REV-17-3009 Miami Shores Viliage 7::z ~.� vf;
Building Department DT17o10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ��
Tel:(305)795-2204 Fax:(305)756-8972
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INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2014
BUILDING Master Permit No. RC 12-16-348'5
PERMIT APPLICATION Sub Permit No. P=y 1� —Joo
*BUILDING ❑ ELECTRIC ❑ ROOFING * REVISION F-1-EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS n CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 373 NE 101 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#; Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder)-MELISSA MAZETELLI Phone#:319 321 1561
Address:373 NE 101 ST
City: MIAMI SHORES State: FLORIDA Zip: 33141
Tenant/Lessee Name: Phone#:
Email: MELISSA.C.LEE@GMAIL.COM
'CONTRACTOR:Company Name: SDA CONSTRUCTION Phone#:� p�.�7 7 61(7
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Address: 14711 PALMETTO PALM AVE
City: MIAMI LAKES State: FLORIDA Zip: 33014
Qualifier Name: Phone#: 3
State Certification or Registration M CGC 1516767 Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: REPAIR DETAIL FOR CEILING JOISTS
..Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 5 'q CCF$ CO/CC$
Scanning Fee$ -7 . Radon Fee$ DBPR$� Notary$
;a
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ ! 7-0 ' Bond$ _ rn
i TOTAL FEE NOW DUE S G o 14 W
(Revised02/24/2014)
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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: 1 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 o 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 low brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement irust be posted at the Job site
for the first inspection which occurs seven(71 days after the building permit is issue in the abs' of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
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Signa re Signature _
OWNER or AGENT TRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of fc.elY1.5 1L- ,20��by Z CP day of ►r 20 by ,
rho is personally known to who is rsonall kno to
me or who has produced ) U eA as me or who has produced as
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identification and who did take an oath, identification and who did take an oath.
NOTARY PUBILI NOTARY PUBLIC:
g • .. I Sign:
Print: c•+or �.�., L YS CAVEDA
Print:
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APPROVED BY Plans Examiner Zoning
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Structural Review Clerk
(Revhcdo2/24R024)
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