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WS-14-1177Miami Shores Village Building Department 90050 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: JOB ADDRESS: BUILDING Permit No. iE,,T� JUN 00214 RR EE C BY: FBC 20 �O Master Permit No. W S 1'_1 t ROOFING City: Miami Shores County: Miami Dade Zip: .33 /SO Folio/Parcel#: 1/- 310/ —O1 -1 - O Z I O Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): W qan myem+uru t✓LC Phone#: Address: `` IIlli tg Bel � eadl Llan d pn y i City: 14 rr I State: FL Zip: 3313,p Tenant/Lessee Name: Email: CONTRACTOR: Company Name: S A R;"4111�4mct hzo dayi w, /h G Phone#: h s G) 413 " 4 1 Address: q 2 3g s W 227 if # 2i City: CuA r bow State: PC Zip: 33 :9 0 Qualifier Name: d UG 11 C • 8 uaoLe Phone#: h 14 , q 13- -0/61 State Certification or Registration #: ('6C E6 4 q 3 ! Certificate of Competency #: Contact Phone#: l p (o 1 y 13 Email Address: 1?V_#P Giy 1 rl /fid DrI j C o "A DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 8000 % Square/Linear Footage of Work: Type of Work: DAddition WAIteration ONew ORepair/Replace ODemolition Description of Work: % 3 O n tri ( �1 Aj i a jAx"d ! 14,r„�G L f " �')/ l t�QiO �✓ ✓. Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ - I 1 : " Technology a tr 131:5 171 TOTAL FEE Now �..r.0��ArA 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 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 Owner or Agent The foregoing instrument ,was acknowledged before me this day of le' Arc.. , 20 ` , by 1q,1 v 0 d SK V C who is personally known to me or who has produced —0 L- As identification and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this- day of Jo �� , 20 �, by , )J&11 C t , who is personally known to me or who has produced L a L as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ^y �npn ca mal 4'1, Lu l! n SqW§plon # FF 000194 Bonded Through National Notary Assn. APPROVED BY Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Devil. by -Entity Name 4 It Florida Limited Liabiliity Company KALYANI VENTURES, LLC Filing Information Document Number L12000146241 FEI/EIN Number 46-1443305 Date Filed 11/20/2012 State FL Status ACTIVE Effective Date 11/26J2012 Principal Address 1015 BELLE MEADE ISLAND DRIVE MIAMI, FL 33138 ailing Address 1015 BELLE MEADE ISLAND DRIVE MIAMI, FL 33138 Registered Agent Name & Address SUSSMAN, HAROLD S 5300 N. FEDERAL HIGHWAY FORT LAUDERDALE, FL 33308 Authorized Person(sl Detail Name & Address Title MGR SUSSMAN, HAROLD S 5300 N. FEDERAL HIGHWAY FORT LAUDERDALE, FL 33308 Report Year Filed Date 2013 03/25/2013 2014 04/28/2014 r Page 1 of 2 http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetaillEntityNatne/flat-112... 6/6/2014 CFN: 20140390420 BOOK 29172 PAGE 4795 DATE:06/02/2014 09:44:15 AM NOTICE OF COMMENCEMENT HARVEY RUVIN, CLERK OF COURT, MIA -DARE CTY A RECORDED COPY MUST BE POSTED ON THE .JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO No. 11-3101'ni9-yW6 STATE OF FLORIDA: COUNTY OF MIAMI -DADS THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. I. LrI description of properly and stmt /address: Name and address of fee simple titleholder. 4. Contractoes name and address: 5. Surety: (Payment bond required by owner from contractor, if any) ' - Name and Address: Amount of bond $ S. Lender's name and address: 7. Persons within the state of Florida desigrinted by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenoes Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the woradon date Is 1 year from the date of recording unless a different date is specified) Print Owner's Name—&A aA S ,UWIQ,n Prepared by .. 20 _1 Address: CANCELLEI