REV-17-2207or in
Questions/Comments/Concerns
Miami Shores VillagEMonique smith, 786-253-2869
NEC
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
BUILDING
PERMIT APPLICATION
0BUILDING ❑ ELECTRIC Ei ROOFING
77-7.
Uti 3 L 2017
FBC 20! 5 '
Master Permit No. i C " //c
Sub Permit No,V �) 14-
REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
I2,2/i 1 100 'T .
JOB ADDRESS:
City:
Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Construction Type: A�FloodZonne:{ ' ' BFE: FFE: /;�
OWNER: Name (Fee Simple Titleholder): VA'LD i Wilk 001.° V Nal) P #: 1019 2f 2 0b'3
Address: t Ne. t0 ET f
Occupancy Type: Load:
City: HI A .S 1-1-074.6S State:
Zip•J3 /3
Tenant/Lessee Name: /3-4-104-Cnn �f-' fir-- Phone#:
Email: � . t t. Pin Q U ISL L D''�f" @-A- 1- I . A/ i T 2c) --e, 2
V
CONTRACTOR: Company Name: * j -h r" `� �+ Phone# �� 2tC-4--'4-R65
J
c , �y�
Address: �c7 ° NIA./
24/7�
City: A-tdL i State: FC- zip:33425
Qualifier Name: K cc M A so a"Ta q ` Phone#:
State Certification or Registration #: C6 C 1 r i Z( 0 U Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
4.21) 4C( N 6 crcoe VP rtioQd( - -
Description of Work: EV/ d t 9 N
ocr T c tnit e
K,t rc,-fcN pm-L.L.. --- i+ l L.e-r-r• 1,4 is ".
Specify color of color thru tile:
Submittal Fee $ �� Permit Fee $ 'R 5 - CCF $ CO/CC $
Scanning Fee $
Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 1 O I • CO
(Revised02/24/2014)
• , 1
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
those pro • rtv is subiect to attachment. Also, a certified of the recorded notice of commencement must be posted at the job site
for the firs insp ction which occurs seve ( days • er t building permit is issued. e absence of such p . sted notice, the
inspection - '1 of approved and a rein • • c ion f will • - charged.
Vitwp
Signatur
gnature
0 ER or A ENT
The foregoing instrument was acknowledged before me this
day ofCT , 20 -R , by
\ ''d is personally known to
me or who has produced V -L V i iS )d CSas
identification and who did take an oath.
NOTARYI
cPUBLIC
Print:
Seal: } o�'sY °"g Notary Public State a} Florida
`} ; 5indl6 AlvRrez
My Cammisaion FF 166750
horn Expirar091081201P
APPROVED BY
(Revised02/24/2014)
CON CTO
The foregoing instrument was acknowledged before me this
5),_ -1'6 day of )' ; ' �i_,� , 20 I 1 . by
, who is personally known to
we or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
Structural Review
00°',.� KATHERINE RIVERA ~.
`f Notary Public - State of Florida
Commission 0 FF 186117
;�F c�,°;• My Comm. Expires Jan 2, 2019 -
'•nn��
Zoning
Clerk
JIMMY PATRONIS
CHIEF FINANICAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 9/6/2017 EXPIRATION DATE: 9/6/2019
PERSON: SORTO KENIA
FEIN: 205910087
BUSINESS NAME AND ADDRESS:
VAS RENOVATIONS, INC
750 NW 25 AVENUE
MIAMI FL
SCOPE OF BUSINESS OR TRADE:
33125
Licensed General Contractor Licensed Roofing Contractor
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609