MC-16-1048 {
A
Mi Shores Village REcFv�D
I Bui ing Department APR 19:201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949 '51 ,
FBC 20 kq
BUILDING Master Permit No. ac
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING 0 MECHANICAL QPUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 276 NE 104 ST
'city: Miami Shores County: Miami Dade
Folio/Parcel#: 11-2136-013-0310 Is the Building Historically Designated:Yes ' NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
4
OWNER:Name(Fee Simple Titleholder):WILLIAM L BROWN Phone#:305-757-9089
Address:276 NE 104 ST
City: MIAMI SHORES State: FL Zip: 33138 '
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SOLAR BEAR SERVICES Phone#: 305-863-1830
Address: 10125 NW 116 WAY#10
City: MEDLEY State: FL Zip: 33178
Qualifier Name: MARK VEILLEUX Phone#:
State Certification or Registration#: CAC1817134 Certificate of Competency#:
,DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$6150 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition
Description of Work: EXACT AC CHANGE OUT - i,✓S
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ S v1 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ '
(Revised02/24/2014)
l
.Y
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
_ j
'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.
i
"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 rein pection fee will be charged. [
VSignature Signature JJA_&
-------------
or AGENT CONTRACTOR
The foregoing instru ent was acknowledged before me-this The foregoing instrument was acknowledged before me this
16 day of MARCH 20 16 by 16 day
/of MARCH 20 16 by
V/JX_L-l-M�"Ja A\Lho is personally known to M r'Z_� Y �` �(�(�Cwho' nall know to
me or who has produced EL I JDL as me or who has produced as
j identification and who did take an oath. identification and who did take an oath.
NOTARY P BLIC: NOTARY PU IC:
Sign: Sign:
I' Print: Print:
COMMI ION#FF142531
Seal: ' ��% Seal:
I :x
COMMISSION#FF142531 ,; EXPIRES: Sept. 15, 2018
10. EXPIRES: Sept. 15, 2018 ;F FL ``� WWW,AARONNOTARY.COM
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APPROVED BY �,(QExaminer Zoning
Structural Review Clerk
(Revised02/24/2014)