REV-17-2407Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
305) 756-8972
BER: (305) 762-4949 .
BUILDING
PE IT APPLICATION
BUILDING ❑ ELECTRIC
0PLUMBING ❑ MECHANICAL
JOB ADDRESS:
ROOFING
Master Permit No.
II'i( REVISION
Sub Permit No.
El PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
S iuuu o3 s
i
coo
s
FBC 201`
LEN'1/72401
❑ EXTENSION,
CANCELLATIONEl
RENEWAL
SHOP
DRAWINGS
City: Miami Shores County:
)
Folio/Parcel#:
OccupancyType: Load:
Miami Dade
Zip: '33 50
Is the Building Historically Designated: Yes NO
Construction Type: Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C4 SS ( _ZAJ l- LLC Phone#: 30c •-• C k O — / 9 05
Address: 1 R ) ,.i k.. 3( CT Co 57
-
City: 0. y .?•c J ),t.& State: C L
Tenant/Lessee Name: t Phone#:
Email:
'Zip: 3 3I 6 0
CONTRACTOR: Company Name:
Address:
City:
Vc6-'i P -C • 1\c-- `Phone#: ? S-'./ -27 'F /kz -
Vo.q ;UV 2fic 'T-
v U t le_ /State: Zip: 3
Qualifier Name: ---------1— y�2AI LLYn1JC) . 1114QJ.2 t Phone#: IA -2/-0 r / ('2-3
It
State Certification or Registration #: C b( lc 1 087? Certificate of Competency #:
Phone#:
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
Square/Linear Footage of Work:
Value of Work for this Permit: $ _j Z s�
Type of Work: ❑ Addition ❑ Alteration
n New ❑ Repair/Replace' n Demolition
Description of Work: �YEV `StCDII O C ��U�t�r — �� VKJZ &J C
X20 S S FLc\o�!
CiRR } 0.. JA
Specify colorof color thru the
SubmittaIrFee'$ `}"Permit Fee'$ -R S CO
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews Ai Z2) • ,�
(Revised02/24/2014)
Eiwa:+ "111.-0
• rptiit:t ' fiLvere oi5
alb
4
, :>» 41711' C�`h«,
CCF $ d 4 nr.ra 4 ha;CO/CC $ 4 n ,a �;•.
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $204-1, t T
Bonding Company's Name (if applicable)
BondingCompany's Address
City
State _, u _ Zip
e `f
Mortgage Lender's Name (if applicable) ; `< x °, --:a.` .•�•r
Mortgage Lender's Address T'. ° #' .
I i
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
OWNE .r AGENT
The foregoing instrument was acknowledged before me this
0 9 day of Orr , 20 / , by
Cu ycp.6.? CG ?/24vho is personally known to
me or who has producedC
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
Seal:
&leS4 c.-, Yj4 ci
**********
APPROVED BY
(Revised02/24/2014)
Signature
ACTOR
The foregoing instrument w.. acknowledged before me this
Lv day of [��Gv--- , 20 (, by
Qrry�r>
Al.c>..-csjr7who is personally known to
as me or who has produced -L. tL—
Ebesber Delgado
Commission # G8121251
Empires. J 27,' 2021
**9onde0tio**
identification and who did take an oath.
NOTARY PUBLIC:
as
Seal:
1/)
Plans Examiner Zoning
*
ALDO TORRES
Notary Public - State of Florida
Commission # FF 997586
Fmrdx iresjJun 1, 2020
ide
Structural Review
Clerk
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018
DBA: 904 INVESTMENT LLC Receipt #: ENG ERAL CONTRACTOR
Business Name: Business Type:
Owner Name: FERNANDO MARQUEZ
Business Location: 12095 NW 44TH ST
SUNRISE
Business Phone:
Rooms
Seats
Business Opened:02/24/2015
State/County/Ce rt/Reg : CGC 1510 8 7 8
Exemption Code:
Number of Machines:
Employees
2
Machines
Professionals
For Vending Business Only
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
2.70
0.00
0.00
29.70
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
904 INVESTMENT LLC,
12095 NW 44TH ST
SUNRISE, FL 33323
Receipt #01A-17-00000143
Paid 10/04/2017 29.70
2017 - 2018