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PW-16-58 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,Fl- Phone: LPhone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250635 Permit Number: PW-1-16-58 Scheduled Inspection Date: February 23,2016 Permit Type: Public Works Inspector: Hernandez,Rafael Inspection Type: Final Owner: MINSKI,JOEL&ANDREA Work Classification: Public Works Job Address:9969 NE 4 Avenue Road Miami Shores,FL 33138- Phone Number (305)510-0916 Parcel Number 1132060171230 Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Phone: (305)957-3857 Building Department Comments INSTALLING A NEW GAS SERVICE LINE BY iMractlo Passed comments DIRECTIONAL DRILLING INSPECTOR COMMENTS False TO CLOSE PERMIT#PW15-2063 Inspector Comments Passed Failed Correction a Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid Permit NO. PW-1-16-58 %st+O" y Miami Shores Village Permit Type:Public Works 10050 N.E.2nd Avenue NE Permolt Work Classification: Public Works •• Miami Shores,FL 33138-0000 Permit Status:APPROVED 11 Phone: (305)795-2204 RExpiration: 04/13/2016 Issue Date: 1/14/2016 Project Address Parcel Number Applicant 9969 NE 4 Avenue Road 1132060171230 Miami Shores, FL 33138- Block: Lot: JOEL&ANDREA MINSKI Owner Information Address Phone Cell JOEL&ANDREA MINSKI 543 MIN Street (305)510-0916 NEW ROCHELLE NY 10801- 543 MIN Street NEW ROCHELLE NY 10801- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 Total Sq Feet: 0 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Building Fees Due Am]$2.00 Pay Date Pay Type Amt Paid Amt Due CCF Invoice# PW-1-16-58281 DBPR Fee DCA Fee 01/14/2016 Check#:6069 $ 116.20 $0.00 Education Surcharge Permit Fee $Scanning Fee Technology Fee Total: $11 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. OWNERS AF IDAV : I certify that all the fo ing information is acc to and that all work will be done in compliance with all applicable laws regulating construction a zo in . Futhermore,I autho a the a-nam a or to do the work stated. aAl January 14,2016 Au 6rIzed Signature:Owner / Ap licant / Contractor / Agent ate Building Departmiiintoopy January 14,2016 1 Miami Shores Village Building Department 2116 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ` l INSPECTION LINE PHONE NUMBER:(305)762-4949 ��1 FBC20g1 -- BUILDING Master Permit NoW 12=_g:1 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL F_JPILUMBING ❑ MECHANICAL MN PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP C� C �I (� CONTRACTOR DRAWINGS JOB ADDRESS: 1�01 �` ` ` City Miami Shores County Miami Dade Zia: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):RIGHT-OF-WAY Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0811 Address: 5101 N.W. 21 AVE., SUITE 460 City: FT. LAUDERDALE state: FL Zip: 33309 Qualifier Name: JESUS VEGA, JR. Phone#: 945-453-0811 State Certification or Registration#. E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State Zip: Value of Work for this Permit:$2000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: ��AJC�� �� 2A_tj (S - 2—n fo'3 Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ 0 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �r� (Rev1sed02/24/2014) 4 ' , Bonding Company's Name(if applicable) 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: 1 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 ,by �_day of �� 20 / ,by who is personally known to ��FS� 5 t(�e,� S ,who i �nay kno to me or who has produced as me or who has produced as identification and who did take an oath. identification a ho did take an oath. NOTARY PUBLIC: NOTARY PU IC: `oiPa'P�e; HUBERT NUNEZ Notary Public-State of Florida « M COMM. Ex ires �} ,+,1Nw� « e )� P� Sep 11,2017 Sign: Sig Co "' Branded l hrough National Notary Assn 1; Print: Print : Seal: Seal: d(� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) rl�1k k PWS- 5-2063 Miami Shores Village F ?? ? =P bli Works a 10050 N.E.2nd Avenue NE ef7m, 11NQ1# r1r}4C8t0lJ:Public 3TC ~' Miami Shores,FL 33138-0000 jelitiftaf+J .A aV$— � Phone: (305)795-2204 FXORL�I p' aw Expiration: 1119/2015 f 7 Project Address Parcel Number Applicant 9969 NE 4 Avenue Road 1132060171230 JOEL 8 ANDREA MINSKI Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell JOEL&ANDREA MINSKI 543 MIN Street (305)510-0916 NEW ROCHELLE NY 10801- 543 MIN Street NEW ROCHELLE NY 10801- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 TECO PEOPLES GAS SYSTEM (305)957-3857 (305)970-1783 _..... _....._ , Total Sq Feet: 00 Scanning:3 Available Inspections: Inspection Type: Final Excavation Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# PW-8-15-56724 DBPR Fee $2.00 08/14/2015 Check#:5705 $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 08/21/2015 Check#:5726 $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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,PLU ING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I p6rtify that all the for9gqing information is accurate and that all work will be done in compliance with all applicable laws regulating consction and oni Futhe e,I thori e e above-named contractor to do the work stated. August 21,2015 Authorize Signatu e:Owner plicant / Contractor / Agent Date Building Dep ment Copy August 21,201 1 ECEIVRD U� ROAD 42 � TO STOP LOA ON �►U V ROAD gt➢Rt. Butter Spate By Seo Table 5D 25g' C B A a _ b - ■■ ��i ■ Worr,Area � ROAD D Device Spade-Ta sgf9' EBaN f w{WORK f n2em7 . V{0 J f-. See 7asrel _.�-. jgi n. R o aHEAo D�-ice Sparing-Taper __'; hC(e5 village IOFB 0 see Tall;., �i am1 S ROAD ®ATE Mim PP MW To STOP �crR,OVF_D DISTANCE BETWEEN SIGNS TABLE 1 DEVICE SPACING BU FER SPACE Saeed sparing(ft.) s9ax.Distance Between Devises tit-i t (-�.I,,I.�•�G DEP s &M. (mph) a B C D - fm J Aft.J Type of 40 or less 1gg Zgg ffig Igo S Comes Type I ar wt _ Baracades of Ve uue155 45 3SD 35f1 35g 115 fmph) Tubarine Marker. Pauds m Dr-- r-i 1'�t'-, n�PT 2{l�f-w 20050 1 WO 1 500 15901 250 - `nff 55 or renter 2&M16401ggO 50 Taper Tangent Tapir Tangent --- pICV tltl,� 5 2W 25 to 45 ID 50 Io ,7: 1,0 G(;N��l 1F � nn--�pPIS ,[D _05 The ROAD MAC I MILE sign rnaay be used as 5O to 70 20 50yD IgD - -- =S �fitD RIF CIU LJ'` an alternate to the ROAD WORK AHEAD sign. _ 45 -to 50 425 W beyond the ROAD WORK AHEAD sign or GENERAL NOTES _ — DURATION NOTES 1 55 495 midway between signs whichever is less. 1.Work or—vicros shau tm confined ra one traffic lane,lectin!the oa6osrre Ogre 1.ROAD WOO AHEAD ars¢Ke EE PREPARED TO STOP a;gns may 570 ....BE PREPARED 7O 57gP sign nOa1 fee osh'dted odor to traffic. 5o 6mitd&9 A alb of tko sartditrarrs go rte: 65 645 tors ods of 45 HPH or foss. a.N*14 ooevati are 6t1 rrineaJeg of Jess. Tg 73O pe 2.Additional.one-way rmnrol may he fgrrrred ey rhr forkirrli�nwa rl: Swd/i;rpp ig 45 rrrDu or{cgs. 1.FOag-carrying vehicle; '^» r.$As sio assCrni—ea wen;.A-aov h;v rine wank area v1h m Brdfer Spare cnwrvd Z.Official vehicle; trot a disfaarre J.Pilot vehicles; equal ar rhe ft t ni soave. be attained due g atest rir 4.Traffic sig:rars. d•Vefsictes en Bae mor@'area dr�e eugnrrrten4ity,ratatrng, varrsdiairXs,the greatest Olastr ag,oscillannq,ov V ape Cglas operating. alta"2511 length shall be SYMBOLS e.Vokeme aced'—pk.dy Bit cot roadway has be—considered. Used,out not less than 200 ft. When/laggerg are the sola meals aI--at the Naggers etre{!to in ® slow a•each wIn-or in dirt commlotration S alt limes. Lyprk Area direct 3.The OBE-LANE ROAD signs are to be rally c"cred and the FLA66ER signs eirher Sign With 1r a Ur !Odin.) renes ed or tally covered when no work is being perforeed and Phe hie,way is Orange Flag And Type B Light open to twp-ay traffic. ••• 0*: •• • • • • • •• ■ channelizi Device f5ee bade,r—MOP 4.Wirer a side road;mc,sotts the hi rod ;thin tee TTC zone,advaignal TIC • • • • • • CONDITIONS ng g aY�- • •• • • • • • ddvicog shall be placed in aceordareee with other appfica&le TCZ Jndeves. • •• • • • • ••• WHERE ANT VEHICLE,EOUIPHENT, D Work,.Zone Sign ••• • • • • • • • WAIKERS OR THEIR ACTIVITIES 5.The two ehanrrelizirtg devives directly in lead of Che murk area and tie 000 •• • • • •ftCROACH THE AREA BETWEEN 0-"w Flagger channelizing device directly at tad end of the work area:nay be oorieted oror.ide9 THE CENTEILUN£AND A UH£z' vehicles In the work area,hale high-lami;ity ratatimg,ffaghhv,ogcillali q,s OUTSIDE THE EDGE OF TRAVEL WAY. ,♦ 1.01onated flogger Asgitt—e Devices strobe lights operating. (AFAD),Wilh bait • ••• • ••• • • .Far Tem ear Raised Ruoible Strips, q Lane Jdeattiricaion Direction of Trat/ 6 ic y ps,general TCZ re uiren*ergs and addifib,al • : • • • • • - in/onnhtion,rater to Index No.60. ••• • • • • • LAST C DESCRIPTION: 2015 • •• •• • • • • IND£If SHEET REVISION TWO- O-WAI, • • • NO NO. 07/01/14 DESIGN STANDARDS WORK TIM TRAVEL V;AY 603 1 of 2 ••• • • • • ••• • • • • • • • • • • • • ••• • •• •• • • • •• •• • • • ••• • • o� F"LAIC SiR6A4E WAGE REPLAOE MT SAW CYT ASPMT � WoucemT I • � � s'4 gTal WSTe 6" _,tt ,N. E. _4th AVENUE ROAD-':., �'. .' ... :• P ',. .\.• :.•• •a :RIGHT OF WA -: FIA A 6ATCA GAS MAIN •• ,'•. , ,, r.LiN a• / ' +•• ASP VEttA ;. LT -v_... , •• ,,.. ►••W� p• a '? •• •t+• .,+, y,• ''�'� N ENT + '•TCFI ,r vAR>as 1z• :. \• RASIN:. ® • • 6666 6666•• in 6666••- +•a•• • • ' "'y t' .. "'� 6666 • •• • • n • .CATCH• +' ♦� 6666 .. .* ,ti•, .,/ ;'.' � 1 REST ATI OF A CUT •. "� FOUND 1/a' oR pN p D SOD RESTORATIQt'�• SIL •• 6.66•• IRON PIPE*•••• �t 6.66•• FOR UTILITY CROSSING Soup: NOT TO SOW � • �a ••6• 6.6.6• •• � t• :+ • + ,, • • • • s •• • • �r•• 66.66• •6.66• • •� ,\ • :i `t ;•: +, �/ •6.66• •6.6 •6i66• •6i• 9'•�� i 6 •••►•• .w 'I'' ti,,•• �.'•• +• a ,'� •66.6• ' • SET NAIL y.• ♦•; .••• ..•.•• •.•...,d STAgIR�t?� ••Ir•. b & DISC ..� ,•. •••6•• • • • "•CO►IC •6.16•• o #5734 • • 6 • . DRtYEWAY• ' : • • •• 4 C.LF. �,6•,?• • 6 • • • • • •6666• 0.38' E,w t ., •� ' ;9 6j' a• , •• • • ••• • • • • }+ +12i. ' .•• •• , p. GENERAL NOTES ROP. RISER WITH ,♦.•• , l+�S�l�/� •••• : 11.72 '•30.1 �� �ORAL TI�Y 3/4" PLASTIC GAS 1, REPLACED BASE MATERIAL OVER DITCH SHALL BE TWICE THE CENTER LINE 22.63• SVC. TO BE DIRECTIONAL BORED • ` S. +,, ,•,,• THICKNESS OF THE BASE, MIN. 8" AND MAX, 18" ld MONUMENT LIVE ® � 27.3' •'� •; r , , : 4• 1 BASE MATERIAL SHALL BE PLACED IN 6" MAX, (LOOSE MEASUREMENT) R/W RIGHT' 0 OF WAY ( O-W ,• , ,•.• • '•` LAYER AND MAX, DENSITY EACH LAYER THOROUGHLY ROLLED OR TAMPED TO 9875 OF p/l PROPERTY LINETM STORY C. • 1' ASPHALT CONCRETE PAVEMENT JOINTS SHALL BE MECHANICALLY SAWED E O.P, EDGE OF PAVEMENT J 0� B.S. _sf 3 C B`S' I RE�DDdCE X969 wALLCnrP.) ° 4 SURFACE MATERIAL SHALL BE CONSISTENT WITH SURROUNDING SURFACE T,T, TAPPING TEE �'. r •` /' MATERIAL (1.3 MIN. THICKNESS) E F♦VEXCESS FLOW VALVE 13 � 1 S. BASE MATERIAL SHALL HAVE A MIN, LBR, OF 100 AND A MIN, CARBONATE SVC, SERVICE LINE 21. CONTENT OF 70R (8075 FOR LOCAL STREETS) � '4 �;•, . 6, CONTRACTOR SHALL SOFT DIG TO VERIFY LOCATION OF EXISTING UTILITIES PE PLASTIC 10 r�0• 30,0 ' db'® •I••• a �L~ a STM, SEW. STORM SEWER O •. e,, A/C '�I �•• ,i V •• •• • STEM `t;FIATT, O' Q F 3 a sit '+ ' I' ' �• +z y•/p K 6 CLF O V PROP.3/4" PLASTI t5t' w � �Ry. 7G Cc 4 /^b� 0.05 E.� O x ' GAS SVC. TO BE� ' '` ' N v 0. iri DIRECTIONAL BORED' - QD �+ '� I tV i g O ALL EXISTING UTILITIES SHOWN ON ; 3 5• I + ' THESE PLANS ARE TO BE ! SET tj41L , '• W� N CONSIDERED APPROXIMATE & 6' C.L.F. 1 & D •// , SHOULD BE VERIFIED BY THE 1.6' N • "". ••+ I XI ST .2" SK. 9573 ' +• J•` ' CONTRACTOR PRIOR TO THE 0.301 E ` ' " 'j:' GAS MAIN START OF WORK OPERATIONS. --I—• _ -� Aa�P 0,70 WALL: y is • qALW­ :.g00' W.' mW -- ---N. 4 jm M1 IL RIW FOUND 1/2 : '. s W a E 15' < IRON PIPE A, 3 CAP. NO ID 4' TIE IN SVC. TO GAS MAI „r ? + SCALE: 1"090' d GROQ 3 0/8 0.05'(N) WITH T.TIE.F.V.Lu 1 ' 1 $ PROP.3/4" PLASTI + / GAS 36" MIN, DIRECTIONAL BORED , Ix I 1 —ca,s— —GAS I 4 4 1 XT 2" SK. GAS MAI , O O Na OF 013M PROFILE CROSSING ON ALLEY SCALE: (V) 1:5' (H) NTS. SUM No.: 1 Drawing File: \\browardfs\volt\USERS\PGMXC\Documents\RESIDENTIAL\2015\NE 4 AVE RD.. 9969, MIAMI SHORES. FL\9969 NE. 4 AVE. RD.MIAMI SHORES, FL,dwg 05/12/2015 . ... . . . . .. . .. . . . .. ... .. . . •.. . ..• . . . . . o . ... . . . . 000 .. • . ... . . ... . . . . ... . . ... . . . . . . . . . . . . .. .. . 00 .. .. . . . ... . . . ... .. .. ..• .. . . ... .. . .. .. . . . . . . . . . . . . . ... . . . . ... . . . . . . see .. . .. ...• . . . . . ... . . .. . . . .. ... .. . ... . . :00 .. . . . . . . .. . . . . . ... .. z, �. Miami Shores Vill ���� age AUG 14 2015 Building Department B� 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 201 s� BUILDING Master Permit No,RG�J�—��3 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL ❑PLUMBING [] MECHANICAL MPUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9969 NE.4th AVE. RD. City: Miami Shores County Miami Dade zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type, Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): RIGHT OF WAY Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#• Email: CONTRACTOR:Company Name: TECO PEOPLES GAS Phone#: 954-453-0806 Address: 5101 NW 21 AVE. STE. 460 City. FT. LAUDERDALE state: FL __ZIP: 33309 Qualifier Name: JESUS VEGA Phone#: 954-453-0806 State Certification or Registration#. E1608 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State Zip: Value of Work for this Permit:$ 1000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLING A NEW GAS SERVICE LINE BY DIRECTIONAL DRILLING Specify color of color thru tile: Submittal Fee$ S o-ry-) permit Fee$ 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) 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 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of .20 by day of i/d 20 /-S by who is personally known to � �_� U1g9,L 4 o is personally kno h to me or who has produced as me or who has produced as identification and who did take an oath. identificat' and NOTARY PUBLIC: HUBERT NUNEZ NOTA PUBI� ,o Notary Public-State of Florida _•a »• My Comm.Expires Sep 11,2017 Commission#FF 043679 Sign: ''%°����°o-•`, Bonded Through National Notary Assn. Print: Print: Seal: Seal: B�k�k#�F N�RkRiRi#�k•#�k4h�M+k�Y4�YM�k�k�k k+k#B #k J+Y�i�k �k�k�k k�kk ki+tk k�k�k�t�F•##R�k R R+kl��kb#R�R+k#•#irk�kkohM4#�M+R�k+k�Y�M##ik�k#t�k#�k k##R+k�kb## APPROVED BY 1 v (� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)