REV-16-2671 Miami Shores Village RECEIVED
Building Department SEP 20%
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax: (305)756-8972 BY-_q_ - —.
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014 '�:�
BUILDING Master Permit No.IF-W, -'7-Po-�OFS3
p
PERMIT APPLICATION Sub Permit No. i )-C\r vo
X BUILDING ❑ ELECTRIC ❑ ROOFING '� REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Iq b iJL 10� SS
City: Miami Shores County: Miami Dade zip: 3313ff
Folio/Parcel#: 11 -02%310-0%3-wo30 Is the Building Historically Designated: Yes _NO
Occupancy Type:�i r Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Phone#:-305 .�13-�77oi�1
Address: lc1b NL 105 ST
City: tPA%cmmi Shotes State: FL Zip: 3313SS
Tenant/Lessee Name: Phone#:
Email: W1A-oNw\9@yyw ..YW\aoAi .2dV
CONTRACTOR:Company Name: M21, Cdr1C'trt)CONJOCN OAn.c xc. n[S l i7 Phone#: :) b-23A-411ob b
Address: 2SaS- I,,_ PSk IC.\ jn'
City: Rtc,\eo.4, T State: T-L_ zip: 3'301h
Qualifier Name: t�CVwc_o Phone#:
State Certification or Registration#: C&C ISI V"6 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ N-15 Square/Linear Footage of Work: 18
Type of Work: ❑ Addition ❑ Alteration ❑ New /❑ Repair/Replace ❑ Demolition
Description of Work: Wim, reInC(?_ b�� lhkwn al IRceorc�/ ac)c).�i-�ov.u1 15� �-
Specify color of color thru tile: 'l
Submittal Fee$ Permit Fee$ 0c) CCF$ • V CO/CC$
s� •` • r•
Scanning Fee$ �o Radon Fee$ DBPR$ � 2- Notary$
Technology Fee$ ' �0 Training/Education Fee$ d . 4o Double Fee$
Structural Reviews$ Bond$
61
TOTAL FEE NOW DUE$_ to
(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 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.
l
Signatur Signature —/1/e,�4
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before me this
day of ✓ 20J by .2-1 day of C 20 , by
i who is personally known to Ll ss[f-ft lf&�VCO who 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: Sign:
Print: Print: vS
Seal: i "Notary Public- tate of Florida S E
AGUSTIN EXPOSITO
My Comm.Expires May 31,2017NotaryPuMk-State of Florida
Commisaion#�FF 017ry My Comm:Expires May 31,2017
I �°•4;,; Bonded Through National Notary ASND. Commisaion#fF 017526
*i0meoilPbtlQh'NAt"atlltllA►jAlSl1. **********
APPROVED BY _ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
5582 N.W.7th STREET SUITE 202
X;6.:
•••• :• .• • 000
SURVEY No. 14-0000259-1
L ,FLORIDA 00, �� �TEEPHONE (35264-2560 V+Zi rs nr.
FAX:(305)264.0229 • • • • • • ••
•
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VOL s4,, STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSION REGt1L ATICFN
CONSTRUCTION INDUSTRY LICENSING BOARD (
850) 487-1395
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TALLAHASSEE FL 32399-0783
PACHECO, LISSETTE
DSII C®NSTRuCTION CONTRA OR tP
2525 W 3 CT
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STATE OF FLORIDA
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CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395''
2601 BLAIR STONE: ROAD
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TALLAHASSEE FL 32399-0783
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fr+am architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND
restaurants,and they keep Florida's economy strong PROFESSIONAL REGULATION
Every day we work to improve the wa ",do business in order CGC1518896 ISSUED, 07/13/2016
to serve you berier for informatio =*Vr rvices,please
"gg onto wwwmyfloridalicense.cornTWO you can find more CERTIFIED GENERAL CONTRA( ,O
lhforrnati n about our divisions and ft, ions that impact PACHECO LISSETTE
you,subscribe to department newsjed learn more about DS6 CONSTRUCTION CONTRACTORS CORD
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STATE Of FLORIID
DEPARTM&T"OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
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