DS-13-284Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 186819 Permit Number: DS -2 -13 -284
Scheduled Inspection Date: March 07, 2013
Inspector: Bruhn, Norman
Owner: COMERFORD, YORNET
Job Address: 10565 NE 2 Court
Miami Shores, FL
Project: <NONE>
Contractor: ARTEK CONSTRUCTION MANAGEMENT CO
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)751 -7467
Parcel Number 1122310130590
Phone: (786)255 -6124
Building Department Comments
REMOVE EXISTING WOOD DECK ON BACKYARD AND
INSTALLATION OF PAVER PATIO ON SAND
Infractio Passed Comments
INSPECTOR COMMENTS
False
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 185739. NO PERMIT POSTED
March 07, 2013
For Inspections please call: (305)762 -4949
Page 31 of 46
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
Permit No.
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 1 0 5 6 5 N n C-+
City: Miami Shores
County: Miami Dade Zip: 3313 S
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): S a". C O Me-' Q V. C& Phone #: S q 3" 4 Oct 6
Address: 1 0 5 (, 5' /V 2 n di
City: NN ■ O- Sa o State: F t Zip: 3N 3 $
Tenant/Lessee Name: Phone #:
Email: S G® 04efil -Po R 1-t-e_ ,, PM`o./AN: , e.cly
CONTRACTOR: Company
Address: 3 SW 2clf 4.06
City: 0.1. r` State L Zip:. 33/ 4s
Qualifier Name: C.1 O d e 0,9 e Phone #: A181C 2S G124
State Certification or Registration #: 15'6(61 31 Certificate of Competency #:
Contact Phone #: Email Address: a �'�� .
DESIGNER: Architect/Engineer: . ` Phone #:
Value of Work for this Permit: $ Z, So 6 . 4")
/1 l I a
A 1 1 _ CcY...`sTrZl:C `i' Pnora..„. -
786 Z -6f2t./
Square/Linear Footage of Work:
Type of Work: ❑Addition \Alteration
Description of Work: &M ®V 1. /� ( orJJ
Tv-place.
Im�✓I'
and
ONew OR air/R lace ODemolition
ep ep
®�1i•o n d f O�i'G(•i pet VerS/ .1i'O
pe J-i 'p o!2 iQ no(
tjCCJA
Pa,v -r
fi (70-o at'aN. -1€ 2 /15 /13
Color thru tile: ffel
Submittal Fee $ Permit Fee $ /So a� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ !,
TOTAL FEE NOW DUE $ !''
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
4 +
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. , I he absence of such posted notice, the
inspection will not be approved and a reinspection fpwill be charged.
Owner or Agent
The f• a o' instrument jjas owled ed befo
day o , 201. by� W. ,
who is n ers Hall known to me or who has produced
NOT ' Y A' UBLIC:
Signature Mit
in 1
V•ntractor n
The f• oa g rostrum nt was ackno , led, d befo this d "
day of . _ 20 rb, by
who is pe ovally kn•' to me or who has produced
identification and who did take an oath.
Sign:
Print:
My Commission Expires
identification and who did take an oath.
N I ARY PUBLIC:
Commission
Bonded Through National Notary Assn.
APPROVED BY Q:;7 611 Plans Examiner
Sign:
Print:
My Commissi
r,'Ikf tat-PA . -.14 1 {r o orida
My Comm. Expires Sep 2015
L7Is:' Bonded Through National Notary Assn.
Structural Review Clerk
(Revised 5 /2/2012XRevised 3 /12 /2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09)
FEB -21 -2013 10:23P FROM: TO : 3057568972 P.2
Feb, 21. 2013 9:16AM THE FIRST INS, UROUP CORP No, 9152 P. 1 IEN
CERTIFICATE OF LIABILITY INSURANCE DATE 4M"' "'rl
THIS CERTIFICATE IS ISSUED A;3 A MATTER OF INFORMATION ONLY AND CONFORS NO FLIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRA�`,yT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holds/ Is en ADDITIONAL INSURED, the potiay(ies) must be endorsed. If SUBROGATION *WAIVED, aubjeet to
the terms eea cerrdhiena at Vie p0llay, Certain portages may require an eadoiseMent. A statement an this cortttlarite does not tenter tights Is the
s„-- -aerilflc ire halter In non of such nectar 11asgl._
PRODUCER
First Insurance Group
10967 SW 40 St
MiamI, PL 33165
_ Phone (305)221 -7878 Fox (30554 -7090
INalIRI3D
ARTEK CONSTRUCTION MANAGEMENT
2330 SW 29 Ave
Miami, FL 33146•
305
MIRIAM (305) 221 -7378- .' f +I k_ (306) 584 -7090
mtrl s ms s@aol.com
!NRURER4) AFFOI BM COVERAGE
Maim A : AMERICAN SAFETY INSURANCE COMPANY
uRe*
DEMUR C I
NAIL/ S
INSURER E
COVERAGES — f
CERTIFICATE R: CATE NUMB REVISION NUMBER:
THIS IS TO C ITRE�F1f THAT THE PQL►CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUETO THE INSURED NAMED ABO 'E FOR TH# POLICY PERIOD "'-
INDICATED. HOTWITfISTANDINQ ANY REEUIRENENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS y
CERTIFICATE MAY se ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUOIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1,4
TYPEO�F_INSURANCL A „ +ali!.: .--. --
GENERAL UASILITY
• COMMERCIAL GENERAL LuksiuTY
❑ ❑ CLAINe•MACIc' ❑ OCCUR
Wait AGGREGATE LIMIT APPLIES PER.
Q POLICY 0 ❑ L00
AUTOMOBILE LE LIARILItY
❑ NYAWra
❑ ALL OWNED AVr09
❑ SCHEDULED AUTOS
❑ lasoAmos
NO:44M D AUTOS
0
❑ UMBRELLA Ulm ❑ occult
r EXCESS LIAR r CLAIMS -MADE
❑ DEDUCTIBLE
■
ENT
•
b
WORKERS COMPENSATION
AND HOWLOYDRG, LIAUILITY Y1
OFFFIC Oq SEOL Iad7 T'UTIVE
(Mwdaleno M NN)
�- ��
r--• twrtoN nmussa+Ar
N1A
1
■
_POLICY HgR �__ LIMITS
EACH OCCURRENCE
DAMAGE TO RENT@iS” —'-
. EERMIE8 rI Qt ur yp
IMEO ESP (Arg 0119 DersOn)
PERSONAL A AOV INJURY
GENERAL AGGREGATE:
PRODUCTS - COMP/OP AGO
135Ai1I 85856
•
05/07/2012
05/07/2013
$ 1000,000
$ 100,000
$ 50,000
$ ,1 D00,000
zactopo
$ 2,006,000
r6
COMBINED SM3LE UMIT
tEe ectiSert)
BODILY INJURY (PSrpram) $
EIDDIt,Y INJURY (Per acrtkgt $
PROPERTY DAMAGE
(Per =kW)
OeScHMPTroNOP OPERATIONS / LOCATIONS /VEHICLES WOO ACORD /01,MalflanNReotetbte&ctaadOla wawa
aqua HI, rvaelre,
1. /N
CERTIFICATE HOLD R'
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2 AVENUE
MIAMI SHORES, FL 33136
1 305168 8972
AMMO 26 (2009/09) QF
EACH UCGURRENce s
AGGREGATE $
E. i�C1WC-$ EJ:11g
EL EACHABCIDENT $
EL 0I$EASE.EA EMPLOYEE:
EL 419EASE • POLICY War $
CANCELLATION
y AG �pK' /�idjet
SHOULD ANY OF THE A1+ZOVE DESCRIBED POLICIES SE ,/11C6SLLED SEFOIOk
1
THf: EZPIRATIDN DATE • , NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE P(,OUC ;I' 0
AUTHORIZED RF.FRtSEt4TATAIE
1988.2089 ACOR
The ACORD name an
. All rights reserved.
hut ttlarks of ACORD
FEB -27 -2013 03:03A FROM:
T0:3057568972 P.4
06 -15 -2011
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL. OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE:
PERSON:
FEiN:
08/20/2011 EXPIRATION DATE: 08/19/2013
SPRINGER RICHARD
113679186
BUSINESS NAME AND ADDRESS:
ARTEK CONSTRUCTION MANAGEMENT CORP
2330 SW 28 AVENUE
MIAMI FL 33149
SCOPES OF BUSINESS OR TRADE:
1- CONSTRUCTION MANAGEMENT 2- CERTIFIED GENERAL CONTRACTOR
*
IMPORTANT: Pursuant to Chapter 440. 06114 F.S., an ollicer of a corporation who glade exemption from this chapter by filing a certificate of election ander this
section may not recover benefits or compeaaalian under this chapter. Penman to Chapter 441.00412), F.S., Certificates of aletatoo to be sump... apply only within tite
scope of the business or trade listed on the notice of election to ho exempt. Parauaut to Chapter 440.004131, F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation iI, et any lime atter the filing of the notice or the issuance of the certificate, the person aimed on the ootlee or
certificate no tenger meets the requirements of this section for leaoanee of a certificate. The department shall revoke a certificate at any time far failure of the parson
named on the certificate to meat the requirements of this section.
QUESTIONS? (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OP FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OP ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE: 08/20/2011 EXPIRATION DATE:
PERSON: RICHARD SPRINGER
FEIN: 113879186
BUSINESS NAME AND ADDRESS:
ARTEK CONSTRUCTION MANAGEMENT CORP
2330 SW 20 AVENUE
MIAMI FL 33146
08/19/2013
SCOPE OF BUSINESS OR TRADE
1- CONSTRUCTION MANAGEMENT 2- CERTIFIED GENERAL CONTRACTOR
IMPORTANT
F Pursuant to Chapter 440.05114), F.S., an officer of a corporation who
O elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.06(12), F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed an
Rthe notice of election to be exempt
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for Issuance of a certificate, The
department shall revoke a certiflents at any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
FEB -27 -2013 03:02A FROM:
MIAMI -DADE COUNTY
TAX COLLECTOR
1$0 W. FLAGLER Sr.
lot FLOOR
MIAMI, FL 33150
TO:3057568972 P.2
2012 LOCAL BUSINESS TAX RECEIPT 2013
MIAMI -DADE COUNTY -STATE OF FLORIDA U.S. POSTAGE 2013 PAID
MUST BE LAYEDPLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER EA - ART. 0 810 PERMIT MNp 231
526941- 0 THIS IS NOT A BILL — DO NOT PAY
RENEWAL
BUSINESS NAME /LOCATION RECEIPT NO. 550640 -8
ARTEK CONSTRUCTION MANAGEMENT STATE* CGC1506737
CORP
2330 SW 29 AVE
33145 MIAMI
OWNER
ARTEK CONSTRUCTION MGMT CORP
Sea. Typo of attalitOlo WORKE
T188 GEENLERAL BUILDING CONTRACTOR 1
BUSIN888 TAX mom IT
coas oaf PERMIT TIM
EXISTING REGULATOR OR
ZONING LAW/ OF ma
UNTY OR moo. wan
000F
mon moor OR ANY moon
MOM= NY LAW 19
TH8 Nomura � TIMM
�PpAY�4IBNT RECgygp
zA1OOWitYTAX
60040000167
000045.00
SEE OTI1ER SIDE
DO NOT FORWARD
ARTEK CONSTRUCTION MANAGEMENT
CORP
RICHARD SPRINGER PRES
2330 SW 29 AVE
MIAMI FL 33145
IHIh,,llt,,,Ibl„ 111,1,„ 11,,,11„I„b„ 11„ lllli,,,V8,1
LEGAL DESCRIPTION:
LOT 12, AND THE NORTH 210F LOT 13, OF BLOCK 14, "FIRST ADDITION TO
PASADENA PARK" ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK G,
AT PAGE 82, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA.
MAP OF SURVEY
20.00 —.e
LOT 10 OF BLOCK 14
P.B. 6 - PG. 82
1 �
115.00' (R M)
90°02'40°
O
Iai 25.6\ a Z� � 3 R
` "rs,�wev e
0.50'
PROPERTY ADDRESS:
FOLIO No. I I -223 I -013 -0590
I0565 N.E. 2nd COURT
MIAMI SHORES, FL 33 138
WALLL
ON -UNE tt
U
0 E
N Ql
�.d
J
LD CATI ®N MAP
NOT TO SCALE
- SAMUEL
- WELLS
- FIDELI
COMERFORD
AOAIATIMA
E COMPANY
- UNIVE
- KEYES TITEE SE ACES
0. I 0
20.0a
GENERAL NOTES:
LEGAL DESCRIPTION PROVIDED BY OTHERS.
EXAMINATION OF THE ABSTRACT OF THE TITLE WILL HAVE
TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY,
AFFECT THIS PROPERTY.
THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR
EASEMENT OR OTHER RECORDED
ENCUMBERANCES NOT SHOWN ON THE PLAT.
THE PURPOSE OF THIS SURVEY I5 FOR THE USE IN OBTAINING
TITLE INSURANCE AND FINANCING
AND SHOULD NOT BE USED FOR OTHER CONSTRUCTION,
PERMITTING, DESIGN, OR ANY OTHER PURPOSE WITHOUT
THE WRITTEN CONSENT OF LANDMARK SURVEYING ASSOCIATES, INC.
UNDERGROUND PORTIONS OF FOOTING, FOUNDATIONS OR OTHER
IMPROVEMENTS WERE NOT LOCATED.
ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED.
WALL TIES ARE THE FACE OF THE WALL.
FENCE OWNERSHIP NOT DETERMINED.
BEARINGS REFERENCED TO LINE NOTED AS B.R.
BOUNDARY SURVEY MEANS A DRAWING AND /OR GRAPHIC
REPRESENTATION OF THE SURVEY WORK PERFORMED IN
THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND /OR NOT
TO SCALE.
NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNI F95 NOTED.
NOT VALID UNLESS SEALED WITH THE SIGNINGS SURVEYORS EMBOSSED SEAL.
DIMENSIONS SHOWN ARE PLAT AND MEASURED UNI FSS OTHERWISED SHOWN.
ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D. 1929 UNLESS OTHERWISE
NOTED.
THIS 15 A BOUNDARY SURVEY UNLESS OTHERWISE NOTED.
THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF
THE ENTITIES NAME HEREON. THE CERTIFICATIONS DO NOT EXTEND TO ANY
UNNAMED PARTIES.
Sc-oP-
(2)12.1.-L o Ve
bcac ' 1 OL
Seers (J� "
1 1 5.O O' (R Sc M )
A PORTION OF
LOT 13 OF BLOCK 14
P.B. 6 - PG. 82
)20C -'
W0ac- j-eCVN
CO- 1, J- c-d awe
A.pprox
� v r-4P\e. 00
Taal Shores 1YiU ae
21,5113
SUBJECT TO COMPUANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND RE(ULATIONS
CERTIFICATION:
SURVEYOR'S CERTIFICATION: I HEREBY CERTIFY THAT THIS 'BOUNDARY SURVEY°
15 A TRUE AND CORRECT REPRESENTAION or A SURVEY PREPARED UNDER MY
DIRECTION. THIS COMPLIES WITH THE MINIMUM TECHNICAL STANDARDS, AS 5ET .
FORTH BY THE STATE OF FLORIDA BOARD OF PROFESSIONAL LAND SURVEYORS IN
CHAPTER 6I G 17 -6, FLORIDA • % IN15TRATI CO!.- URSUANT TO 472.027,
FLORIDA STATUTES.
SIGNED O ' FOR THE FIRM
ERNESTO E. E5PINO5� r .M +o. 2946 -STATE OF FLORIDA
NOT VALID WITHO AN AUTHENTIC ELECTRONI IGNATURE AND AUTHENTICATED
ELECTRONIC SEAL D/OR THIS MAP 15 NOT ID WITHOUT THE SIGNATURE AND
THE ORIGINAL RAI5 . SEAL OF A LICENSE SWRVEYOR AND MAPPER.
FIELD DATE OF SURVEY:
04 -28 -2010
BENCH MARK:
ELEVATION:
N/A
N/A
FLOOD ZONE:
COMMUNITY:
PANEL:
X
120652
302
ELEVATION:
DATE OF FIRM:
SUFFIX:
N/A
09- I I -2009
L
ALL BEARINGS AND DISTANCES SHOWN HEREON ARE RECORD
AND MEASURED UNLESS OTHERWISE NOTED.
ABBREVIATIONS AND LEGEND:
NC
APPR.
ASPH.
B.C.
B.M.
C.B.5.
CONC.
C*G
V.G.
D.M.E.
DIA.
D.H.
(M)
(R)
R/W
U.E.
P.B.
PG.
P.C.P.
P.0.5.
TYP.
0
x O
=DENOTES AIR CONDITIONING UNR
= DENOTES APPROXIMATE
=DENOTES ASPHALT
=DENOTES BLOCK CORNER
=DENOTES BENCH MARK
=DENOTES CONCRETE BLOCK STUCCO
=DENOTES CONCRETE
=DENOTES CURVE 4 GUTTER
=DENOTES VALLEY GUI 1 CR
=DENOTES CENTERUNE
= DENOTE5 MONUMENT UNE
= DENOTES DRAINAGE 4 MAINTENANCE
EASEMENT
=DENOTES DIAMETER
=DENOTES DRILL HOLE
=DENOTES MEASURE
=DENOTES RECORD
=DENOTES RIGHT -OF -WAY
=DENOTES UTILITY EASEMENT
=DENOTES PLAT BOOK
=DENOTES PAGE
= DENOTES PERMANENT CONTROL
POINT
=DENOTES PPOINT OF BEGINNING
- DENOTES TYPICAL
=DENOTES WOOD FENCE
=DENOTES CHAIN UNK FENCE
=DENOTES IRON FENCE
=DENOTES FOUND IRON PIPE (NO ID.)
=DENOTES FOUND NAIL AND DISC
m
0
z
m
1
J
U
QQ�
DL
w
d
0
04-28-2010
REVISION / UPDATE OF SURVEY
DESCRIPTION
H
O
JOB No.
7004-033
ST+4rE OF'FLORIDA ` R
AG"# 6 590 42.
DEPARTMENT OF BITS INES S AND
PROFESSIONAZ, REGTTLATION
CGC1506737 /11/12 110423866
CERTIFIED RA,D CONTRACTOR
SPRINGER, R
ARTER CONSTRUCTIONS MANAGEMENT CO
IS CERTIFIEb under the provisions of Ch; 489 FS
ExPi ration irate: AVG 31, 2014 L12061100.960
PERMIT #
CONTRACTOR: !EYQ) 0VdtSr
()L/5
-k)01 )1,
SUBMITTAL DATE:
ADDRESS: J C75&Y5
NAME:
90-
RESUBMITAL DATES:
PROJECT TYP
PAR°
ON1N.
/ \ f \ FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRS /DERM
PLUMBING
NOC
MECHANICAL BLDG