RC-11-1424r
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164939 Permit Number: RC -8 -11 -1424
Scheduled Inspection Date: November 21, 2011
Inspector: Bruhn, Norman
Owner: ZEGAR, CHARLES AND MERRYL
Job Address: 29 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: BUILDING CONCEPTS OF FLORIDA
Permit Type: Residential Construction
Inspection Type: Final Building
Work Classification: Alteration
Phone Number (212)397 -9019
Parcel Number 1132060130090
Phone: (305)796 -0096
Building Department Comments
REMOVE & REPLACE KTICHEN CABINETS
Passed
Failed
MY-1(
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 162913. Not ready. NB
November 18, 2011
For Inspections please call: (305)762 -4949
Page 18 of 47
11 111111111111111111 11111111111111111111111
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST; INSPECTION
PERMIT NO. &* ' Ng ?TAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713,'Fiortda Statutes, the following information
is provided in this Notice of Commencement.
CFN 2011 8052920
OR MI 27785 Ps 3550 (fps)
RECORDED 0 %')9/2')11 13:41:28
HARVEY '1+UVINr.: CLERK OF COURT
11IAhI -DADE COIJHTYr FLORIDA
LAST PAGE
�Spacee above reserved for use of'recording office
1. Legal description of property and street/address: 0114 .. ® 4 7 :..0 > 3138
2. Description of improvement:
3. Owner(s) name and address:
Interest in property:
Name and address of fee simoletitleholder:
4. Contractor's n, .. e, add and pho a number
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number.
Amount of bond $'
'5. Lender's nine and address:
7. Petsons within the State of Florida designated by Owner upon wfiom notices or other documents may be served °as provided by
Section 718.1-3(1X4)7., Fi rida Statutes.
Narne, address and phone ntirriber:
8. In addition to himself `Owners 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, address and phone number:
9. Expiration date of this Notice of Commencement
(the expiration date Is t year from'the date of recording unless date Is specie
WARNING TO OWNER ANY�PAYtMtENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMM CEMENT ARE CONSIDERED
IMPROPER - PAYMENTS UNDER CHAPTER 713, PAR`f' 1, SECTION 71313 FLORIDA STATOTE8, AND C R ULT .I 44f0(JR IgAYIN� 1WICE FOR
IMPROVEt4ENTS TQ YOUR PROPERTY, A,(NOTIQS,QF COMMENCEMENT MOST BE 'RECORDED AND POSTED' ON THE JOB 'SITE BEFORE THE
FIRST.INSPEC11ON. IF YOU'INTEND TO OBTAIN FINANCING; CONSULT VIII YOUR LENDER OR AN ATTORNEY 0004g Q0MMENGING WORK
OR RECORDING YOUR NOTICE OF COMMEND ENT STATE OF'FLORIDA,•QOUNTY OF DADS
Otgnature(s)4Of
Prepared By
Print Name.'
title/Office`
STATE OF RL�
COUNTY
The foregotn tnatr1
By + ,..
U tndivic t I
ersotlsit If S vn, or I pio tCti ed 46 ,161 T identificat'
ignat re. af' Nattify Ptib
PAM :Nate:
VERIPIGAtION PO UANT TO CtIO`N . 'S PLCrDASTA
Urtdet'penelties iif `patty''rdeclare that'Thatre Teed t%ie;cregaing and'
that the facts etated emit ar. true, to the best•of my knowledge and ballet.
Signatures) of • ( o' • er(s)'s Ai
B
By �� , By
f HEREBYCERTTFY that this rs a true copy of the
t/DIrector/Partner war rn this office on day of
Preperedd:;�'r`>
Print,I+l' ro
TWO iA
Cc?Uti�'
atkho
to me this
d�f a
for
Myteiatn.' xpires Apr S. 014
7- Caiernlssien # DD 978958
1
#nager who signed above
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No. 1 I LI 2,-y
Permit T s.e: BUILDING )) ROOFING
OWNER: Name , _ o der): Phone #:
7
Address: 2
City: /4177 *2/ State:
Zip: 33/ .>g
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 44— 2 " 5
City: Miami Shores County: Miami Dade Zip: 3-5`-?(P
Folio/Parcel #:
Is the Building Historically Designated: Yes 3 NO Flood Zone:
it/<� �/ZL, �S Phone #: 5;::::7
CONTRACTOR: Company Name: r /[fir
Address: goy? ? ,/ ki 6 7
City: /l/ Z2/ State: �� Zip:
Qualifier Name: Z4 Cr OZ Z.60/1-7
State Certification or Registration #: 66C 03/ 8' 7 Certificate oe f Competency, #:
Contact Phone #: ,Afn ,7 9.. a) �� Email Address: k. 7e c..%1 / a /° 60-V1
DESIGNER: Architect/Engineer: Phone #:
Phone #: 77..: ,00
Value of Work for this Permit: $ /1) e'` Square/Linear Footage of Work: —7 Al
Type of Work; 1 Addition ‘ Alt ration UNew L]Repair/Replace ❑Demolition
Description of Work: 7/4'- d 7 &----A1 (.2467
******** * * * *** * * *** * * *** * ** * * * * * * * * * * ** Fees * * * * * * * * * * * *** * * * * * * ** r**** * * * * * *** * * * * * * * **
Submittal Fee CID Permit Fee $ f6e°43 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ A�
TOTAL FEE NOW DUE $ '355- W
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In t e absence o uch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this
day of ,20 / /,by If ei 4/1
who is p ona11 ' known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC ;;
lI �'
Sign:
Print:
My Comma noiss Expires:
— �- — a a ®-a a a_ a r a
•
•
CARLOS G MENIEL
� _ _ Notary Public - Sta e-of Fiurida
III , MY Comm. Expires Apr 5, 2014
Commission # DD 978958
I
•
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of d' i1/ ,20i% ,by A
who is pers nally known to me or who has produced
as identification and who did take an oath.
***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09)
r. �45rtt
avrtzts
NO POINT ALONG COUNTER TO BE MOR
2 FEET FROM G.FI PROTECTED RECEP
PUT DM RECEPTACLE UNDER SIN
ALL FIXED APPLIANCES ON DEDICATED
ADD SMOKE/CARBON MONOXIDE DETECTORS.
ANY AND ALL CLOTH AND RUBBER
INSULATED CONDUCTORS TO BE REPLACED.
silt
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24"
23"
It
131"
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24"
16"
298"
814"
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NO POINT ALONG COUNTER TO BE MORE THAN
2 FEET FROM G.E I PROTECTED RECEPTACLE.
PUT DIW RECEPTACLE UNDER SINK.
ALL FIXED APPLIANCES ON DEDICATED CKTS.
ADD SMOKE/CARBON MONOXIDE DETECTORS.
ANY AND ALL CLOTH AND RUBBER
INSULATED CONDUCTORS TO BE REPLACED.
t"
All dimensions _size designations given are
subject to verification on job site and
adjustment to fit job conditions.
ZEGAR ,z2_9 iG l 7/ 572-
SMART BUY KITCHENS
3305 NW 79TH AV
Tel. (305) 471 0722
Fax (305) 471 0959
FREDDY BETANCUR
This is an original design and must not be
released or copied unless applicable fee has
been paid or job order placed.
Designed: 6/28/2011
Printed: 8/3/2011
All
Drawing #: 1
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
SMART BUY KITCHENS
3305 NW 79TH AV
Tel. (305) 471 0722
Fax (305) 471 0959
FREDDY BETANCUR
Designed: 6/28/2011
Printed: 8/3/2011
ZEGAR
ZEGAR Drawing #: 1
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
4.0".
ZEG R
SMART BUY KITCHENS
3305 NW 79TH AV
Tel. (305) 471 0722
Fax (305) 471 0959
FREDDY BETANCUR
Designed: 6/28/2011
Printed: 8/3/2011
ZEGAR
Drawing #: 1
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
SMART BUY KITCHENS
3305 NW 79TH AV
Tel. (305) 471 0722
Fax (305) 471 0959
FREDDY BETANCUR
Designed: 6/28/2011
Printed: 8/3/2011
ZEGA
LZEGAR
Drawing #: 1
Note: This drawing is an artistic
interpretation of the general appearance of
the design. It is not meant to be an exact
rendition.
SMART BUY KITCHENS
3305 NW 79TH AV
Tel. (305) 471 0722
Fax (305) 471 0959
FREDDY BETANCUR
Designed: 6/28/2011
Printed: 8/3/2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 163134 Permit Number: PL -8 -11 -1460
Scheduled Inspection Date: September 23, 2011
Inspector: Bruhn, Norman
Owner: ZEGAR, CHARLES AND MERRYL
Job Address: 29 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MG PLUMBING & SPRINKLER SERVICE
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (212)397 -9019
Parcel Number 1132060130090
Phone: (305)525 -9236
Building Department Comments
PLUMBING WORK FOR KITCHEN REMODEL
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
September 22, 2011
For Inspections please call: (305)762 -4949
Page 4 of 6
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATIO
FBC 20
Permit Type: PLUMBING
Permit No. PI 1 - 1
Master Permit No. Re,
OWNER: Name (Fee Simple Titleholder): e4.J / ",r Phone #:��0 /m 7
Address:
City: MI0141 f ieiL.S State:
/rib' J7--
Zip:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: ...-./-4? e 9' Sl
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes )C NO Flood Zone:
.(9d�� .tee
CONTRACTOR: Company Name: 4 ' 9iL ;? !A C`c /�� D// /--, Phone #: , ]O r-6-2,(::
Address: /T e,r 4./.4....),,74,-0.z..57--;
City: /11 L -Al d A �� � State:
• Zipc)-14)/1.v7 Qualifier Names -ra3.1 ' / I/V Phone #:
J —cr7.. 97- ,-
State Certification or Registration #: 01--e. 036 9.4 0 Certificate of Competency #:
Contact Phone#: i0rcf-2,j —ILO % Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ get5 Square/Linear Footage of Work:
Alteration
Description,4 Work:
❑New
*+ x***** ** *a: ***** **** *********** **** * *** Fees** ****+ x*** *********** x: **+x****** ********* ****
Submittal Fee $ Permit Fee $ Am 0 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ [ 0 c ' QO
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AM CONDITIONERS, ETC
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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agen
The foregoing instrument was acknowledged before me this 9 The foregoing instrument was acknowledged before me this
day of �o , 20 LL , by , day of , 20 /f , by
who is personally known to me or who has produced who is e or who has produced
As identification and who did take an oath. as identification and who did take an oath.
Signature—f ! (r F'4.P.ec7
Contractor
NOTARY PUBLIC:
J
Sign: �' / ; l 4f
Print: +� ! U
API!!! onfm. Expires Apr 5, 2014
My Co iresCommission # DD 978958
NOTARY PUBLIC:
Sign:
Print: ate
My Commissi
S�4
CARIOS Q MEN7EI
Notary Public - State of Florida
My Cumm. EWpilla Apr 5, 2014
Commission # DD 978958
* **** ****** ***** ***** * * *** ** ************************************************ ******** * ** *********** ** *******
APPROVED BY f' Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
587193 -5EIPT RENEWAL
BUSINESS NAME / LOCATION
REC NO.
MG PLUMBING 8 SPRINKLER SERVICE STATE* CFC056920 b12435 -8
INC
1265 NW 203 ST
33169 MIAMI GARDENS
OWNER
MG PLUMBING 8 SPRINKLER SER INC
Sec. Type of Business
Tsts Ag6s rjelIMBING CONTRACTOR
BUSINESS TAX RECEIPT. it
I HOLDER TO VIOLATE ANY
I EXIEnNO REGULATORY OR
ZONING LAWS OP THE
IcosEur IT � NOR
• HOLDER FROM ANY OTC
2010 LOCAL BUSINESS TAX RECEIPT 2011
MIAMI -DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 2011
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10
THIS IS NOT A BILL — DO NOT PAY
FIRST -CLASS
US. POSTAGE
PAID
MIAMI, FL
1 PERMIT NO. 231
I PERINT oR UOEI
REQUIRED BY IAN. THIS IS
THEE HOLDE OUA COA--
TI MS.
PAYMENT RECEIVED
NIAN I -DADS COUNTY TAX
COLLECTOR:
08/09/2010
60010000113
000045.00
SEE OTHER SIDE
WORKER /S
1 °
DO NOT FORWARD
•
MG PLUMBING 8 SPRINKLER SERVICE
MERVIN GORDON PRES
1265 NW 203 ST
MIAMI GERDENS DR FL 33169
illihn luiliidhill( unhi))ii,))lii>!Jaldl)))h6iial
tP 1 tai+ ley: is
•
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 164608 Permit Number: EL -8 -11 -1459
Scheduled Inspection Date: September 22, 2011
Inspector: Devaney, Michael
Owner: ZEGAR, CHARLES AND MERRYL
Job Address: 29 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: STEVENSON'S ELECTRIC SERVICE COMPANY
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (212)397 -9019
Parcel Number 1132060130090
Phone: (305)253 -1500
Building Department Comments
ELECTRICAL WORK FOR NEW KITCHEN REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Com
zL
September 21, 2011
For Inspections please call: (305)762 -4949
Page 22 of 29
s
AUG 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. f \I-1 4
Master Permit No. `` — %
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): aiitle-ZeS
Address: - /t/6 9/ S
City: Ni / 6 state:
Tenant/Lessee Name:
Email:
26-44/2-- - phone#:iff 7
Phone #:
Zip: 5.3 % P'
JOB ADDRESS: Jr �� ' 5771-
City: Miami Shores
County: Miami Dade
Zip: 33/ 3
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address: ( 7ld SL) y
City: F ~U State:
NO Flood Zone:
��✓ Phone#: 3 r o s3 1�
Zip: 3315 7/
Phone #: Cr?$3 L Sot)
Name: ' .! ' --bei e-Aso >)
Qualifier
g • ' 1 'Y Competency State Certification or Re/ istrati��� Certificate of Com etenc #:
Contact Phone #: 73t
3�•7�c74
DESIGNER: Architect/Engineer:
Email Address:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address °Alteration
I
w °Repair/Replace
Descripti n of Work: AA/ �� /°� -
❑Demolition
ao" Pere
* ****+x** ****** * * * * *** ** **** x******* **** Fees***** *x: ************* * **** *****x:*************
Submittal Fee $ Permit Fee $ /'�e',0a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ ' I C)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S At 'IDAVIT: 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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued_ In the absence of such posted notice, the
inspection will not be 'proved and a reinspection fee will be charged:
Signature _ �'�s" Signature
Owner or Agent
The for :oing instrument was acknowledged before me this
day of
,20L by Chalk T. e 7t ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
My Commission Expires:
* * * * * * * * * * * * * * * * * * *
APPROVED BY
40V-1N. KELLE LANE JACKSON
* MY COMMISSION #EE05
EXPIRES:July 1,2015
'>FOvoig Bonded Aro Beet Nor Sys
;rev s,"
// i,-4,11/Plans Examiner Zoning
Contractor
The foregoing instrum was acknowledged before e t his /
day of 4 a= , 20 I� , by at ei cif �9 enro�°+'s
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUUBLIC:
Sign:
Print: , `Y.: �B�£, KELjE LANE JAMSON
My Commission Expiri ;: t_S MY COMMISSION # EE 069085
EXPIRES: July 1, 2015
4ro iitr o' Bonded Nu Budget Swkss
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk