REV-17-253 12017
Building Department BY:
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' N Q, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
\ Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-0949 �h
FBC 201
BUILDING Master Permit No. PC—ko—I G .-.2 22
PERMIT APPLICATION Sub Permit No. RTV Qi - n - 3
Jf BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 925 NE 95 Street
City: Miami Shores County: Miami Dade Zia: 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:\)EX C VA.Ot. 6 Phone#: (-k54--us-c)5-1ei'e
Address: i l i i 1 Y t,A[ 'DtZ
City: tate: 1;L. Zip: 325
Qualifier Name: t2Oi`8y�—t=n k^-;;;k2A Phone#:
State Certification or Registration#: CCC-—i 5?-0-6---W3 Certificate of Competency#: 1
DESIGNER:Architect/Engineer: nu4,.j Phone#: C' 9�a/�SS81 i
Address: 4932 Vii.+ o4�T City:��an I State: - Zip: 33i 5 S
Value of Work for this Permit:$ "600 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ —�—
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ n Bond$
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 L Signature -
/ginstrument
OWNER or AGENT NTRACTOR
The foregoing instrument was acknowledged before me this The foregoi was acknowledged before me this
o day of 20 1 a by 3s>O day of 20 by
(6yaAc10 V lL1pa]c- Q)A ,who is personally known to 12=Da\- 4 y who is personally known to
me or who has produced 0.L as me or who has produced t1—. as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: ; Y d %, Ricardo Dominguez NOTARY PUBLIC: o
Commission I FF958686 ¢�'�VZ
Commassio n FIF958686
Eye fres:February 8,2020 �' : rebruary 8,2020
Sign: n Notafy Sign: ,
o,,"aFQ`,,`,
Print: lZkC;&N'2 4 Print:
Seal: Seal:
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y ST,APPROVED,BY �. ,r. Plans Examiner Zoning
4
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