REV-17-1486BUILDING
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
Master Permit No. RC6-15-1624
PERMIT APPLICATION Sub Permit No. 1 -tu �� ° 10 cc)
❑BUILDING ❑ ELECTRIC
ROOFING 0 REVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF n CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
1201 NE 94th Street
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): G/(/ 7Z4d pe cog Phone#: qeg. ,5-‘2 �/ l
Address: , Zo/ A) 6 l ru 57 7
City: M/ ( iz State: R,a-( 4 Zip: 3 3/ 38
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Pau Plumbing Contractor, Inc. Phone#: 305-5584)535
Address: 7740 W 2nd CT Bay #3
City: Hialeah State: FL Zip: 33014
Qualifier Name: Reynaldo Soto
Phone#: 305-934-2894
State Certification or Registration #: CFC1426010 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: t City: State: Zip:
Value of Work for this Permit: $ (/ J co Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: UH /304 -Ft-
New
❑ Repair/Replace n Demolition
LA, A-7 `v`- j-6�iTc1 ,
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ I 5-6 CCF $ ` Z CO/CC $
Scanning Fee $ J . �1� Radon Fee $ ' 2- ' DBPR $ `
BI' • 2 Notary $
o ' 46
Technology Fee $ \ 6 0
Training/Education Fee $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
2
Bond $ 0
TOTAL FEE NOW DUE $ I �o
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.
Signature
OWNER br AGENT
The foregoing instrument was acknowledged before me this
day of , 20 \ , by
erneernetr to Losvh13s personally known to
me or who has produced 20 - -Go 2 —ICQs—
identification and who did take an oath..(j0-,
NOTARY PUBLIC:
Sign:
Print:
Seal:
EXPIRES: November 2, 2020
;P� Bonded Thru NotaryPublic Underwriters
:,��F Fro,,
1
. �'.._.
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
j� day of ,20 / 7 ,by
p/ti`19ed41 p', who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Prin
Seal:
'6g•. ZENAIDAMIGUELES
= MY COMMISSION # FF 911210
Q= EXPIRES: December 18, 2019
1.,4G,h°e' Bonded Thru Notary Public Underwriters
************************************************************************************************************
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk