Loading...
REV-17-2592 Miami Shores Village Fm�" r � Building Department r s 2017 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20(�{ BUILDINGUMANrritNo. RC11-16-3197 PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING Q REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:' 10804 NW 2 AVE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-002-0140 Is the Building Historically Designated:Yes NO NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):ANGELA HENAO Phone#: Address: 10804 NW 2 AVE City: MIAMI SHORES State: FL Zip: 33168 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: MCI CONTRACTORS INC Phone#: 305-897-6328 Address: 11820 MIRAMAR PKWY SUITE 216 City: MIRAMAR State: FL Zip: 33025 Qualifier Name: MELQUICEDECVIVEROS Phone#: 786-251-2978 State Certification or Registration#: CGC1516249 Certificate of Competency#: 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 �1❑ Repair/Replace ❑ Demolition Description of Work: '�G G� �'x`54r TL e— -0` '� - G� J —4 Specify color of color thru tile: Submittal Fee$ Permit Fee$ S " CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ �' W Bond$ TOTAL FEE NOW DUE$ ( � W ;f (Revised02/24/2014) 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 xc eding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law bra hur will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commen me t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the bse ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature A Signature OWNER or AGENT CONTRA OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledge b re me this day of DLTr7 � 2 by 31 day of ©VM-8,4 � *014 by &Ar10,rx J7AL;7-kQ who iW-�O? to Ml'LG2�CU�c2.. 0cv't�d5,w ow to me or who has produced as me or who has produced Q O`er � as A. identification and who did take an oat OA \� identification and who did take �`tk�`���y2� NOTARY PUBLIC: �y� CO NOTARY PUBLIC: Sign: Sign: �= Print %A-!-(5'��Pi Print: C['i1L�o`To�lkt-�� e Seal: o^� Seal: APPROVED BY t Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)