REV-18-1091 Miami Shores Village RECEIVED
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
BUILDING Master Permit No. `Q1
PERMIT APPLICATION sub Permit No.
❑BUILDING 0 ELECTRIC ❑ ROOFING REVISION EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 269 NW 111 TER.
City: Miami Shores County: Miami Dade Zip: 3 3.1 3 ff
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):BLESSED MANAGEMENT CRAP LLC Phone#:(786)400-0647
Address:23550 SW 207 AVE
City: HOMESTEAD State: FL Zip: 33031
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: SUNSHINE ELECTRICAL CONTRACTORS CO. Phone#: 786-443-9590
Address: 1300 SW 85 CT
City: MIAMI State: FL Zip: 33144,
Qualifier Name: MARIANO SANTIESTEBAN Phone#:
State Certification or Registration#: EC 13005807 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ t�d0�`�p Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: �;eink(i�G, �2 CQn CSL ��. %_)e.c) A1n G`FC�
:
Specify color of color thru tile:
_ a
"Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
i
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ Ngn4v
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name(if applicable) Zip
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
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all I
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUM or installation has
FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... laws regulating
PLUMBING, SIGNS, POOLS,
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
applicable laws regulating construction and zoning. be done
to compliance with all
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR p
RO
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
ERTY. IF YOU INTEND
YOUR NOTICE OF COMMENCEMENT." RNEY BEFORE RECORDING
Notice to Applicant: As o condition to the issuance of a building
Promise o good faith that a copy of the notice of commencement and construction lien law brochure will be del/v
permit with an estimated value exceeding$2500, the applicant must
whose property is subject to attachment Also,a certified copy the recorded notice of commencement must b
sted at the Job site
for the first inspection which occurs seven o, days after the buildingeyed to the person
inspection will not be approved and a reinspection fee will be charged. permit is issued. In the absence of such oPosted notice, the
Signature Q-Aj4-
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoingCONTRACTOR
instrument was acknowledged before me this
day of Ipr�\ �7 _
by —�d%ay of 11 20
who is personally known to by
me or who has produced o is personally known to
identification and who did t e an oath. as me or who has produced
as
NOTARY Pt1BLIQ identification and who did take an oath.
/j`' NOTARY P BLIC:
Sign:,
Print: Sign:
Seal: Print:
Seal:
ANTONIO ANTONIO E.GOMEZ
Rosa Maria Sabetela � MY COMMISSION#Fi:913115
Commission#FF973060 EXPIRES:AUG 25,2Q19
*020******************************* Bonde^thrcugh 1st Statekeurm..
OF Bonded thru Aaron to`ary ** *****************
APPROVED BY "" a
Plans Examiner
Zoning
Structural Review
(Revised02/24/2014) Clerk