REV-16-3433 I9V�0
1Miami Shores Village DEQ 926Buildin 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
FBC 2014
BUILDING Master Permit No. RC 16-337
PERMIT APPLICATION Sub Permit No. P-Ep ��-?�
1I u
❑BUILDING ❑ ELECTRIC ❑ ROOFING ® REVISION EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 42 NE 96th Street
City Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3206-013-0640 Is the Building Historically Designated:Yes NO X
Occupancy Type: R-3 Load: Construction Type: IIB Flood Zone: X BFE: N/A FFE: 12.99
11.50 low
OWNER:Name(Fee Simple Titleholder): LUNI USA, LLC Phone#:
Address: 235 Llincoln Road#310
City: Miami Beach State: FL zip: 33139
Tenant/Lessee Name: N/A Phone#:
Email:
CONTRACTOR:Company Name: RK Builders, Inc (dba for Moonlight Editions, Inc4hone#: (954) 980-4430
Address: 1835 E Hallandale Beach Blvd #736
city: Hallandale Beach State: FL Zip: 33009
Qualifier Name: Robert Kirchgessner Phone#: (954) 980-4430
State Certification or Registration#: CBC 060255 Certificate of Competency#:
DESIGNER:Architect/Engineer: Robert Kirchgessner Phone#: (954) 980-4430
Address: 1835 E Hallandale Beach Blvd#736 city:Hallandale Bch State: FL Zip: 33009
Value of Work for this Permit:$ Square/Linear Footage of Work: —2466" 0
Type of Work: ❑ Addition ❑ Alteration El New Repair/Replace ❑ Demolition
Description of work: PLAN REVISION: Repair/Replace deteriorated framing &wall finishes, uncovered
during renovations
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$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
f2'`NE 16th Street
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.
7*W*
`ti Signature
nature g
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I day of 20 ,by 2- 1 day of 20 t J.. by
who is personally known to Robert Kirchgessner ,who is personally known to
me or who has produced as me or who has produced L as
identification and who did take an oat identification and who did to oath.
NOTARY BUC: NOTARY PUBLIC:
Sign Sign:
Print: V. C4o^S'. C .\01S Print:
. vlc IA Rom
Seal: r '�" '` VICTORIA ROSADO Seal: �' - MY COMM
MY COMMISSION#FF971492 :, ISSION#FF9T1492
a' EXPIRE
I ' EXPIRES March 15,2020 S March 18,2020
(407)30 ,153 FIQrlpery EOfN
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APPROVED BY � Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)