PL-16-2723 RECEIVED
Building Department OCT 05 016
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 By:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FFBC 20��P lU
BUILDING Master Permit No. R C I ^ 2z� zz
PERMIT APPLICATION Sub Permit No. e Iy_o " 7.2 23
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
MIfILUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 925 NE 95 Street
City: Miami Shores County: Miami Dade Zip: 33138
1-3206-014-3100 X
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): 925 NE 95, LLC Phone#:
Address:
600 NE 53rd Street
Miami FI 33137
City: State: Zip:
Tenant/Lessee Name: N/A Phone#:917.703.6010
Email: ivsucre@gmail.com
CONTRACTOR:Company Name: VIef u0 (N �' `q
J�nyCA0A, 'w`T�j'4' ipA.ne#: T?f 6
Address: 1 1 1 f( 4'*Y''''ip'fes pri vc-
City: �a��a �� state: fl- 333 Z5
Zip:
Qualifier Name: 12 D.Do(,i=oyen4- Phone#: i?5� 90'0 5?-f 6
State Certification or Registration#: (f *G 14 Z I Z 9 Z Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �—`,�/�Q.oa Square/Linear Footage of Work: 1�oF
Type of Work: El [Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: 1�
Submittal Fee$ Permit Fee$ CCF$ ``- 2 C) CO/CC$
Scanning Fee$ Radon Fee$ 3 DBPR$ 3� Notary$
Technology Fee$ 5 . (DO
Training/Education Fee$ U� Double Fee$
Structural Reviews$ Bond$
���i I g 5 q Co
I . .
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 CO TRACTOR
The f regoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
AVk-�- day of OGtO��_ 120 1.. by 4" day of o 20 Ito by
k6t:k tO V\UA%,i3 -J eE ,who is personally known to Pgzm�-T--owho is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: � —z _ Sign: �7--�_.
Print: Q\WT--5 C) Z>oc\ MI--Sc-* - Print: C�CAC� OM 1
Seal: , Ricardo Dominguez Seal: y , Ricardo Dominguez
��<': Commission I FF958686 � '' ��= Commission # FF958686
Expires:February 8,2020 Expires:February 8,2020
Appg%1h,N Aaron Notary gQ l 4
APPROVED BY to ��� Plans Examiner Zoning