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BPP-18-2133Project Address Miami Shores Village 10050 N.E. 2nd Avenue N Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. BPP -8-18-2133 Permit Type: Poole Whirlpools/Hot Tubs rWork Classification: Repair Permit Status: APPROVED Parcel Number issue Date: 91712018 1 Expiration: 03/06/2019 Applicant 9400 N BAYSHORE Drive 1132050100110 AMINE DOUKKALI MARIELA B F Miami Shores, FL 33138- Block: Lot: Phone AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776 MIAMI BEACH FL 33139- 801 N VENETIAN Drive MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone SELENIS TECHNOLOGIES LLC (786)443-9590 In Review nents: Amount Approved:: In Review $500.00 Denied: $6.00 of Work: Swimming Pool Occupancy: Private ional Info: SWIMMING POOL REMODELING. Bond Return ,ification: Residential Scanning: 4 Fees Due Amount Bond Type - Contractors Bond $500.00 CCF $6.00 DBPR Fee $4.50 DCA Fee $3.00 Education Surcharge $2.00 P&Z Review Fee $35.00 Permit Fee $300.00 Plan Review Fee (Engineer) $60.00 Scanning Fee $12.00 Technology Fee $8.00 Total: $930.50 Valuation: $ 10,000.00 Total Sq Feet: 231 Pay Date Pay Type Amt Paid Amt Due Invoice # BPP -8-18-68507 09/07/2018 Credit Card $ 730.50 $ 200.00 08/10/2018 Credit Card $ 200.00 $ 0.00 Bond #: 3884 Availahla Incnactinnsc Inspection Type: Final Review Electrical Review Electrical Review Structural Review Mechanical Review Building Review Building Review Plumbing Review Planning Review Planning Review Planning 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio and 30ning. thermore, I authorize the above-named contractor to do the work stated. VAIaLi o September 07, 2018 Author d Signature: Owner / Applicant / Contractor / Agent Buildi g Department Copy September 07, 2018 1 Miami Shores Village . I ads 10 2018 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 t'p BUILDING PE MIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING FBCC20 19 r Master Permit Nor ( pi- 2133 Sub Permit No. ❑ REVISION 0 EXTENSION [:]RENEWAL F-1 PLUMBING F-1 MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: CI qa d At �3py g fjofl.E D4 City: Miami Shores County: Miami Dade zip: 3 3 13 8 Folio/Parcel#: (r - 324 - �) O- ©j O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): AM ) Iv E -TOOK KAL 1 Address: 9q'00 N i�pyS l� NL City: P(/ b M j 4 lei c� Tenant/Lessee Name: Email Phone#: 3G� - (-"4'A - 9D ib State: 4:�`- Zip: 3 3 I T T Phone#: CONTRACTOR: Company Name: 50645 r Phone#: W6 - �L3 0fS % 0 Address: 3 0 3 If 0- nS w 1-G �4iz 2 City: 4AQ�,��CSLO� , State: �L Zip: J Qualifier Name: Phone#: State Certification or Registration #: Cj22CI 924/51 Z. Certificate of Competency #: DESIGNER: Architect/Engineer: Add City: e#: Zip: Value of Work for this Permit: $ 10/00-1 Square/Linear Footage of Work: 7iE>1 - Type of Work: ❑ Addition E9 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: .S W H I N G t)o OL- " 'D CL I N 4 Specify color of color thru tile: Submittal Fee $ - 0� Permit Fee $ 300• CX3 Scanning Fee $ Technology Fee $ n Structural Reviews $ �d (Revised02/24/2014) Radon Fee $ 3 - W Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $'J n I dp�� 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 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 OMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with on 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 4-0�� OWNER or AGENT CONTRACTOR The forree�going instru ent was acknowledged before me this Z91 day of 20 It by who is per Hall n to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign. Print: l _ Seal: CLARISSA A. RODRIGUEZ MY COMMISSION # GG 041376 "- -a= EXPIRES: December 30, 2020 Bonded Thtu Notary Pub#c Underwriters ********* APPROVED BY (Revised02/24/2014) as The foregoing instrument was acknowledged before me this day of J C&I 20 / S by who is personally known to me or who has produced as identification and who did take an oath. NOTAR6PBLIC- Sign: Print: Seal: ANTONIO E GOMEZ 3AA-1M1tCOMMISS"IFF9131% EXPIRES: AUG 25, 2019 Bonded through Is( State Insurance Plans Examiner 31 1 N Zonin g Structural Review Clerk 8/2/2018 Property Search Application - Miami -Dade CountyAPPRAISEROFFICE OF THE PH "" PER " F I Summary Report Property Information Folio: 11-3205-010-0110 Property Address: 9400 BAYSHORE DR Miami Shores, FL 33138-2952 Owner MARIELA B ROVITO JTRS AMINE DOUKKALI JTRS Mailing Address 9400 N BAYSHORE DR MIAMI SHORES, FL 33138 USA PA Primary Zone 1700 SGL FAMILY - 4001 SQFT & Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/4/0 Floors 2 Living Units 1 Actual Area 5,742 Sq.Ft Living Area 4,541 Sq.Ft Adjusted Area 4,651 Sq.Ft Lot Size 10,750 Sq.Ft Year Built 1971 Assessment Information Year 2018 2017 2016 Land Value $430,000 $360,340 $360,340 Building Value $4,646 $404,637 $410,032 XF Value $4,048 $26,091 $26,322 Market Value $438,694 $791,068 $796,694 Assessed Value $405,340 $791,068 $796,694 Benefits Information Benefit Type 20181 20171 2016 Non -Homestead Cap Assessment Reduction $33,354 2018 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES BAY VIEW PB 40-16 LOT 13 LOT SIZE IRREGULAR OR 14902-2244 0291 1 Generated On: 8/2/2018 Taxable Value Information OR 2018 20171 2016 County Price Exemption Value $0 $0 $0 Taxable Value $405,3401 $791,0681 $796,694 School Board 03/20/2013 $800,000 Exemption Value $0 $0 $0 Taxable Value $438,694 $791,068 $796,694 City Sales which are qualified Exemption Value $0 $0 $0 Taxable Value $405,340 $791,0681 $796,694 Regional Exemption Value Taxable Value $0 $405,340 $0 $791,068; $0 $796,694 Sales Information OR Previous Price Book- Qualification Description Sale Page 03/20/2013 $800,000 28555- Qual by exam of deed 3512 02/01/1991 $327,500 12244 Sales which are qualified 2244 14350- Sales which are disqualified as a result of 11/01/1989 $0 2745 examination of the deed The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disciaimer.asp Version: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 457-1395 .may 2601 BLAIR STONE ROAD TALLAHASSEE FI -;32399--0783 CERRON, VALERiO SELEN18 TECHNOLOGIES LLQ` 277 GALEON COURT CORAL GABLES FL 33143 Cortgratuia#ion;it Wtth.fh� ►iraeaise taubecame.osts of itre iaearly oste'rrn �tidiatvs ►ic2ttsrrd by e t'�apsrrtmertt bf Business grsd ," +?� ,�'^�r'.a,r.,+�,+;.-�.y..xC.� = `" _.,, ;,w` --: ,::^rr :tk'��.:�?.�x�.,c�`�".,°;� _ � �`� Prrr#es »at f2agtAa€itift: t)ur rcrfes is nate �anri bus#iaesses range `• STATE OF FLORIDA from atcttiTecisto yacti€ brokers, lrorrt br?xtsrs to barbeque restaunts, anaihey keep Fiotlds's econany s€tong. DEPARTMEN 9F.BUStNESS AND PRQF1rSitALZECiiLIiTIC3N v Everyday vie work io improve the way we do businass #n order r CGCiv2A52 �x:;ISiJBi�i3$l�i2Jt►15 p , - { ` v* to serve you better.. For. information about our services. p#sase GCrf2T#f#EL7:G?#tii�Nl log onto www:ruy##orirlailnse.com. There you can end more �1OTA, 1 in rmation about our divisions and ties regulations that impact tt�, you;;subs to department newsletters and learn more ebout Esssj3atimettt in4tiativs3s. lei j.i CERRON, YAL ,� � �. r SELEN#SIEC 13t` �GZA 45 < the s , y 5 Our rriissitui at €�► Depadment is License se. EfCrcientiy; Regulate ` , FaIlOji.Wb' tA(i5t3ii1l}�trTtik1'Sk'YbytN318r6i3ttla%yC1UGa[1 serve your Cusksrfsers. Tftank"you for doing business its Florida, �� 15GERi#FIED'untlerttteprovisit+nsofL'h489CS. mid congratulations rN7 your new license!t�ppra on a% RLGt 2rst9 I tEQ9£Y?�ilfit7C19R j t� '-.�s'C.d .^r!!v.�'x.r ,•1 a,. .,. '1;.a ... .7 "..'� � .,, �:... 5�",y':3.,.'�Y �•.. 1321Mwo RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF. BUSINESS AND -PROFESSIONAL REGULATION 0ONSTRUCTION INDUSTRY LICENSING BOARD CaE•3Gi#Ei�93t;x -- .. � .fit, _ «mss; t!7�f ' ♦ v :.. . i '! IiCt ±7Gry l l►» t3 i/'iTR. la`TOR Nlrr#%tC�iA�►a�ri=IFIt3 Undia,' a pii visions.of CIt�"pter4Sl ExpirtCtrt t;ifiie AUG1, 2016.-. .&Z- "SELNIFT-E l+iCiC.i3O► .. (�[1jtyyfa��7*��tf�-�n Yi(ry to �j. t�� �L ��! �RViYiF�+��G. �*+{d.�� '�.tX .. �'A. �jJ•�'�ti �x .}.: �'•�t +ti MUM- ttartt t2tits biSPLAY A5 REQUIRED BY IJkW sm � t-tsaat3ati% nz .........._.._ _. lLocal Business Tax Receipt Miami -Dade County, State of Florida � -THIS IS NOT A BILL - DO NOT PAY' 7215374. �ILBT I BUSINESS NAME&OCATION RECEwrNO` EXPI $ES ( t sELEnus TECHNOLOGIES LLC RENEWAL SEPTEMBEi R 30,201,8 1 30310 SW 152 AVE 7499337 HOMESTEAD FL 33033 Must be displayed place of business C Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER.; � - SEC. TYPE.OF BUSINESS SELENIS TECHNOLIDGiES LLG: t 196 GENERAL BUILDING CONfRACTOA PAYMENT RECEIVED 6y TAX COLLECTOR. dC? 11ALERlO CEClRC7N. .ICGC1524512 , t 1 , rket(s) I i S4540-09126/2017 CREDITCARb-1,7-062683- Thio local Business Tax Receipt only confirms paymentef the Local Business Tax, The Receiptis not a license, J permit or a certification of the holdsr'sqqualifications,todobusiness. Ndldgr must comply ur#tlteny goaernmental or nmagovernmeatel regulatory lavas end requirements which apply to the business. € a s The RECEIPT N0. above must be displayed on all commercialiehlctes - iVliam(-0otla Code Seo Sa X76. For more information, visityyy�(ySt}tt#trpidade.agyij�Fpjipc,�pf � t � 3 '`'"' CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDlYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 08/06/2018 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 holier is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 (305 418-8411 }CONTACT v ) {305 418`8413 NAME,,Ma�NereZ Westward Insurance Services, Inc _ ____.�_._.� „...__._._......_..._.._�................._._ PHONE _ _ _ "', "FRX IA,c. No. y; (305) 418-8411 Noy 418-8413 4905 NW 72nd Avenue _ ._ ........µ ,..(_3p5), EMAIL AOD'R' ss:Westwardm5 beiisouth.net Suite 5 I Mlarn FL 33166 __ _. _ _..._..._. —� ._...___ INSURERS AFFORD!NGCOVERAGE NAICk INSURERA: United S� ecialt Insurance Com an ._ INSURED INSURERB_m:SUnz Insurance COm�yt'an Selenis Technologies, LLC - INSURERC,_Berkshire HathawaJ Guard 30310 SW 152nd Ave _ Homestead, EL 33033 INsuRER D INSURER F UMBRELLALIAe OCCUR ! EXCESS LlAB INSURER F: _.. RCYISIViV IVt,J7tflC5CK: 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. TADD..._......�...w. .___..W. LTR TYPE OF INSURANCE LINSOI POLICY NUMBER j COMMERCIAL GENERAL LIABILITY M 1DD�YY ; MSM DD�YY LIMITSWY W A ..... y/ CLAIMS ' EACH OCCURRENCE $ 1, QQQx000 iiihaG Or._ _ _ -MADE OCCUR --..... ---_....__..... SII 1002A207383 I PREMISE (Ea xcu rence .._ $ 1 dQ,QQQ, _... _..._ •�� 02/14/2018 02/1412019 MED EXP (Any one $.LOQ ................._.... _........_........ _... .__ ....... _... __... _............... PERSONAL 8 AOV INJURY $ 1 QQ0 QQQ GEN'L AGGREGATE LIMIT APPLIES PER: _. _..... PRO- POLICY i GENERAL AGGREGATE $ 2L000.,000 { .......E JECT I LOC ( PRODUt l'S - COMPIgP OG $ OOO QOO OTHER: I AUTOMOBILE LIABILITY ,/ ANY AUTO i ! CgMBINE INGLELIM17 ! ;,,,{Ea accident„_ _W �' A(�%�d(�Q • OWNED SCHEDULED AUTOS ONLY I -AUTOS 1 SEAU927294 HIRED 1 = NON -OWNED ( AUTOS ONLY AUTOS ONLY 07/30/2018 BODILY INJURY ,Per person) is 07/3012019 BODILY INJURY (Per arcldan ), g PRgPER 1YDAMAGE $ I PIP ( _!Per acc;dentj. _ _ _ pip $10,000 UMBRELLALIAe OCCUR ! EXCESS LlAB j EACH OCCURRENCE $ CLAIMS -MADE AGGREGATE g ._ ................. DEG RETENTION $ , is WORKERS COMPENSATION 'AND EMPLOYERS' LIABILITY PER OTH Y (STA' LITE 3 ER ANYPRO°RIETORIPARTNER!EXECUT{VE YIN N I A B OPPICEP,MEMSEREXCLUDED? Ell (Mandatory In NH) E L EACH ACCIDENT 1 QQQ 0 It yes, descrbe and r j WC01000001018 03/01/2018 E L DISEASE FA EMPLOYEE $ 1 (�(�(� QQQ 03,0112019 - - ......_ a_. _... - ......_...._ gESCRlPTION OF OPERATIONS below ! E, L. DISEASE -POLICY LIMIT $ 1 000 ,000 DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) Certified General Contracting Company Certificate holder is listed as an additional insured with respect to general liability. Coverage is afforded for contingent and contractual liability and x.c.0 ( Explosion, collapse, and underground) hazards. This insurance is on a primary and non-contributory basis. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E 2Nd AVENUE MIAMI SHORES, FLORIDA 33138 Almon az : an f alma% 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 Maylin 01988.2015 ACORD -VV 0910 rayr¢scerrcTO RIarK5 or ^'L,VKU All rights ..... ,..,..,..,, ..a...c ar.0 00 00 a ..0. 0 • : RECEIVED 's �14mr SHORES VILLAGE AUG 291018 BUILDING 1lVSPff9TlON DEPARTMENT A.*PF1ILID"AY; JC9� t13. BUILDING PERMIT Application is hereby made Jor the approval of the detailed statement of the plans and specifications herewith submitted for the build- ing or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the L%yls o blvet9ate of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division.4 Miaoii•MWms Vill•Ne sail be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at 41drog•dilreg progress If the work. • � • • � • f�•, •• � /yip] / +" + • • 1 Date.- = -------•-----(-jV-•----------- -------- _...-- /— ...._..., 1 .. ` .l. Owner's Name and Address.__ . __ %1.......... A -= - - 5 ------•--•---- No.--q�� ---- Street_1 ,./.�✓t� Registered Architect and/or Engineer�.kq5z.r.A?..S........... Le..�......... .. �? f�a�-.�..�_.................................._...-............................. ..... Name and address of licensed contractor ®e ca_✓-�5 — -- Location and legal description of lot to be built on:, Lot------- -- Block --------------- -- _--------- ----- Sub( 'f---- ------------------------ Street and Number where work is to be done __------ 4_. State work to be done and purpose of buildinp�(by rs)_-L-Z-_`!t__�_�?-__._.._._.1__ 1u !��::�:_�__. C' ..e &.,A cat 4-o...L Am -a -:o Kas-F•- - and for no other purpose. New Building ---------------------- .------ .. Remodeling ----------------_-------- Addition -----.-----------------= _ Repairs.--_-.-----------._.._.-_ No. of Stories ------ --------_----- - be constructed of____________________________ Kind of ndatton------______'____•_____._..----___-.--_-_-____-_____'.___..__.--- Roof �9vering... Estimated Total cost of improvements amount of Permit -2 't.,` _ -•----------------- ------------------------------------------------- - Zone cubage required---------------------------'---------------------------- --------------------.Plan Cubage---------------------------------------- -----------•-------------- --------------------------- Distance - --------•---•-------- Distance to next nearest building --------------------------------- _------ _----------- - ----- Size of Building Lot .--_...___-__--_-...---------- _-----_______--_.-_ Maximum live load to be borne by each floor --------------------------- -------------- ------------------------------------- -------------------------------------- I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may besent to ------------------------------------------ --------------- The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub -contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such. su ' actor on work be perfo ed under this permit, as are licensed by Miami Shores Village. Remarks----------------------------------------•----------------------------------------------- (Signed) - ---- �- — - - STATE OF FLORIDA, COUNTY OF DADE. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, persorially ap- peared---------------------------------------------------------------------------------------------------- - me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the_ ----------- _------------------------------------- ___________________________________________ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that'all facts therein by him stated are true. �� �, Permit No.__-__._._1.3�_'7_4�------------ Date _________.____­ ------- _ ..._._ ___fr..\ Read, Sworn to and Subscribed before me. Disapprove (Signed). ------------------------------------------------- ---------------------- - - — - Notary Public, State of Florida Commission Expires ---------- .-------- -- __ PLANN BOARD ------- --- DATE _.. Chairman--------- --------------------------------------•--- --- . ------- --- ---------- Member ------- --- ------•- ------ - -------- _--•---------------------- Member-----------------------------------------•--------------------------------------------------- --- Member ........... -...... -............................................ Member-------------------------------------------•------------------------------------------------ Member Council Approved--------- ------------------------------- -------------------------Date Disapproved -•--------------------•----- ------------------------ --- --....Date 11 NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Plannin_* Board. A re -inspection fee of $1.00 will be charged when such re -inspection is made necessary by improper notice for inspection or faulty materials and/or workmanship. 11 11