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PL-14-2076Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 R1 C I4 -s64 Inspection Number: INSP-272937 Permit Number: PL -9-14-2076 Scheduled Inspection Date: December 13, 2016 Inspector: Hernandez, Rafael Owner: FREHLING, ROBERT AND NANCY Job Address: 1285 NE 95 Street Miami Shores, FL Project: <NONE> Contractor: MITO PLUMBING CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060144020 Phone: (786)553-5003 Building Department Comments PLUMBING INSTALLATION OF NEW 2 STORY RESIDENCE Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments BUILDING PERMIT APPLICATION ❑ BUILDING CZ PLUMBING JOB ADDRESS: 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 ❑ ELECTRIC ❑ ROOFING ❑ MECHANICAL 0PUBLIC WORKS I2P) 5 Ile- City: Miami Shores County: Folio/Parcel#: Occupancy Type: t l - 32 • oto -402 6 RECEIVED SEP 2 4 2014 BY: FBC 20 1J Master Permit No. 12.-C-14 -64 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: 3,13B Is the Building Historically Designated: Yes NO Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Re's GARY F2>i_I/\IC Address: I Zc{ Z M. ff. 9 5 ST City: llai�� '✓I`t�GJ State: 'L Zip: -513/3 Tenant/Lessee Name: Phone#: Email: BFE: FFE: Phone#: (''3, 742 • 1211116 CONTRACTOR: Company IN me: Address: (®} E'ripPlM6I3LL\rnO Phone#: 6-66'3-055 r3 S}-- i* �!� City:..c.' 1 G Q / lf rpState: oft Zip':: 329) 15 - Qualifier Qualifier Name: D ( .5 lJ Phone#: a 3-- . t5 / State Certification or Registratio : � i (7/Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Y5 000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ AlterationNew t Z'' V ❑ Repair/Replace ❑ Demolitionyit� Description of Work: ?l.» IP%1/%,\C4 ub 44 .0ki ' 1J61 4 Specify color of color thru tile: Submittal Fee $ �Y0 Permit Fee $ Scanning Fee $ — ! 400^ Radon Fee $ Technology Fee $ G� - W 3 Structural Reviews $ (Revised02/24/2014) ;01 /050,7-", DBPR $ ' Notary $ 52) CCF $ . 00 CO/CC $ Training/Education Fee $ • (7 Double Fee $ Q} Bond $ TOTAL FEE NOW DUE $ , J 4 C9 . 5O 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 • •proved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 12 day of , 20 14 larcepr , who i me or who has produced as identification and who did take an oath. NOTARY PUBLIC: , by own to Sign: Print: Seal: U.o5 sulizOitlk APPROVED BY (Revised02/24/2014) CARLOS SANABRIA Commission M FF 37673 My Commission Expires July 18, 2017 Signature b s cj1'.. we 2. The foregoing instrument was acknow edged before me this Z3 day of fierr , 20 Ii , by MU) e1.g5 0013 M/IP5 , who is rsorr3ily kn n to me or who has produced as identification and who • take an oath. NOTARY PUBLIC: Sign: Print: Seal: IPl*,01PrARn*************************************** Plans Examiner Structural Review CARL Commission # FF 37673 My Commission Expires July 18, 2017 *************************************** Zoning Clerk ot2too �� _ ��;i toots Tax a �` ,� Sus-�' - of Florid Mi i County, State M arrji-Dade - DO NOT PAY -THIS IS NOT A BILL 6316681 BUSINESS NAME/LOCATION MITO PLUMBING CORP 7879 NW 173 ST MIAMI FL 33015 OWNER MITO PLUMBING CORP Worker(s) 1 tis not a license, l with any governmental confirms payment of the Local Business older must comply alp t0 do b apply to the business. This Local BusinessTaz Receipt only, Miami -Dade Code Sec Ba -276. permit, or a nment l regulatthe ory laws and requirementseto hi haemes or nongovernmental reg la ed on all commercial vehicles - The RECEIPT Nl1• above must be disp Y midade aov x oll For more w • e intormation, visit RECEIPT NO. RENEWAL 6583117 EXPIRES 2015 SEPTEMBER 0, business Must be displayed at p,aCf be Pursuant to County de Chapter SA - Art. & 10 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1427812 PAYMENT L� BY fAX COLLECTOR 07 X52014 $75.00 � CREDITCARD- 14-027553 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 1GONZALEZ, DIANELYS [MITO PLUMBING CORP 7879 NW 173RD ST HIALEAH FL 33015 Congratulations! With this license you become one of the nearly 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constahtly strive to serve you better so that you can serve your customer& Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC 142 7812 ISSUED: 06/02/2014 CERTIFIED PLUMBING CONTRACTOR GONZALEZ, DIANELYS MITO PLUMBING CORP IS CERTIFIED under the provisions of Ch 489 FS. Expiration date : AUG 31.2016 L1406020001082 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GONZALEZ, DIANELYS MFTO PLUMBING CORP 7879 NW 173RD ST HIALEAH FL 33015 ACWC>RD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/04/14 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(ies) 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 Equiinsurance 6839 Main Street Miami Lakes, FL 33014 Phone (305) 557-5578 Fax (305) 557-5197 CONTACT NAME: FRANK FERNANDEZ PHONE (A/G. No. Ext): (305 ) 557-5578 FAX INC, No): (305 57-51 ) 97 - 5 — E-MAIL ADDRESS: ffe m a nd ez@ e q u i i n s u ra n ce. co m INSURER(S) AFFORDING COVERAGE INSURER A : ARCH INSURANCE GROUP INSURED MITO PLUMBING CORP 7879 NW 173rd Street Hialeah, FL 33015- (305) 216-4472 INSURER B : PROGRESSIVE EXPRESS COMPANY INSURER C : INSURER D : INSURER E : FUBA INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: NAIC # 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. 1LTR TYPE OF INSURANCE NSDR WVD POLICY NUMBER (MMIDDDY EFF ) (MMIDD EXP) A • B LIMITS GENERAL LIABILITY V COMMERCIAL GENERAL LIABILITY - CLAIMS -MADE [�I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER •POLICY JECT PRO- J LOC AGL0007195-00 12/10/2013 12/10/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 AUTOMOBILE UABILITY ANY AUTO ALL AUTOS OWNED 1 HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS N N 05372728-2 04/13/2014 04/13/2015 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 25.000.00 BODILY INJURY (Per accident) $ 50,000.00 PROPERTY DAMAGE $ 25,000.00 (Per accident) L UMBRELLA LIAB fl OCCUR i EXCESS LIAB E CLAIMS -MADE _DEC!. RETENTION $ EACH OCCURRENCE AGGREGATE i $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE D i OFFICER/MEMBER EXCLUDED? (Mandatory in NH) j If yes, describe unde ' DESCRIPTION OF OPERATIONS below N/A 07/23/2014 07/23/2015 FT tJ TORY LIMITS ❑ ER E.L. EACH ACCIDENT $ 500,000.00 E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT $ 500,000.00 $ 500,000.00 -- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ' Commercial and Residential plumbing. CERTIFICATE HOLDER CANCELLATION Village of Miami Shores Building Department 10050 NE 2 Ave Miami Shores Village 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. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD Jan 19 16 07:18p Mito Plumbing Corp ACL r1 1F -20-6 3058179577 p.4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, DIANELYS MITO PLUMBING CORP 7879 NW 173RD ST HIALEAH FL 33015 Congratulations! With this license you become one of the nearly 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team 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! DETACH HERE RICK SCOTT. GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1427812 ISSUED: 06/02/2014 CERTIFIED PLUMBING CONTRACTOR GONZALEZ. DIANELYS MITO PLUMBING CORP 1S CERTIFIED under the provisions of Ch.489 FS_ Expiation date : AUG 31. 2016 L1406020001082 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CFC1427812 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS_ Expiration date: AUG 31, 2016 GONZALEZ, DIANELYS MITO PLUMBING CORP 7879 NW 173RD ST HIALEAH FL 33015 0513u Local Business Tax Receipt Miami—Dade County, State of Horida -THIS IS NOTA BILL - DO NOT PAY 6316681 BUSItj NAME/LOCATION MITO PLUMBING CORP 7879 NW 173 ST MIAMI FL 33015 OWNER MITO PLUMBING CORP Workers) 1 RECEIPT NO. RENEINAL 6583117 SSC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1427812 LBT EXPIRES SEPTEMBER 30, 2016 Must be displayoct at plane of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 875.00 07/07/2015 CREDITCARD-15-034187 This Local Buainecs Tax Ilaccipt only cordinns poymout 01 ilia Local 1u!inossTux. The Dooclpl Is not a lime°, petutil, or certification of the holder sqqualifications, to do business. Holder must comply with any governamnlal ar nanrovertunontal regulatory luws earl ruquiremonls which apply 10 Ilia bnsinoss. Tho RECEIPT NO. ahoua must tic displayed on all comet orcial vchiclos- Miami -Dodo Coda Sac 13n -27G. Far marc information, visit www.Ininnlitfugomov/tascgliec ar d96:LO 91. 61. Lief Woo 6uigwnId o}!W LL96L1.990C Jan 19 16 07:57p Mito Plumbing Corp 3058179577 p.2 ACCORD® CERTIFICATE OF LIABILITY INSURANCE L------ DATE (MM/DDIYYYY) 01/19/2016 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(ies) must be endorsed. 11 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 Equiinsurance 6839 Main Street Miamf Lakes FL 33014 CONTACT NAME; Frank Fernandez PHO Ext): (305) 557-5578 (Ate, No): (305) 557-5197 ADDRESS: ffernandeze0 equiinsurance.com INSURER(S) AFFORDING COVERAGE NAIC f1 INSURER A: ARCH INSURANCE GROUP INSURED . MITO PLUMBING CORP 7879 NW 173 St Hialeah FL 33015 INSURER B: PROGRESSIVE EXPRESS COMPANY EACH OCCURRENCE I $ 1,000,000.00 INSURER C: INSURER D: FUBA DAMAGE TO RENTED PREMISES (Ea occurrence) 1 $ 100,000.00 INSURER E: INSURER F : MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 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 )SSUED 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. IN SR LTR TYPE OF INSURANCE ADOL INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYYI . (MMIDDWYYYYI i LIMITS X COMMERCIAL GENERAL LIABILrfY AGL0007195-01 I 12/10/2015 12/10/2016 EACH OCCURRENCE I $ 1,000,000.00 �/ X 1 CLAIMS-MADEX1 OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 1 $ 100,000.00 MED EXP (Any one person) $ 10, 000.00 A PERSONAL a ADV INJURY $ 1,000,000.00 GENL X AGGREGATE POLICY OTHER: LIMIT APPLIES PER: XI JEc°r IX LOC GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS -COMP/OPAGG $ 2,000,000.00 $ B AUTOMOBILE - — — LU\BIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 05372728-6 04/13/2015 04/13/2016 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 25, 000.00 BODILY *WRY (Per accident) $ 50,000.00 PROPERTY DAMAGE Peraccider.l $ 25,000.00 $ UMBRELLA UAB EXCESS UAB `} OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 DED 1 RETENTION $ $ 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ,1 / N OFFICER/MEMBOR EXUOE ANY PROPRIETOR/PARTNER/EXECUTIVE Y (Mandatory in NH) N yea, cloacae under DESCRIPTION OF OPERATIONS below N / A I 106-52732 07/23/2015 i 07/23/2016 PER ERS E.L. EACH ACCIDENT $ 500,000.00 EL DISEASE- EA EMPLOYE $ 500,000.00 E.L. DISEASE - POLICYL11.IIT s 500,000.00 7ESCAIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACO RD 101. Additional Remarks Schedule, may bo attached if more space is raquirod) Plumbing Contractor CFC1427812 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 N.E.2nd Avenue Miami Shores, Florida 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. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 0.\u\61/4 Miami Shores Village -�Ec.��a� Building Department BUILDING PERMIT APPLICATION BUILDING 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ELECTRIC ❑ ROOFING LUMBING ❑ MECHANICAL El PUBLIC WORKS JOB ADDRESS: 1285qs-5 RECEIVED DEC 10 2014 BY. FBC 20 Master Permit No. IZGI4. " 64.4 Sub Permit NorPL 19-90 REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: 1 1214 -c 4 •LEUZC) Occupancy Type: Load: Construction Type: Zip: 33) 30 Is the Building Historically Designated: Yes NO AL__ _ Flood Zone: r `_ OWNER: Name (Fee Simple Titleholder): 2,01tlikkdOl f 44 (A Address: I 2-'f2. . _ cp 51 City: M(AgiT5 State: fi_ Zip: 331.76 Tenant/Lessee Name: Phone#: Email: A(a OC4aE k BFE: FFE: Phone#:( ) 7141 • 3446 CONTRACTOR: Company Name: Address: 1 C4 cr49nt.ocrta3 C ls? (i.kC. Phone#: (21Ai p3--19OZ. City: M( -Mt r �5 State: 'FL Zip: -5/(0 0ualifier Name: `O C Phone#: ( C 3-1 Z- Q pecifit.t State Certification or Registration #: CCC, /5 tlOC) Certificate of Competency #: DESIGNER: Architect/Engineer: Q '! r1leO Phone#:00) '67(e .6404 Address: 4'j Tl - '3`'J City: 114 (/.ltlt. State: "Ft- Zip: 33131 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration CISZ New ❑ Repair/Replace n Demolition MoDif Jzig-Rxi fre_ (1 Sl o TD -irrYr-a-k01-Aii44.ar . Description of Work: • Specify color of color thru tile: Submittal Fee $ Permit Fee $ 401 S ;:y CCF $ CO/CC $ Scanning Fee $ ` (. - 001 Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ .\ TOTAL FEE NOW DUE$ b i,J `- co (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 thatno 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins. -ction which occurs ,seven (7) days after the building permit is issued. I e absence of such posted notice, the inspection wil, n+t be approved •nd a e spection fee will be charged. Signatur OWNER or AGENT The foregoing instrument was acknowledge.' before me this 1 day of 1€L . , 20 4 , by ` Q��-' M� , who is sonally n• n to G NCAPA-- , who is me or who has produced as me or who has produced as identification and who did take an oath. Signat CONTRACTOR The foregoing instrument was acknowledged before me this day of _. ,20 4 ,by wn to identification and who did take an oath. NOTARY PUBLIC: Sign: 0044�a� Print: c$, Seal: CARLOS SANABRIA Commission $ FF 37673 My Commission Expires Ps` � {y 18, 2017 ********* A�`if,i'****** .2O NOTARY PUBLIC: Sign: Print: Seal: /t, �i—• ,,,,,,, CARLOS SANABRIA Commission $ FF 37673 " Commission Exp ires ****************** APPROVED BY 0 Z'! Plans Examiner (Revised02/24/2014) Structural Review ✓� �u . �.�..t `•,::':g,'s,.,,,- n (,• r . •.'ABRIA ,�ii , 1 Fi 37673 I:* +Sion Expires n'�,`iii'P: '.',Y;,,,',. *:3, 201 7_ Zoning Clerk