REV-17-1429BUILDING
PERMIT APPLICATION
UBUILDING ❑ ELECTRIC
❑■ PLUMBING ❑ MECHANICAL
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
RECEIVED
MAY 3 (1 7017
FBC 2014
Master Permit No. RC -15-1024
Sub Permit No. RE V 17:17 k q 2q
❑ ROOFING Q REVISION
111 PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 9701 BISCAYNE BLVD
❑ EXTENSION ❑ RENEWAL
CANCELLATION ❑ SHOR
DRAWINGS
City: Miami Shores
County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3206-014-3320 Is the Building Historically Designated: Yes
Occupancy Type: R-3 Load: Construction Type: V Flood Zone:
OWNER: Name (Fee Simple Titleholder): JOSE G. CASTRO & MARIA G. ALE
Address: 9701 BISCAYNE BLVD
NO X
X BFE: FFE:
Phone#: 305-582-2836
City: MIAMI SHORES State: FL
Tenant/Lessee Name: N/A
Email: info@r-method.net
Phone#:
Z;p: 33138
CONTRACTOR: Company Name: A.A. J ((j I UM V ((S & (loc.
Address: 1154:) "v4 '1,
City: iv An `IA (♦ • State: ft"- •
Qualifier Name: AlA114 ilhifi5PC o
State Certification or Registration #: ' Of C' 1 il VI Is
..
PFione#:
Zip: 3716c
Phone#:S�' .8119 3",
Certificate of Competency #:
DESIGNER: Architect/Engineer: JOSE RUBEN JIMENEZ, ARCHITECT
Address: 300,0AKWOOD LANE SUITE 100
Value of Work for this Permit: $ 2500.00
Phone#: 305-582-2836
City:" HOLLYWOODState: FL Zip: 33020
Square/Linear Footage of Work: 55 Sf
Type of Work: ❑ Addition Iidi Alteration ❑ New i I Repair/Replace n Demolition
Description of Work: Revisions for renovating one of the existing bathrooms in the 2nd Floor.
Specify color of color,thru tile:
Submittal Fee $ P
Scanning Fee $ 3 • Gz,
2 •fib
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
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Permit Fee $ 15.° ' U O' CCF $ �.%� 4,10 '� roe'«C� tC
Ott'_ 1 $
Radon Fee $ 2 • 5 DBPR S. . 25 Notary $
Training/Education Fee $ v G a
7
Double Fee $ 951
Bond $
TOTAL FEE NOW DUE $ ' b .C-- 3V
'1 t
t
BondingCompany's,Name (if applicable) .
Bonding Company's Address
ri r
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage LAder's Address
City State Zip
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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
NER or AGENT
Signature.
NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrumerit was acknowledged before me this
day of MA- 20 ^] by day.of , 20 /7 , by
C,FAr_ • l , who is personally known to 414 -in /4 P.s. , who is personally known to
•
me or who has produced ,(V (2. LICe3.-.Se" as me or who has produced personally /N oWn as
identification and who did take an oath.
NOTARY PUBLIC:
r
identification and who did take an oath.
NOTARY PUBLIC:
Print: V ILD A.-
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APPROVED BY
(Revised02/24/2014)
Sign:
Print: 1/)fq lib►/ O(
Seal:
Plans Examiner
Structural Review
******************
Zoning
Clerk