DEMO-17-2446PERMIT # Derm0 a -- Zuu Lo
CONTRACTOR: ` C C r13 - ear In
SUBMITTAL DATE: tO 1Z, I \j
ADDRESS: ctlu S N co I0(1-11
G U t
NAME: - \ \)\ 1' `v `v "1 5
RESUBMITAL DATES:
PROJECT TYPE: .-EX1 0
ZONING
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PLUMBING- NG- •-e'
STRUCTURAL
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ELECTRICAL
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BUI DING ",=_
License
License #
Expiration Date
Local License Occ
Insurance - Liability
Insurance - Workers Comp
5133301 J.
09-0005333702-5-09
WC249102
09/30/2009
10/10/2009
08/25/2009
CTRICAL SERVICES INC
Local License Occ
Florida Electric
Insurance - Liability
Insurance - Workers Comp
181-755
EC13003459
09AL070415
PWC00359512
09/30/2013
08/31/2014
05/20/2013
07/10/2013
ER INC
Insurance - Liability
Miami Dade Building
Worker Comp Exemption
Local License Occ
Municipal License Occ
018FL000040005
10BS00557
FEIN 264727768 •
00699700-2
11-699700-2
10/12/2013
09/30/2014
08/29/2014
09/30/2013
09/30/2013
f•
CORP
x State License All
Local License Occ
Insurance - Workers Comp
Insurance - Liability
00900426 EXPIRED
CHC056820 EXPIRED
1071929027 EXPIRED
043335737 EXPIRED
08/31/2002
09/30/2002
08/07/2004
05/18/2005
PRESS INC
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
❑ PLUMBING ❑ MECHANICAL
Miami Shores Village
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
REC£1VE'a:
OCT 12 1011
at 41
4-1
FBC 20 ►LI / -
Master Permit No. be.rn0 jR ' Z(JL.{
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION
(PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: C//ys N • l) V4, J ftYY-
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel#: I I - 320 (o -C 1 3 - 00(0 b Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): j 1'! K ri\f
Address: C10J1 3tSC4y nt R(Vc.
City: 01 • A m'► 6110YYj
State
Flood Zone:
❑ RENEWAL
❑ SHOP
DRAWINGS
NO ✓-
BFE: FFE:
Phone#:
Zip: .3.33Q y
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: "\PC -E Ai ► ate ri els an • Phone#: 20S- 2[ 4 R Z C 1
Address: 2 1 S-6 W• t 0 "' Ave.
City: 4i 4 (ea State: r-t. Zip: 33o t U
Qualifier Name: l7Av • 61 ‘PwSt. 4 Phone#:
State Certification or Registration #: 66-e 1, CI e•7 ¢7 Certificate of Competency #:
DESIGNER: Architect/Engineer: City: Phone#:
Address: State: Zip:
Value of Work for this Permit: $ Q600 • 411) Square/Linear Footage of Work: o1-cr0v
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑emolition
Description of Work: `zer✓to PeY P�••.^ l €C_Le-r, ^c) bw L C- C`oiv`e4-f
rti p( �L' 100 r vw►
Specify color of color thru tile:
Submittal Fee $ 50 Permit Fee $ ZSO CCF $ 1 2 0 CO/CC $
Scanning Fee $ 491 Coadon Fee $ C� '5 0 DBPR $' ,�r'�✓ " S Notary $
1
Technology Fee $ • (.Training/Education Fee $ LA �J Double Fee $
Structural Reviews $ " Bond $
TOTAL FEE NOW DUE $ St ( g ' L4 •
(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 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.
Signatu 4V I.` Signature �/�-AP-A-14,14
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
ID day of 10
I , 20 11 , by I 0 day of to , 20 I , by
+ (r-)� �t Z , wh is personally known>o . :zeLd D cE,t(5 � t, , who isersonally- nowt'' to
me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
********
� ti�av P 4% SANDY ROMERO
1:9 -tx Notary Public • State of Florida
314 ,= Commission # FF 915708
0I,, 0,0,croe My Comm. Expire Sep 7, 2019
APPROVED BY
me or who has produced as
NOTARY PUBLIC:
Sign:
Print:
Seal:
****************+
Plans Examiner
caMd
S'av‘d 7 P-oM'Orc.)
'S�iNu
ERO r
( Notary PAirbNc .NDY RState a1 Florida 1
** '•i Commi* n F* Ssk !
�i os Fv ,•
y Lomm* xplres Sep 7, 2019*************
Zoning
(Revised02/24/2014)
Structural Review Clerk