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217 NE 97 StPage 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 per 1 to da' rk and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet thelkndaids of ail 6Vegut t Fii :ectrtV tion 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 flcor 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 •F FLORIDA, COUNTY OF MIAMI -DADE Sign e of Owner Print Name Swoorn to and subscribed before me this „e 9 day of , Signature of Notary Public - r:* of Florida � r " P t it s. '`: I 1 E. Johnson ' Capon # DD 018060 � • W = EFires May 31, 2005 Bonded Thrn 4 44` i atic Bonding Co., Inc. SEAL: Personally known '' OR, Produced Identification e of Contractor / Qual re OF FLO '7(4_ Print Name c� Swom to and subscribed before me this day of Dl To t )-eo Signature of No Public - State of Florida el, Zahurali Damji Padamsey SEAL: * ;, , MY COMMISSION # CC960215 DARES December 1, 2004 PERMIT APPLICATION BONDED THRU TROY FAIN INSURANCE. INC. MIAMI -DADE Personally known OR, Produced Identification Type of Identification Produced: Type of Identification Produced: !C G • at lie 4 t / r F Air 6 . CONTRACTOR , Name sl G J - q _ (LAM A l n /S -TR • License No. 0 1 A 5 ® Home Telephone Address 1 ?8 NE ICO3 51 NO /LT tr1 )` 0 C---g , F ` Telephone (3os) 9' 7 7 7 3 I x c L( 7. 7(0 I -) `7 ame Qualifier N706644._ A Ai 41, FtE,..D, 34._ PROPERTY OWNER New Construction _ � (� /� Nam ed n R LL Z..G \ 7 ` D ' ( .Cn° H-R,Niki l n /S -TR • Address / 9a /v / p d . 4 /),//, -9V/ 51(70,e59/ Af: .33/3 Home Telephone Business Telephone 30.§-_76— Q -5 9/ Fax 32) S_ 75 $ - SS TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'1 Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. 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 submit- ted 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 Address: Z 1 7 AtE 9 7 S i �� T A/ A/k l 1+0 &C. FL- 3 Address Apt. 1, City State Zip Description of Work Folio Number )' ' , 3 2 D — 0 1 - 5 Lot � 7) 1 1 4- Block 3 Subdivision in li• SHR SeC 1 PB / 0 PG 7 b Current Use of Property eariiai6+Pe/c/ Proposed Use of Property _ Tenant Information ' O /Cce-/ PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Si bit/ PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax u� Ititl 5 l G C4 i Zoning Linear Feet ((o , (o Square Feet ( ni ts ).if t< Floors 1 e of Work 4.500 ^ Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Master Permit No. PERMIT APPLICATION P DE Subsidiary Permit No. ENGINEER Name License No. Address Telephone Fax Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ 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 Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) $6o $ u Z 0 ( sq.ft. = x/1010 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) $ $ SECTION Zoning Electrical Fire Mechanical Plumbing Public Works Structural Building Official DAT b.S PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) LI CONTRACTOR REGISTRATION (On File) TOTAL $ 0,4D PERMIT FEES ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL ° (305) 795 -2207 ° FAX (305) 756-8972 0 http : / /www.miamishoresvillage.com ELECTRICAL TYPE Minimum Fee QTY. TYPE Dryer QTY. TYPE Outlet, Appliance QTY. 'I'VPI 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 r Water Closet Demolition Low -volt, Intercom/7:eleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New PLUMBING TYPE A/C Condensate QTY. TYPE Drains, Roof QTY. TYPE Miscellaneous Fixture QTY Tvl'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. MECHANICAL TYPE Minimum Fee A/C Central, Tons A/C Wall/Win. Tons Air Handler, Tons Barbecue Bath Fan - Vented, # QTY. TYPE. Condensate Drain Cooling Tower Dryer Vents, Number of Ductwork, Cost of Fire Sprinkler System Fireplaces, Number of QTY. TYPE Generator Heating Strips, each Paint Booth Piping, Flammable Liquid Process/Pressure Piping Pressure Vessel Refrigeration, Tons Vent Hood, Cost Ventilation, Cost Periodic Inspections RECEIVED AND REVIEWED BY: DATE: Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/21 /2003 Applicant: CARLYLE COCHRAN CO Owner: JOB ADDRESS: 9705 NE 2 Contractor SIGN A RAMA Local Phone: Parcel # 1132060134230 % Signed: Signed INSPECTOR) Building Permit Permit Number: BP2003 -91 AVE Contractor's Address: Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 31 Fees: Description Amount FEE2003 -368 Building Permit Application Fee $60.00 FEE2003 -369 CCF $0.60 Total Fees: $60.60 Total Fees: $60.60 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 7/20/2003 Construction Value: $500.00 Work: WALL SIGN 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 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, sery is or employees In consideration of the iss . nce to me of this permit, I agree to perform the work covered hereurjr Jr in coop pliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, s tements or specifications submitted to the proper authorities of Mian3 Shores In accepting this permit I assume responisibility for all work done by either myself, my agent, servan - or employes. / REG C:01 041003 1110 11C 401 006173 CHARGE $60.60 (Contractor or Builder' BY: B 1 Page 1 of 1 AV 97/1, iret'l Sign Location 217 NE 97th Street N AV 9r71 /?.Sired Sign Location 217 NE 97th Street N cupuncture & Kerbs cupuncture & Herbs 303612 -6 BUSINESS NAME / LOCATION SIGN A RA(A INC 1798 NE 163 ST 33162 NORTH MIAMI BEACH MIAMI -DADE COUNTY BUILDING CODE COMPLIANCE OFFICE 140 W. FLAGLER ST., SUITE 1602 MIAMI, FL 33130 (305) 375 -2527 W 'CERTIFICATE OF COMPETENCY: z EXPIRES ON.09/30/2004 WHITE SANDS DiG, INC D /B /A: SIGN- A •RAMA 0 C.C.. NO.: 01BS00342 -B.A.. MAXFIELD' ROGER ALLEN •S.S. ND.: 265 -99 - 3181 UAL1FYING AGENT (CA) MUST SUPERVISE, DIRECT AND CONTROL AU. WORK. OWNER WHITE SANDS DfG INC Sec. Type of Business 214 RETAIL STORE THIS IS AN OCCUPATIONAL TAX ONLY. IT DOES NOT PERMIT THE LICENSEE TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE LICENSEE FROM ANY OTHER LICENSE OR PERMIT REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE LICENSEE'S QUALIFICA- TION. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 05/22/2002 02030024001 0000041A0 SEE OTHER SIDE INSTRUCTIONS CONTRACTOR TRADE: BUILDING SPECIALTY CATEGORY(S): SIGN:(NUN ELEC)- Signature of Qualifying Agent FRANCISCO J. QUINTANA, R.A. 'Secretary Construction Trades Qualifying Board 1. SIGN.CERTIFICATE - ATTACH PICTURE - FOLD - LAMINATE 2. NOTIFY.CUNTRACTOR SECTION OF.ANY CHANGE OFADDRESS. 3. ABIDE :THE RULES AND REGULATIONS OF CHAPTER 10 OF:.THE CODE OF.MIAMI - DADE COUNTY. WHITE SANDS DMG, INC 1798 NE 163 ST NORTH MIAMI BEACH FL 33162 DO NOT FORWARD SIGN A RAMA INC ROGER MAXFIELD 179 NE 163 ST NORTH MIAMI BEACH FL 33162 TRANSFER LICENSE NO. 317342 EMPLOYEES 1 111111 II 11111 IIIi111 11i1 i11, 1 1 11III11 111 PLACE PHOTO HERE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: AMI DADS COUP 2002 OCCUPATIONAL LICENSE TAX AX COLLECTOR . t c IAMI . At COUNTY r STATE ()F rLO I W FLAGLER ST. $ - X PIRES SEPT - 30 2003 4th FLOOR IAMI FL 33130 MUST BE PLAYED AT PLACE OF BU PURSUANT TO COUNTY CODE CHAPTER BA ART & 303612 -6 BUSINESS NAME / LOCATION SIGN A RATA INC 1798 NE 163 ST 33162 NORTH MIAMI BEACH OWNER WHITE SANDS DMG INC Sec. Type of Business 214 RETAIL STORE THIS IS AN OCCUPATIONAL TAX ONLY. IT DOES NOT PERMIT THE UCENSEE TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE LICENSEE FROM ANY OTHER LICENSE OR PERMIT REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE UCENSEE'S OUAUFICA- TION. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/24/2002 0029000Qk30 000045.00 SEE OTHER SIDE 485817 -2 S IGN A RAM LOCATION 1798 NE 163 ST 33162 NORTH MIAMI BEACH 0 2020027002 2 000045.00 SEE OTHER SIDE DO NOT FORWARD SIGN A RAMA INC ROGER MAXFIELD 1798 NE 163 ST NORTH MIAtI BEACH FL 33162 RENEWAL LICENSE NO. 317342 -4 EMPLOYEES 1 �il�!!!lf�lllt'�1�lIIli�l l llltl�ltl 'III'I11'�1�11l1'II'Iltl��l W SANDS DMG INC 196 Sec. Type of Business WORKERS THIS ISDC SPECIALTY BUILDING CONTRACTOR 3 TAX ONLY. IT DOES NOT PERMIT THE LICENSEE TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT DO NOT FORWARD EXEMPT THE LICENSEE SIGN A RAMA INC FROM ANY OTHER LICENSE OR PERMIT REQUIRED BY LAW. THIS IS NOT A ROGER A MAXFIELD JR PRES CERTIFICATION OF THE 1798 ' N E 163 S T LICENSEES QUALIFICA- N MIAMI BEACH FL 33162 TION. FIRST -CLAS: U.S. POSTAGI PAID MIAMI, FL PERMIT NO. 2: FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 NEW LICENSE NO. 507040 -4 C Cs# 01BS00342 2002 O CC UPATIONAL L IN I-DADE COUNTY ,-k-STATE OF 4 n s tl' XPIRES SEPT 30. 2002 MUST , E DISPLAYED T PLACE PURSUANT TO COUNTY CODE CHAPTE IAMI -DADE COUNTY AX COLLECTOR "z 40W. FLAGLER ST 4th FLOOR IAMI, FL 33130 485811 -2. BUSINESS NAME / LOCATION )SIGN °A :RAMA -INC 1798 NE 163 ST ' -33162 ;NURTH°MIAMI BEACH OWNER LWHITE SANDS DMG Sec. Type of Business WORKERS ' 1.96..SPECIALTY BUILDING•CONTRACTOR -3 THIS Is AN OCCUPATIONAL TAX ONLY. FT DOES NOT PERMIT THE LICENSEE TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE LICENSEE FROM ANY OTHER LICENSE OR PERMIT REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE LICENSEE'S QUALIFICA- TION. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: ;09/18/2002 00200000304 000045.00 SEE OTHER SIDE LICENSE NO. 30- 5070404 CC NO: BUSINESS NAME / LOCATION SIGN A RAMA INC 1798 NE 163 ST OWNER :WHITE SANDS DMG INC NOT VALID IN: AVENTURA, HIALEAH, KEY BISCAYNE, PINECREST & SUNNY ISLES Licensee must register in the city where work is to be done. PAYMENT RECEIVED MIAMI -DADE CNTY TAX COLLECTOR: 09/18/2002 00200000305 000175.00 DO NOT FORWARD SIGN A RAMA INC ROGER A MAXFIELD JR PRES 1798 NE 163 ST N MIAMI BEACH FL 33162 SIGN A RAMA INC ROGER A MAXFIELD JR PRES 1798 NE 163 ST N MIAMI BEACH FL 33162 FIRST -CLAS U.S. POSTAL PAID MIAMI, FL PERMIT NO. RENEWAL LICENSE NO. . 507040 -4 C C= # < 01BS0034; FIRST -CLASI U.S. POSTAG PAID MIAMI, FL PERMIT NO. 2 01BS00342 IS HEREBY LICENSED TO DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. SPECIALTY BUILDING CONTRACTOR DO NOT FORWARD TAX COLLECTOR ■ 140 W. FLAGLER ST. 14th FLOOR MIAMI, FL 33130 LICENSE NO. 06- 5070404 CC NO: BUSINESS NAME / LOCATION SIGN A RAMA INC 1798 NE 163 ST' OWNER :WHITE SANDS DMG. INC RESTRICTED TO THE CITY OF: NORTH MIAMI Licensee must register in the city where work is to be done. PAYMENT RECEIVED . MIAMI -DADE CNTY TAX COLLECTOR: 07/05/2002 02020027001 000012.50 vve�rrrnv OCCUPATIONAL LICENSE MIAMI -DADE COUNTY .STATE OF FLORIDA PURSUANT TO DADE COUNTY ORDINANCE 66 - EXPIRES SEPT. 30, 2002 DO NOT FORWARD SIGN`A-RAMA INC :ROGER A'MAXFIELD JR PRES 1798 NE 163 ST N MIAMI BEACH FL : 33162 CRUZ FIRST -CLASt U.S. POSTAG PAID MIAMI, FL PERMIT NO. 2 01BS00 LICENSED TO DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. SPECIALTY BUILDING CONTRACTOR , . .. • . , . . • • Acupuncture s 2izc ' PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date `I 1 ? 19 % Job Address Z{ '7 NE. c ) 4 1 sr Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee ((.pC3 CAS c; O a) IA— Master Permit # L't 2- G / S Owner's Address ZS t 4 t 00 ` Phone ( 5) 7 S( —' f 4 'C 7 Contracting Co. OyJr- ;£ v__ Address Qualifier SS# - Phone State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Fito ems► TI N ( c* FA. ", •r G E OF STo CC dc-o �J Square Ft. 12. 2 Sc ) Estimated Cost (value) 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 AN 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 ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S 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. Signature of owner and/or Condo President Date Signature of Contractor or Owner- Builder APPROVED: Zoning Mechanical Building fzIjcier w / toOA") L Tr. I kNI G h 2r-e—re- 7 , -3 Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder "y Commission Expires: My Commissio _ , (4 OrVICIAL NOTARY SEAL o !. SANDRA la LIONTIEL 71 0 COMMISSION NuMIBER v CCC4012 FEES: PERMIT e f RADON C.C.F. d b NOTARY ' BOND Electrical - coo 3'I‘/g a Date TOTAL DUE tX. fc7 Plumbing Engineering . . . . . .• • • • c in •Yi n 1\if cif ant e Scak: 1 eat 0,8426 ft. Font: Timms .New Roman Plain Pavp.aml by:: Rotitrt Gutork (Ivan Yin Macai Cower, PA :217 NE 97th Strvot Mm Shorm .FL 33130 4:11.Fiff,t111:s4i1411V.%g01.g.E... 511 4k M. • lft14s.:ifgksgitz: Quan Yin Medical Center . , . Traditional caline5e Medicitte Ac'punctur nd Hut ology ROb G Phy5iClan , A,Q �-- ‘A� - 0G `�' qs'- qlfit 7 (7-- q9