REV-17-1466 Miami Shores Village I ��"��"��'��
g JUN 01 2017
Building Department 5BY:__
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:.(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 St'h
FBC 201 A
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. —
❑BUILDING FE-1 ELECTRIC ❑ ROOFING M REVISION ❑ EXTENSION ❑RENEWAL
4
❑PLUMBING ❑ MECHANICAL []PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 101 North West 100 Street
City: Miami Shores County: Miami Dade. Zia:
Folio/Parcel#:1131010220300 Is the Building Historically Designated:Yes NO
Occupancy Type: Res Load: Construction Type: EXst Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Nomade Realty LLC Phone#:7862510138
Address:230 North East 107 Street
City: Miami State: Florida Zip: 33150
Tenant/Lessee Name: Hassan Benjelloun Phone#:7862510138
Email: hassanb@me.com
CONTRACTOR:Company Name: Donald Marese Electric Inc Phone#: 9546306910
,Address: 2722 Thomas Street
City: Hollywood State: Florida Zip: 33020
Qualifier Name: Donald Marese Phone#: 9546306910
State Certification or Registration#: EC 13002571 Certificate of Competency#:
DESIGNER:Architect/Engineer: Juan A Rodriguez/Jomolca Phone#: 7864862029
'Address:625 SouthWest 82 Avenue City: Miami State: FL Zip: 33144
Value of Work for this Permit:$ 5 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of work: Full Service Change, Kitchen and Interior remodel, Smoke/Carbon Detectors,
,Pipe Instant Hot Water, Lighting, Switch and Plug, Minor Demo.
Specify color of color thru tile: r
Submittal Fee$ _Permit Fee$ j6 �'Vy a OF CO/CC$
Scanning Fee$
Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ C;�J .
(Revised02/24/2014)
r
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 on 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 ' Signature
OW NT CONTRACTOR
The fore • trument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of T66LIi2 020 1 7 ,by � day of�K-11 20 �� by
A55Alk a:g t Iloi vv,who is personally known to ��V�L{l A'Yai42— ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
i
NOTARY PUBLIC: NOTARY PUBLIC:
�V i G`G.-
Sign: � Sign:
Print: cti� Print: "< M
V �"RICI :gam es July o6,2020
Seal: :.s A FERLES
Seal: ,9!,^,•� EXPIR
rAMISSION#GG009157
•.PJRES July 06,2020
APPROVED BY u��y Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)