RC-13-2375b�
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BUILDING
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 APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
Permit No.
. C� A -I
OCT 18 2013
BY:
FBC 20 l O
Master Permit No. 2L,) 0 —
ROOFING
City: Miami Shores County: Miami Dade Zip:
Foho/Parcel#:
Is the Building Historically Designated: Yes
NO ✓� Flood Zone:
OWNER: Name (Fee Simple Titleholder):,& e-,,, e-1 Phone#: �c-3ar— 3D2-;
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: sroo W (OL
City: C Pr
State Certification or Registration #: LX
Contact Phone#5 n--'�, 302-)400
cc5 %oO Phone#:(0 7i�7 �P
of Competency #:
DESIGNER: Architect/Engineer: Phon
�aluey oh' Work for this Permit: $ [ V '�' Square/Linear Footage of Work:
Type,af Work:,,,❑Addition ' ❑Alteration ❑New "--�Repair/Replace
-Description of Work: z i'
Color thru tile:
3DD 1 Z
❑Demolition
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
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 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 the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature " �tkgnature,
Owner or Agent
The foregoing instrument was acknowledged bgf re me this J Ott"
day of , 201 by t+J %per 1 ,
who ispersonally known to me or who has produced "er-5
Li ctsn St As identification and who did take an oath.
NOTARY PUBLIC:
Print: 1'" ►SsC. dZ . (,,L'-^
My Commission Expires: 0 -20
APPROVED BY
Notary Public, State of Flori
Commission# EE 107488
My comm. expires June 28, 'g
Ckbowledged
orThe foregoing ' enwas before me thip__
day of D , 201, by
who i _personally known me or who has produced
Plans Examiner
Structural Review
as identification and who did take an oath.
NOTARY Ul
Sign:
Print:
My Commission
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
STATE OF FLORIDA
DEVARTHENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TA
I LLAHA9SEE FL 32399-0783
GARCIA, NICKEL
N.G. RXCELLzNT SERVICES CORPORATION
2471 XW 67 STREET
MIAMI FL 33147
I— '°`'
Congratulations! With this license yqu become one of the needy one million
Floridians licensed by the Department of $usiness and Professional Regulation.n.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Everyday we work to improve the way we do' business in order to serve you
For information about our services, please log onto w'ww.myflorjdalJ1cen9e.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn more about the
Departmenrs 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.
c
Thank you for doing business in Florida, and congratulations on your new license!; f.CFRT
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DURABLE POWER OF ATTORNEY
1, Lilian M. Diamond, of Towerside Terrace, Apt. 1705, Miami, Florida, 33138 a
Marton Gaal, of 4000 Towerslde terrace appoint
act for me in any tawiul Bray with res ' �� 1705, Miami, Florida, 33938, as my agent to
Pett to the following subjects:
(A) Real Property transactions. To lease, sell, mortgage, purchase, exchange, and acquire,
and to agree, bargain, and contract for the lease, sale, purchase, exchange, and acquisition of,
and to accept, take, receive, and possess any interest in real proP party we,
on such
terms and- conditions, and under such covenants, as my Agent shall deem proper, and to
maintain, repair, tear down, atter, rebuild, improve manage, insure, move, rent, lease, sell,
convey, subject to liens, mortgages, and security deeds, and in any way or manner deal with all
or any part of any interest in real properly whatsoever, including specifically, but without
limitation, real property lying and being situated in the State of Florida, under such terms and
conditions, and under such covenants, as my Agent shall deem proper and may for all deferred
Payments
accept tpur ase money notes payable to me and secured by mortgages or deeds to
may from time to time collect and cancel any of said notes, mortgages,
security interests, or deeds to secure debt
(8) Tangible personal property transactions. To lease, sell, mortgage,
hase, exchange,
and acquire, and to agree, bargain, and contract for the lease, sale, purchase,exchange, and
acquisition of, and to accept, take, receive, and possess any personalproperty
tangible or in angible, or interest thereto, on such terms and conditions, auundersuch ver,
covenants, as my Agent shall deem proper, and to maintain repair, improve, manage, insure,
rent, lease, sell, convey, subject to liens or mortgages,or to take an other security interests
said property which are recognized under the UniformCommercial Code as adoadoptedat that in
time under the laws of the State of Florida or any applicable state, or otherwise hypothecate
(pledge), and in any way or manner deal with all or any part of any real or personal property
whatsoever, tangible or intangible, or any interest therein, that I own at the time of execution or
may thereafter acquire, under such terms and conditions, and under such covenants, as my
Agent shall deem proper.
(C) Business operating transactions. To conduct en
affairs of any and alt lawful business ventures of whatever nature or kind may now ore in, and otherwise transact e
hereafter be involved in.
(D) Claims and litigation. To commence, prosecute, discontinue, or defend all actions or
other legal proceedings touching my property, real or personal, or an
any matter in which I or my pr y Part Thereof, or couching
defend, settle, ad' property, real or personal, may be in any way concerned. To
fust, make allowances, compound, submit to arbitration, and compromise all
accounts, reckonings, claims, and demands whatsoever that now are, or hereafter shall be,
pending between me and any person, firm, corporation, or other legal
and in all r as eg entity, in such manner
my Agent shag deem proper.
Page 1 of 2
-THIS -POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL
IT IS REVOKED.
THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE STATE OF
FLORIDA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES. IT WAS
EXECUTED IN THE STATE OF FLORIDA AND IS INTENDED TO BE VALID IN ALL
JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL FOREIGN NATIONS.
I am fully informed as to all the contents of this form and understand the full import of this grant
of powers to my Agent
Signed this X? ZX day of 4✓ , 20�
V72 - le
[Social Security]
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
STATE OF FLORIDA
COUNTY OF
ocument was acknow , ged before me on [Date] by
[name of principal].
[Notary Seal, if any]:
7
mill 111 11
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4gn)aAtur/eof Notarialofficer) ,
A P*kAftAAN me, AW Notary Public for the State of Florida
INYMMMOSAPNI&M7
My com issiop expires:
Page 2 of 2
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