RC16-229300,W\co?
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BUILDING
PERMIT APPLICATION
*BUILDING ❑ ELECTRIC
PLUMBING [l MECHANICAL
JOB ADDRESS: 142 NW 103 ST
City: Miami Shores
Miami Shores Village
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
RECD .r ED
FBC 20 Vf sill
Master Permit No. kc, 1 6. - 219
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION pi RENEWAL
Il
PUBLIC WORKS n CHANGE OF ❑ CANCELLATION ❑ SHOP
DRAWINGS
CONTRACTOR
Miami Shores, FL 33150
County:
Miami Dade Zip:
Folio/Parcel#:11-3101-022-0010
Occupancy Type:
Load: Construction Type:
Is the Building Historically Designated: Yes NO _
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): U S Bank Trust c/o Caliber Homes Phone#:
Address:13801 Wireless Way
City: Oklahoma City State: OK
Tenant/Lessee Name:
Email:
11
Zip: 73134
Phone#:
CONTRACTOR: Company Name:
Address: 4337 E 11 Ave
A & J General
ELLfD
Phone#: 305-599-2782
City:
HialeahState: Florida
Qualifier Name: Miguel Guerrero
State Certification or Registration #: CGC 1519495
Zip: 33013
Phone#:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: __ Zip:
Value of Work for this Permit: $ X 3 i 00 Square/Linear Footage of W
ork: X ) SJc7
Type of Work: ❑ Addition LJ Alteration ❑ New Repair/Rep
((-11,4j,v�.r '1 uitsa r —,�' V6W-bat , �
lace LJ Demolition
Description of Work: r" l '
L% -i-ct _ %?u/ ,Z x312.2,6., /26, e
Z.)h€ ,4 /`)%64-,r'a%zP'60764
/fi.LU.O 9 z.+tR.AC4t w%'1 r-( 'i2�.1 w -347/
Specify color of color thru t�le:`yf-CAO c
Submittal Fee $ Permit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
cO/cc $
Notary $
(Revlsed02/24/2014)
Bond $
TOTAL FEE NOW DUE $
•
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 q dia reinspection fee will be charged.
Signaturera
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
CC day of n21r , 20 ((0 , by I 5 day . 0 t.t"..k2' , 20 l , by
2L {) at(1 _42_ , who is personally known to m/ mpi. _ _ _ «f o is personally known to
me or who has produced
J-1)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as me or who has produced as
identification aplwho did take an oath.
NOTARY PUB
Sign:
0 HODGES
My Commission Expires
February 11, 2019
************««*
APPROVED BY
(Revised02/24/2014)
Plans Examiner
YS M. HEIVIANDEI
MY COMMISSION / FF 914511
EXPINE5:Ap127,2020
Sonikl Zhu Notary Marc Undeiw we
Zoning
Structural Review Clerk