARY
Zoning Building
Mechanical Plumbing
Ins. Co. o4J wit E
7,54,
o1z9o2,
Owner Builder Date
4 ,02% John M Farquhar
**My Commission CC908801
Expires March 27, 2004
f/ e2,
to Co actor or Owner Builder 1 ate
Commission Expi
BOND
TOTAL DUE
Electrical
Structural Engineer
/0171oV —
ITEM
BATH TLB
UNIT
FEE
ITEM
SWITCH OUTLETS (atoce -r4)
UNIT
/
FEE
ITEM
'SPACE HEATERS
UNIT
FEE
BIDET
LIGHT OUTLETS �ctorli })
2.
CENTRAL HEATING
DISHWASHER
RECEPTACLES (Aloft')
2.
A/C (WIND)
DISPOSAL
SERVICE TEMPORARY
A/C (CENTRAL)
DRINKING FOUNTAIN
SERVICE SIZE IN AMPS
DUCT WORK
FLOOR DRAIN
' SERVICE REPAIR/MIETER CHANGE
REFRIGERATION
GREASE TRAP
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
INTERCEPTOR
RANGE TOP
UNDERGROUND TANKS
LAVATORY
_
OVEN
ABOVE (MOUND TANKS
LAUNDRY TRAY
^ WATER HEATER
U.F. PRESSURE VESSELS
CLOTHES WASHER
MOTORS 0- 1 HP
STEAM BOILERS
SHOWER
MOTORS OVER 1- 3 HP
HOT WATER BOILERS
SINK, POT /3 COMP.
MOTORS OVER 3- 5 HP
MECHANICAL VENTILATION
SINK. RESIOENCE
' MOTORS OVER 5- 8 HP
TRANSPORTING ASSEMBLIES
SINK, SLOP
MOTORS OVER 8- 10 HP
ELEVATORS/ESCALATORS
TEMPORARY WATER CLOSET
MOTORS OVER 10- 25 HP
'
FIRE SPRINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 HP
COOLING TOWERS
WATER CLOSET
MOTORS OVER 100 HP
VIOLATION
INDIRECT WASTES
A/C WINDOW
REINSPECTION
WATER SUPPLY TO:
AIR CONDITIONERS
.
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
i
HEATER -NEW INST.
GENERATORS TRANSFORMERS
f
HEATER - REPLACE
GENERATORS TRANSFORMERS
I
LAWN SPRINKLER -WELL
SPECIAL PURPOSE
_
SWIMRMIING POOL
•
OUTLETS COMMERCIAL
WATER SERVICE
•
SIGN TUBES
SEWER CONNECTIONS
SIGN TRANSFORMERS
.
UTILITY -SEWER
SIGN TIME CLOCK
UTILITY -WATER
FIXTLRES
.
SEPTIC TANK
ANTENNA '
RELAY
TELEVISION OUTLETS
IRAINFIELD, 4' TILE/RES.
VIOLATION
PUMP & ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
:ATCH BASIN
)ISCHARGE WELL
)OMESTIC WELL
AREA DRAIN
100F INLET
30LAR WATER HEATER
:IRE STANDPIPE
POOL PIPING
.AWN SPRINKLER SYSTEM
3AS RANGE
I4ETER SET (GAS)
,AS PIPING
(AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
Q$TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING
ADDENDUM TO BUILDING PERMIT APPLICATION
ELECTRICAL
MECHANICAL
Switch for Exhaust
Fan and Light Fixture
over sinks
31"
•
Damaris Rivera
1140 NE 100th Street
Miami Shores, FL 33138
305 - 531 -1714
2 20 Amp
GFI Outlet
Light Fixtures
1 60" 1
Exhaust Fan & Light
Ail
•
Vanity
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 5 /9/2002
Applicant: RAYMOND MATEO
Owner: MATEO RAYMOND
JOB ADDRESS: 1140 NE 100 ST
Electrical Permit
Permit Number: EL2002 -156
Contractor BENNETT ELECTRIC SERVICES CO Contractor's Address: 6900 NE 4TH COURT
Local Phone: NONE
Parcel # 1132050190430
Permit Status: Approved Permit Expiration: 11/5/2002
Page 1 of 1
Legal Description: 5 53 42 MIAMI SHORES SEC 8 REV PB 43 -67 LOT 7 BLK 178 LOT SIZE
P QAA: ,6 a- o ho, bo
Total Fees: x$-90
G C 6 Total Receipts: $0.00
Construction Value: $600.00
Work: Addition of bathroom 2 damp GFI (dedicated circuit) above vanity. Work in matter bedroom bathroom see attached customer provided diagram.
If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all
ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to
and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without
authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the
ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents, servants or employees.
Signed /; is / -' '�• CTOR) BY:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
RAYMOND MATEO
DAMARIS RIVERA
1140 NE 100TH ST.
MIAMI SHORES, FL 33138
PAY TO THE VI
ORDER OF
'I(jiif4 *6 40
Washirigton Mutual
Washington Mutual Bank, FA
Miami Beach/Alton Road 1742
1801 Alton Road 1 - 800 - 788 - 7000
Miami Beach, FL 33139 24 tour customer SOM0O
NOTES
.1:26708413 lu: 386111 25448111.0v
63- 8413/2670
386254 /� /
DATE ,/7( / /Ota
,i I$
DOLLARS _ i agas
'0718
718
IMP