RC-16-591441( •
1
BUILDING
PERMIT APPLICATION
UILDING
PLUMBING
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
❑ ELECTRIC ❑■ ROOFING
(7, 707,TVED
MA 0 4 2016
BY,
TFBC 20 N
Master Permit No. t�-=� 3� -
Sub Permit S S9 1
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9325 N. BAYSHORE DR.
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:11-3205-027-0540
Occupancy Type:
Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): OMAR CASSOLA
Address: 9325 N. BAYSHORE DR.
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
Phone#:
City: MIAMI SHORE State: FL r..
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: LITECRETE, INC.
Address: 8095 NW 64 ST
City: MIAMI State: FL
Qualifier Name: ANTHONY VALINO
Phone#:
zip: 33138
Phone#: 305-500-9373
State Certification or Registration #: CGC 059735
DESIGNER: Architect/Engineer: THOMAS H. FORD
Phone#:
Zip: 33166
Certificate of Competency #:
Phone#: 786-138-3257
Address:4900 SW 74 CT City: MIAMI
Value of Work for this Permit: $ 10,500.00
Type of Work: ❑ Addition ❑ Alteration
State: FL Zip:
Square/Linear Footage of Work: 2,350
❑ New ❑ Repair/Replace
Description of Work: LIGHTEIGHT INSULATING CONCRETE
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ tom"-' • 03 Permit Fee $ •3 1 S r G
Scanning Fee $r ' 03 Radon Fee $
Technology Fee $ . ` Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ 6.G0 co/as
DBPR $ f" -Is Notary $
a.�
Double Fee $
Bond $
TOTAL FEE NOW DUE$ 361 "
0
0
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
OWNER or AGENT
The fore:oing instrumt was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,,,,,/,'
eAm </ 550 4- , who is personally known to q4 1,..1 V c.,1, -1 c , who is personally known to
me or who has produced as me or who has produced NJ/in.. as
Signature
CONTRACTOR
,20 / G ,by
)-94t" day of Tt.4,r'I , 20 / b , by
identification and who did take an oath.
P
NOTARY P
Sign:
Print:
Seal:
LIC:
111111 Deli
■ila' �•�
�a= Notaty Public - State of Florida
Commission FF 228273
c My Comm. Expires Aug 31.2 r 19
-Ml- sn.
APPROVED BY
(Revised02/24/2014)
to/
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
rrirtn '
2-ra, cl • . n ..� >Ic
EIDA C. HERNANDEZ
OMMISSION # EE 832598
EXPIRES: January 1, 2017
Bonded Thru Budget Notary Services
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Plans Examiner
Zoning
Structural Review Clerk