PL-13-974Inspection Worksheet
Miami Shores VIIIa0e
14088 N.E. 2nd Avenue Miami Shores, FL p
Phons: (345)796-2204 Far. (M)758-8$72
Inspection Number: INSP 206636 Permit Number. PL -6-13-974
Sdieduled Inspection Bate: January 28,2M4 Permit Type». Pitpmbin - Resid,+ Inial
Inspector: Diaz, osvaido
Inspection Type; 'Pinal
Owner: Work CtassWicetion-.Adctitiai /Attention
Job Address. 10850 NE 10, Court
Miami Shores, FL. 33138- Phone Number
Pahl Number, 9tZ 32428 30;
Project <NONE -
Contractor MITO PLUMBING CORP Phone: 6}8534#T±li3
uotnments
REPAIR. REPLACE EXISTING 8 NEW HALF BATH
MASTER BATH': RELOCATION
Falft
inspector Comments
F7/
CREATED AS REINSPECTION FOR INSP-19U931. NOT READY
SEAL PENETRATIONS
HALL BATH SECURE TUB SPOUT ARILS SHOWER HFAD
PROVIDE HACK SPLASH BEHIND LAV
Failed SECURE DISHWASHER
MASTER SHOWER NOT WORKING AS REQUIRED
Correction
Needy
Re -Inspection
Fee
No AdcfWwaf lnsp-%-Wns-am be scheduW urd
winspecUon fee is paia
JanusLey 21,1014 For )=iatsInctions please Gall: {306)762-4149 Page 10 *In
6?.
Miami Shofes village r
r` AUG 0 8 20
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.22041": (3 5) 756.8972
INSPECTION'S PHONE NIJ1 B i (3055) 762.4949
JOB ADDRESS: & 61 J b _'j e f o
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO 7�
OWNER: Name (Fee Simple Titleholder): V'
Address:
City: State:
Zone:
Tenant/I.essee Name: Phone#:
Email:
r • 1:.
CONTRACTOR: Company Name:. � 1 a �' ^ r Phono:., '
Address: t• " / / � V
City: State:
Qualifier Name: Phone
b`
State Certification or Registratioln #: _ l Z I rtifi ' tto of Competency #,
Contact Phone#:��' S �� Email Address: �A.aeJ►�'t r
6 /'�
DESIGNER: Architect/Engineer: Phone#: `®
SLTG..........
�t$l�et°➢�1 21 'b ��,apOY G 'hq
Value of Work for this Permit: $ . r k:
of Work: DAd gym`
Type dress OAlteration ° °� Ofebw.saa�Es�F a Of %tiep ce ODemolition
Description of Work:
• e
Submittal Fee $ Permit Fee
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Zip
Zip
Application is hereby madeim 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
IlAPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR. LENDER, OR . AN ATTORNEY BEFORE
k9C, ORDING YOUR NOTA& OF"CO1ViM' " tNCkMENT:'
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will a appro a reinspection fee will be charged.
r� a
Signature Signature
Owner or Agent /� Contractor
The fore omg instrument was knowledged before me this V
day of 4, 201-a, b lAA ,
pp ���� who is pers ally known to me or o has produced��
l� Z " 2k 1-1 '0 6 "0 As identification and who did take an oath.
NOTARY
The foregoing instrument was acknowledged before me this
day of UC , 2013, by AIIM� � .N-,�
who is personally known to me or who has produced
FOM
*"yft0-8WdFkrW
of Com. bow so Is. 20th
identification and who did take an oath.
ARY PUBLIC: .U%%+%u1uw
Prinb!,ll (-7A f I
771
My Commission Exvf es: '�„$ ' t01 $� My Commission Expires
Qada�kak$agasIaskskskskeknksk�kakakskdvBasIvsIwkskakak'k ak�kHaAasIssIakvkskHa�&8+akak=kvksk'k:ksIasIaskskxkakakskak��k�knk'AaksI+�I+�aH�kakak+kdsdv�sk�$snksksk�ink$ssIa�Issk$ak.koA�IaHaoRsIasksk�Is8a8a8sak8aak�knk$+gsHs:ksk
APPROVED BY �- �3 Plans Examiner Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/(Y7)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department cF-'v7`
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAY 4.12A
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949--
FBC 26kO
BUILDING
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: t� ® �' Lo (�_ 7 o
Permit No. P L 1 3 'cam
Master Permit No. k I S e i� 4 n 5
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple'
Address: l 7 u -"b 0
City: i o (CA_; 6 -y. e
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:. V S 4 q 0
City: _ '�-Y R & ('_�
Qualifier Name:
NO 'V' Flood Zone:
State: Zip:
r--
Phone#:--�/V6 �'
State:�__� Zip:
(�;btA (.c Phone#•
State Certification or Registration #: C E�.. I q Q it 1 Certificate of Competency#:_
.y
Contact Phone#: E 6 142 S51 Email Address: V)�t uph b (Vl �f
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $Square/Linear Footage of Work:
Type of Work: ❑Address Alteration ONew 00tepair/Replace
PP P �
Description of Work: �� �.� �e. �!�� �� -e g d i
Submittal Fee
Scanning Fee $
Permit Fee $� . CCF $ CO/CC $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
ODemolition
TOTAL FEE NOW DUE $ °
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
zip
Application is'hpreb� 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 hat all *orkiwill 34m#one in compliance with all
applicable laws regulating construction and zoning. ° a►
'WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PR6PERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE -OIC COMMENCEMENT."
Notice to Appfi& at. -Ak a condition to the issuance of a building pmt with an estimated value exceeding; $2500, the. appAcant 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.
Signature
Owner Agent
The foregoing instrument was ac ow edged before me this
day of /_, 20)3, by Gdr.��7fi�N ,
who is personally known to me or who has produced
As identification and who did take an oath.
p` Signature
Thq foregoing instrumentwas acknowledge efore me this
day' of ' Y , 201 by A-N/ic(_Ys aw ui
who is personally know tonne or whg has•.produced
as identification and who did take an oath.
NOTARY PUBLIC• ���\\Illuu►u,/ NOTARY PUBLIC: 1111111111/t//ON
Sign: ' ' o • co - sign: _ 016 .
Print: _ w y° Print, U9t c
—' Carty X100
My Commission Expires: .��j'• a' ,A�+a�` MY,Cop issiioi� pires ?.gyq,'+.. 59
'�/, 0,9'' .... '• v fit°' .6� i' +' . i �! b • �°•tr ¢�rb 1'�"�}'��.....•�(•k \\�.
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)
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 Type: Electrical
JOB ADDRESS: ®� <z /VC /40 C
FBC 20
° vLn51
FY-__ >s
Permit No.�.m��
Master Permit No.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titlehc
Address:
NO
Zone:
City: -L In 161 t�4 &/? -5 State: ro Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: cG"� 'l r- Phone#: 6S"D
Address:
City: � �4A- U a 1' Z -Z ( tate: L Zip:
Qualifier Name: Phone#•
State Certification or Registration #: 30 13 n 13 Certificate of Competency #: �2 �
Contact Phone#: Y�Lf 6 -0 �Email'Address: &CAS
DESIGNER: Architect/Engineer.. Phone#:
Value of Work for this Permit: $ /41? ® Square/Linear Footage of Work:
Type of Work: OAddress DAlteration ONew Repair/Replace
Description of Work: �• 2 dl S r` p e f I /1 t,
Submittal Fee
Scanning Fee $
Permit Fee $ ' Z Q e f f _ CCF $ CO/CC $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
ODemolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
zip.
Application it heteb.y 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 CO GEMENT.'
Notice to Applicant As a condition to the issuance of a building permit with an estimated value cue ing $2500, the applicant must
promise in gobdittzt•h• that a copy of the notice of commencement and -construction lien law brochure. will be delivered t9, 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 Agent
The foreg instrume
day o 20
. a Rignat%re�'J
Contractor
The
o is ersonaffi own to me or w" produced
t'JyMu) As identification and who did take an oath.
NOT.
041 11 1KF,I,I=L-1W1
My Commksion L0eR:
day of(
who is
ZWas Uacknow edged befor Mme flus
n to me or who has produced
I V1 �- 'Ul�Wentification and who did take an oath.
Sign:
Print;
oAMi�
ae�YaY3e4r�FdnkakrksYsYde9e4nt�ede3r►YQrAraF4e�YaYsk&�k�Y�YaY3:9e9eirs�ak�Y►Y9ednk9rik�YsY9eaY�tr9esYrk4rkstaktkeF�YaY9raYFrded ak9t�k9reb�akaY&3ede�Y3e3:3ed�&4rSeFraYtk►Yat JeakdrsYsk►Y�YaY9ta4skde4r�Yskskfr
APPROVED BY �' �/ �(/ Plans Examiner Zoning
Structural Review
(Revised 3/122012XRevised 07/10/07XRevised 06/102009XRevised 3/15/09)
Clerk
To: P®ga ^�. qP 2 2013-05-06 17:16:49 (OMT) 1707701141 2 Prom: M®tt La Planta
Fax: 3057568972@myfax.com
GGRTIrIGATG Or L1ADILITY INOURIB1NGG
DATE(MMUDDIYYYYI
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
05/06/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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 CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
LaPlante Agency
2715 State Rd. 580
Clearwater, FL 33761
CONTACT
NAME: Jessie Clemons
PHONE 727 796-8566 c No : (727)791-1 2
ADDRESS: jessie@japlanteagency.com
INSURERS AFFORDING COVERAGE NAIC 0
License * A149680
INSURER A: North Pointe InsuranceCompany
GENERAL LIABILITY
INSURED
Cassia Electrical Contractors Inc
INSURER a: Florida Citrus Business & Industries Fund
INSURER C:
8261 NW 48th St
INSURERD:
and Glen Walker
INSURERE:
Lauderhill, FL 33351
INSURER F:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCEPOLICY-EFF
POLICY NUMBER
MIDDIYYY
POLICY EXP
M1DDNYY
LIMITS
A
GENERAL LIABILITY
3094110169
07/29/2012
07/29/2013
EACH OCCURRENCE $ 1 00,000
X COMMERCIAL GENERAL LIABILITY
PREMISES Ea occurrence $ 100,000
MED EXP (Any one person) $ 5,000
CLAIMS -MADE � OCCUR
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO- LOC
AUTOMOBILE
LIABILITY
CEO BIINED SINGLE LIMIT
iden $
ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED
BODILY INJURY (Per accident) $
AUTOS AUTOSSCHEDULED
HIRED AUTOS NON-OWNEDPROPERTYDAMAUE
AUTOS
Per accident)$
UMBRELLALIAB
HCccLML':-MA.E
EACH OCCURRENCE $
EXCESS LIAR
AGGREGATE $
DED RETENTION$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
10650798
10/26/2012
10/26/2013
X WC STATU- 0TH-
ER
Y I N
OFFICER/MEMBFELUDEDCUTIVE❑
NIA
E.L. EACH ACCIDENT $ 1,000,000
(Mandatory in NH)
If yes describe under
EL.DISEASE -EAEMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 11000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addidonal Remarks Schedule, If more space is required)
f`MOTICINATC unr n—
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
IV IV755-ZUIU ACORD CORPORATION. All rights reserved.
ACO RD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Printed by J LC on May 06, 2013 at 01:17PM
E
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
05E000248
CASSIA ELECTRICAL CONTRACTORStINC'
WALKEk GLENWORTH
'.Is certified. under the provisions of Chapter 10 of Miami -Dade County.
STATE OF FLORIDA
DEPARTMENT OF BUSINSSS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-135
•
1940 NORTH sTRFLT32399-0783
TrfiALR;BR, a M WORTH C
CASSIA ELECTRICAL CONTRACTORS INC
8261 NW 48TH ST
LAUDERHILL
FL 33351
Congratulations! With this license you become one of the nears one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto www.myfloridalicanse corn.
There you can find more Information about our divisions and the regulations that
Impact you, subscribe to department newsletters and seam more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for' doing business in Florida, and congratulations on your new license!
STATE OF FLORIDA �l�S'L '
DEPARTMENT OF BYi9INESS
PROPESSZONAL REGULATII
BR13013013 08/09/12 126
REG ELECTRICAL CONTRACTOR
WALKER, GLENWORTH C
CASSIA' ELECTRICAL CONTRACTi
(INDIVIDUAL MUST 149ET ALL"
LICENSING 'RRQUIREKMgTS PRII
TO CONTRACTING IN ANY AREA
HM RHOISTEMM unaer the previsis• a
tax0ieat3aa datee AUG 31, 2014 onL12080
- --- ---- --._ „__, DETACH HERE. .._...._ ...._ ...... _.__.
t s « 6:08 e Z •®• _ , e _ ..
Ac# .6259034 STATE OF FLORIDA.
DEPARTMENT OF.:13USTRESS AND PROFESSIONAL REGULAT109
ELECTRICAL "CONTRACTORS• LICEN'S.1-iO SOAR SEt#L3.2080
08/0 V20'12.1126002850 1-E&13
ThaCkLECTRICAL CONTRACTOR
Named below HAS R$GIST19RZD
Under the provisions of Chapter 489 FS_
Expiration date: AUG 31r 2014
(INDIVIDUAL MUST MEET ALL LOCAL LICENSING
REQUIRMMTS PRIOR TO CONTRACTING IN ANY AREA)
WALKER, GLENWORM C
CASSIA SLLCTRICAL CONTRACTORS INC
8262 NW 48TH ST
LA10DERHILL FL 33351
RICK SCOTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
KEN LAWSON,
SECRETARY
MIAMI -DADS COUNTY 2012 'LOCAL BUSINESS TAX RECEIPT 2013 FIRST-CLASS
TAX COLLECTOR MU j 600E COUNTY- ST'ATH OF FLORIDA
let FLOOR140 FLAMER ST. EXPIRES SEPT, 30, 2013 UAPOSTAGE
MIAMI, FL $9130 ML%y 8E DISPLAYED AT PLACE OF BUSINESS MIAMI, FL
PURSU NT TO COUNTY CODE CHAPTER $A - ART. 9 & 10 PERMIT NO. 231
568093-0 THIS IS NOTA SILL -00 NOT PAY
BUSINESS NAME/ LOCATION RENEWAL
ELECTRICAL CONTRACTORS INC CC # OSE000248 592529-3
DOING BUS IN DADE CO
OWNER
CASSIA ELECTRICAL CONTRACTORS IN
See, type or Eusinme WORKERIS
IS IVY6A k&FCI'RICAL CONTRACTOR 3
I��r Ascan: rr
M m V1011AT4 AM
N a RMULATeay
11 LA NtB W TH
rt on crnf s _ _ DO NOT FORWARD
NOTME A t�,fnQuACrt OF CASSIA ELECTRICAL CONTRACTORS INC
MIX �o QFa" '` GLENWORTH WALKER PRES
PAW=ffR8MM 8261 NW 48 ST
MW"
aouecroa:McowmTAX LAUDERHILL FL 33351
02240041001
000075.00 lar##rrr#Iratf#:rfIt; #rI1fa#tfttfrf►t If 11111,11115rj1AllIf#
SEE OTHER SIDE
z—
.:t
AX COM r A • r . • =••�VB h'." •."�'NA.li7G1! . 20i8 FIRST-CLASS
• Y ' _ •°.ice':
jy
• . :E%-2` H c7i•.. •...: U.S, POSTAGE
rr,:J.�'' -:'.; ry ,�S71�TEpFFIQ PAID
_ ; IFI S SEPT. 30•'' 7f3 PERMIT NO. 231
THIS IS NOT A Bill — DO NOT PAY
RECI"(PT'No. 30-5925293 CC NOa OSED00248
BUSINESS NAME / LOCATION RWSPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
CASSIA ELECTRICAL CONTRACTORS INC AS SPWFIED HEREON.
DOING BUS IN DADE CO
OWNER :CASSIA ELECTRICAL CONTRACTORS INC
SEE BACK OF RECEIPT FOR ELECTRICAL CONTRACTOR
A LIST OF NON -PARTICIPATING
MUNICIPALITIES
Receipt holder must DO NOT FORWARD
t4r rotor in the city
where Work Istobe CASSIA ELECTRICAL CONTRACTORS INC
dyne. GLENWORTH WALKER PRES
8261 NW 48 ST
Whtttfr FIRZIMM LAUDERHILL FL 33351
V,UWI-M9C0IJ* YTAX
" 09%25/2012
02240041002
000200.00 #f 1 ### ## f�,6 ##
iatl:.t iS2.�t.ri)!„:t rfi 1;f.tltrtt ::tt tsttt ,ttr