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MC-15-2885 N01 M0.1'1-15-288$,,, Miami Shores Village ■ Perth )rp8.'Mechani�ai 10050 N.E.2nd NW r; n 2d Aow Miami Shores,FL 33138-0000 hfi � Phone: (305)795-2204 K, P8 7 tit S B i 01VVED tORI�D'A is Expiration: 05/18/2016 ,r. . Project Address Parcel Number Applicant 175 NW 100 Street 1131010230320 Miami Shores, FL 33138- Block: Lot: CHRISTIAN LANSER Owner Information Address Phone Cell CHRISTIAN LANSER 175 NW 100 Street (305)772-4313 MIAMI SHORES FL 33150- 175 NW 100 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 COOLING CONTROLS INC (305)226-8651 w ._.. Total Sq Feet: 0 Tons: Available Inspections: Additional Info:RELOCATE CONDENSING UNIT. Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Electrical Date Denied: Type of Work: Review Planning Scanning:3 Review Mechanical Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# MC-11-15-57769 $2.00 11/20/2015 Credit Card $66.20 $50.00 DCA Fee $2.00 Education Surcharge $0.40 11/16/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNaAFFT: I certifytha II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con rung. Futher r ,I orize the above-named contractor to do the work stated. November 20,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 20,2015 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249290 PermitNumber: MC-11-15-2885 Scheduled Inspection Date: December 16,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: LANSER, CHRISTIAN Work Classification: Addition/Alteration Job Address:175 NW 100 Street Miami Shores, FL 33138- Phone Number (305)772-4313 Parcel Number 1131010230320 Project: <NONE> Contractor: COOLING CONTROLS INC Phone: (305)226-8651 Building Department Comments RELOCATE CONDENSING UNIT. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-247857. NO ACCESS TO YARD OR PLANSIPERMIT @ 4:50 (786) 3440525 CONTACT PERSON Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 15,2015 For Inspections please call: (305)762-4949 Page 39 of 51 d �� � ►� Miami Shores Village Building Department ` 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �"� FBC 20 [y BUILDING Master Permit No. � PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING PIMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP PW CONTRACTOR DRAWINGS P JOB ADDRESS: W (o z) � - _ City: Miami Shores County: Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ClrrrZl Phone#: Address: (l4 ovi toe-) --j(- City: kL"( 'StAlE>fl-r� State: Zip: Tenant/Lessee Name: Phone#: Email: / CONTRACTOR:Company Name: (�®0 ,7S c Phone#: Address: 3 It �lr rvA iEE� City: /V1 r State: Zip: Qualifier Name: Yoe-( _P2 (1,10 Phone#: 36-r Z2-b 26 571 State Certification or Registration#: M I Z �j 17 3 a Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ze ��<a,-I-� �,a,n n s ,n� U A I Specify color of color thru tile: Submittal Fee$ Permit Fee$ Lt� CCF$ CO/CC-$ ` Scanning Fee$ 'Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ _ (Revised02/24/2014) Bonding Company's Name(if applicable) l 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of com ce ent st b posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In ab ce of s ch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur Signature OWNER or AGENT C NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this day of 4AileO2 / .'- ,20 Z5—'.by day of 42 ov- 20 OV— by / r who is personally known to1�rl Q1 ��Lan -c r, who is personally known to me or who has produced- as me or who has produced �c__ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Sign: rint: rin Seal: o�►a"°� Hots Public Seal: Florid Joanna M Feliciano a row°�w, Notary Public State of Florida o �yComm►sston FF . Joanna M Feliciano Expifes 01/12/2018 2753 � ov Nly Commission FF 082753 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 16-hou-2015 09:04 Unknown 3052271261 P.2 oo2�ss ci WK WK 7.7 ........... .. ......... . e t ` >t .;;;.y;::>:;`:::::•' •':::;:::::::2:::: i`.?:::'::!i 2::+:::::: ::<'YC: ::;'i:'••: .':•.:^;:••::::`;::::::i:::::; ;j 22::: ^::i s i::;.::•i:::::;.:::....;....:'...�.:.::..'.•. :> .X:X' ..sin�>;s��•iK39'lt�t���rfCrnt»:: :;�>:>::>�'<:>:::, i2+f`CY�Ii''T•t�FQ... is< :?:.?>:<:::i::::y fate+r0 �w .:::� tYSC;�§.L13� �., •:rxF•; f$G5:1df;.bLsti'f85S»:<;�. :::: . .�: •: :: `:� :,;:::�;;rtt>:.;::::�r;T::::�::iso:::::::;:.::.:�;;;::•r;:.::;:::.::.:::;;::<::;.;:;•:`:::::�: ;.:`.::.�,... .....p.. .....�?.......... i�+•.f3 .. .g ..stet. Sc. .......................... p SEC_TIPE OF 13tyStOF :i UEitf')�Ci '$JN•ftit3 r0a orF t> 014" 'll PAYMBNT'RECElt6D• ::::..::: ;.:�.;:.:t• 1 S fNC :`•:`•`::': Y TA :00LLbCT0li':•: >:::: .. �yy ::>• 75 :<....$ W/13/22331 S Q . . R 1 �+ 5-035831' This ucai Bnstttss.lax ResaApt Q tly caidirms paydrept.4t-t . q. .Business Tax.the Racer`1 pt s nat a I:iease,. psitltfxokacenliiC�rionb#t3�epotdoFs:ialificati.! s?;m'dtifxiis�nss, Maiderms!:c4.mp. :tiy3thanygovainmental :> gr2taii ai?esrameinal ulaturyfa"jg..Fags'�reeiF6.!Rt��'t1j1r.�iiiFPlytothe busfpes Ttiei AIL1 iP3 No.a54fi=nust bo.i#i.%.AyBd on ail imtercial'i{g 6tes-ts8inailT title G`: 8a-7 F9 r nia i oulotion•viait�nrww miamidade anti%axt 011e r 1 ; RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE.05 FLORIDA DEPARTMENT OF BUSINESS ANSI.PROFESSIONAL REGULATION 01!��T6�tlCl"ld7l�idlilDlf�RY.tifcElliSIN�'�OARU' 't��'•�...• �X\ f✓MG123 The MECHANICAL Gt3NTRACTaR. ;�; :: :><:: :::�: �:•..,� . fi�ar�l�d 1eltiwr:l.S:CERT.I�'&E@ '.:�.��`'•�►�.••` Under the provisions:D€etiapter..4.$9 FS. . Expiration.agt6:'-A G-:S*j.201.6 .: LA • �: .o t. : O E.. NG C 42,1 :..........::::.::::::.:::::.::.:::.:.::::::::::,:.:::,::::::,:::::•:.:::........:::::,. . 65 S AItIAMI 'F :33�FS5 :.. .. ':...: '::ti. .. ..:v:::; ... �.::.:i?:: ISSUED: 0611612614 DISPLAY AS. REQUIRED BY LAW SEO# I.1'406160001068 ........................—....,....................---..............................................,..,..........,,.............................. .... .. :Forton Insurance To:Cooling Controls Inc., 11:42 11/13/15 ET Pg 3-3 A� CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDD/Y 11/13/201515 THIS CT'9FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER71FICATE 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 pollcy(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 CONTACT NAME. Mercy Campuzano Fortun Insurance, Inc. PHONE (305)445-3535 F .(866)415-0825 365 Palermo Ave. EMAIL .mercy.campuzano@fortuninsurance.com INSURERS AFFORDING COVERAGE NAIC 0 Coral Gables FL 33134-6607 INSURERA:Travelers Insurance Co. INSURED INSURER B.Mount Vernon Fire Insurance Co. Cooling Controls Inc. INSURER c:Technolocry Ins Co 11265 SW 47th Terrace INSURER D: INSURER E FL 33165 INSURER F: COVERAGES CERTIFICATE NUMBER-CL11111603575 REVISION NUMBER: 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. ILTR N-SRTYPE OF INSURANCE MP��CY EFF POLICY EXP LIMITS POLICY NUMBERIMMfDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PDR`EM1SE3OE NTED $ 100,000 A CLAIMS-MADE F OCCUR 60-4704][786 /31/2015 /31/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 1000,000 GENL AGGREGATE UM)T APPLIES PER PRODUCTS-COMPlOP AGG $ 2,000, 00 0 X POLICY PRO' LOC $ AUTOMOBILE LIABILITY Ea accident LIMIT- ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ H I $ AUTOS AUTOS BODILY INJURY(Per acddent) $ HIRED AUTOS NON-OWNED S a VAMAGE $ X UMBRELLA UABHCLAIMS-MADE OCCUR EACH OCCURRENCE $ 2,000,000 B EXCfSSLUIB 015A2171 06/30/2015 6/30/2016 AGGREGATE $ 2,000,000 DED RETENTION It Deductible $ WORKERS COMPENSATION X WC STATU OTH AND EMPLOYERS'LIABILITY ANY PROPRIEiOR/PARTNERIEXECUTNE Y f N �L. OFRCERtMEAABER EXCL(R)ED9 NIA EL.EACH ACCIDENT $ 500,00 (Mandatory in NH) rWC35099594 1/6/2015 1/6/2016 500 000 It yy�es describe tinder E.L.DISEASE-EA EMPLOYEE $ Drsd T)ON OF OPERATIONS below EL.DISEASE-POLICY UMIF $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORO 101,Addhlonai Remarks Schedule,It more apace Is required) Mechanical Contracting--Lic:CMC1249385 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Ave AUTHORIZED REPRESENTAME Miami Shores, FL 33134 Hector Forton/IZ ¢ - ACORO 25(2010/05) INS095l"rxxl m ®1988-2010 ACORD CORPORATION. All rights reserved. Tho ArnRrn name anti Innn arra ronictorori markn of Arnpn Ordered By: ��% i ta.� .fit std .Jxxt .' P�• t t�t1y#7�5t� ,—q• n i d2�Z lllillall Ro & obin t tTtr ATTOMMATLAW �� IYlilydl NO 2015 b LOT 4 LOT 9 LOT 10 BLOCK 4 BLOCK 4 BLOCK 4 73.00'P(M,L REMAINDER OF LOT 5 BLOCK 4 Ni�U lug cis�ssi as REMAINDER OF LOTfi &V P.I. BLOCK 4 ,X � 1 'ro.ss'•,, 17.00' v rr 20.80 .^• � r Y REMAINDER OF LOT 7 It ONE STORY b F- v BLOCK 4 o RESIDENCE 0 m >f -- _ 10' h 11.07' L� K CAIN ? R OF LOT 8 •: ^ �, B, .()CK 4 � a Li - Qrry rya 75.00'(b) 75.00'(P)(M) +P r H Z �Q < 17' PARKWAY LL _ N.W. 100th STREET •• �� _ ••••• _ = 16' ASPHALT PAVEMENT •••• a • • •� • •••• :see:*• • • I 0 •••• •64:00: e66:06 ..... JI - . • ...... . • . . • Accepted By: i•••i• •••••• 175N.W.PropertyNotes: • • •••••• Address: • 175 N 100 Street •• ••••• • • Miami,FLORIDA 33150 •• • SURVEYOWS cesRrB71IMT7aseasaMVSIAT ISATRUE useaanc'T M.E.LandSury ct rruen lora ue:e cateeruw. mcaaaiswrmncnman +meacu eying,Inc. srnmaaos.asser St BOARD WFRO°ommxar°1LAM SM'*YORo°°owv'et 10685 SW 190th Street 5}l7,HAa®4 To 97.677.FLrnmAsrnruam. Suite 3110 sierteo FOR THE FIRM Miami,FL 33157 �°'t� Phone:(305)740319 e'ATE or nsx"sY02 Fatc(305)889-3190 NOT VAUD wANa%&,-- S6~Is Norvano Treamm+n�nnt��a,a�rau�a�tveroaaw LB*7989 Nwaat. Survey AU1.10378 Client File#:15-299 Page 1 of 2 Not valid without all pages Surveyor's Legend PROPERTY LACE SFRUCnR6 a.A. REARMO R TEL TaEPROVC FACW HS uszzsccrsa. COR:.BLOCK MALL FND n1UND ROM PMC/ PW AS Norse ON PLAT C CEMRAL NMLE O IN1TA U.P. VRUTY POLE --Y—Y.— cKwa-UN9 FENCE OR WN FENCE L" UC61SC!-aLwasR RAMUS OR RADIAL LUAL anim Unury am --f~ WOOD fact LS! Lam/-stwor R RAD. WRAL nt SEP. SEPTIC TANK ---o--+- MN FENCt: CMC CALCUIATEO POW N.R. NON RAMAL O.F. ORADW" •_..--..-...^.•• EAMUM set scr PM TTP. TYPICAL A/C AIR CDNMTMSR -•••�^.••••_ CENTER LME A CONTROL POW LR. RMV ROD S/M SMV" WOOD at , CONCRETE 10014MENf I.P. ROI PIPE OW ORMNAT p lb soic NARK NAO NAR.@ DISK SCR. SCREEN CONCRETE tM 11"AI Ma P%NAM PARKER-NAM NAM OAR GARAGE E7'7"JJ'J"J7 Ammu P.T. POW OF TANGENCY 0.}L VML"OLE ENCL ENCLOSURE P.C. PMNt OF CURVATURE 0 WELL N.TS Not TO ECAU D(act/nit P.R.N. PERMANENT REiERCNIS MONUMENT 19 nRE 9104AIT F.P. FaAeehRD OtAOR WATER P.C.C. POINT O'COMPOUND CURVATURE ® M.N, MANHOLE T.O.D. VOP OF BANK P.R.C. PDAtF QF REYdR3C CURVATURE 0.NL OV[RIttM taVEs F,*W. EASE LM MATHR .. APPRO%IMATE EDGE OT VATER PAA. POM OF NT6UMaM T% TRANSFORMER C.O.P LDGY OF P.000p1f (` P.O.C. POMC W CONMEACEN(M CONGAED AREA P.C.P. Pimmio"CONTROL POUT Cm CAME N MRER C.V.O. CMVALLEY O{ITTCir ® M.Y. MATER METER LLL RUadDUNNO l4 SETBACK LDV[ IM Y ""NEASs" PA POOL EMRPYENT S. X;k POWER POLE P PrAMD WASUSEMENi CONIC. COV�RCT1 SCAR 1 LPI[ � tCUNNTEV SURVEY IANC CATCH SAWN 0 am ESN? EASEMM N/„ RIONT-Or-MAT C.O.C. COUNry UTWtT E48000 C tkUARATEO 04, ORMNM6 MENEn P.U.E. PUBLIC UT001 EASCUGNF ' Lw am/EO"EA 0*4 L W.G LANE OR 04MCSE VAUOn Em. Lek, IAQSCAPE ROPER E68EM OT GALE, CANAL NAMMANCE 9AS04MI Ulf UTMIS4 1AU"M R.C.C. RIM OVERNANO EASEMENT LAC LOaSCo Acorns E480r1w Ag ANCHOR CASEMENT Property Address: General Notes: 1.)The Legal Description used to perform this survey was supplied by others. 175 N.W.100 Street This survey does not determine or is not to Imply ownership Miami,FLORIDA 33150 2)This survey only shows above ground Improvements. Underground utNes,footings,or encroachments are not located on this survey map 3.)If there is a septic tank,well,or drain field on this survey, Flood Information: the location of such Items was shown to us by others and the information was not verified. 4.)Examination of the abstract of title will have to be made to determine recorded Instruments,9 any,affect this prope Community Number: 120652 rty.The lands shown herein were not abstracted for easement or other recorded encumbrances not shown on the plat Panel Number: 12086CO302L 6.)wap use are done to the rete or the wap. e.)Fence ownership is not determined. Suffix: L T.)Bearings referenced to tine noted B.R Date of Firm Index: 8.)Dimensions shown are platted and measured unless otherwise shown. Flood Zone' X 8.)No identification found on property comers unless noted. Base Flood Elevation: N/A 18.)Not valid unless sealed with the signing surveyors embossed seal. 11.)Boundary survey means a drawing and/or graphic representation of the survey work performed in the field,could Date of Field Work: 09/14/2015 be drawn at a shown scale and/or not to scale Date of Completion: 09/15/2015 12.)Elevations If shown are based upon NGVD 1929 unless otherwise noted 13.)This Is a BOUNDARY SURVEY unless otherwise noted. 14.)This survey Is exclusive for the use of the parties to whom it is certified.The certifications do not extend to any un named parties. 18.)This survey shall not be used for construction/permtWng purposes without written consent from Miguel Espinosa. Legal Description: Lot 16 and East 25 ft of Lots 5,6,7 and 8,of Block 4,of BONMAR PARK ADDITION,according to the plat thereof,as recorded in Plat Book 24,Page 71,of the public records of MIAMI-DADE COUNTY,FLORIDA Printing Instructions: Certified To: While viewing the survey in any PDF Reader,select the File Christian Anthony Lanser Drop-down and select"Print".Select a Mor printer,if ROTHMAN&TOBIN,PA. available;or at least one with 8.5"x 14"(legal)paper. Old Republic National Title Insurance Company Select ALL for Print Range,and the#of copies you would PHH Home Loans,LLC dba Sunbelt Lending Services like to print out its successors and/or assigns as their interest may appear. Under the"Page Scaling"please make sure you have selected"None", please copy below for policy preparation purposes qty check the"Auto-rotate and Center"box This policy does not Insure against loss or damage by reason of the following •••••• Check the'Ch P size b PDF"chkbth • Q r y ecox, en exceptions:Any rights,easements,interests,or claims which may exist by reason •• A�SOK to print. •• of,orrellected by,the following facts shown on the survey prepared by •••••• • •••"• EFRAI N LOPEZ dated 09/15/2015 beating.lob#B-10378: • •••••• M.E. Land Surveying, Inc. •0 •• • • 10665 SW 190th Street,Suite 3110 Miami,FL 33157 •••••• •0*69 0 - •••••• Phone:(305)740-3319 Fax: 305 669-3190 • • • •••.•• LB#,7989 00 Survey*13-10378 Client File#:15-299 Page 2 of 2 Not valid without all pages