DS-18-1330OeD
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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
FBC 203041
Master Permit No. -)S ler•' 1336
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5 NtuRTNrS`r IDS 1 51413"
City: Miami Shores County: Miami Dade Zip: 3S 1 3 8
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): I2-IC.Wi (1-D 4 051 CA -PLOP AR -
Address: S 1\102T4-1 ail Sr (05T STf 7'
City: PA 5 4C (2L$ State:
Tenant/Lessee Name:
Email: 3 SS F$2a Q & 1\pci L�, f_CM qc:f
.
(CONTRACTOR:,Company Name: _ C/ /�!" :t'16)42Q / — V 0�� �s
Phone#: \ I )S0JCo1 3L(
Address: 1 �� S'���
Phone#:
zip: 3313$'
(-2os) 300 - Zo co �I
City: Da, V 1 State:
Qualifier Name: p )0I'1/ (7 7--)e, L'9) c�
State Certification or Registration #: C-61 /522S —4-3 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
-'Value`of Work for this Permit: $ +___ . .-5 0 ) .Squ%Linear Footage of Work: 500 —J64r Q
Phone#(950 39/ 90 2�
Zip: �3333/
Phone#: �J`7 3g / zq.
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
DescriptionofWo?k: —[-O-\C�'�te- rt��—(A-) ti I LnGk.e-S L12
s �a : r,4ep1\o�e.`e e1CQ; f%-ecA Vg.ru l - I S - i 02_O
Specify color of color thru tile:
Submittal Fee $ So`I
Scanning Fee $ 9
Technology Fee $ • Z.0
Structural Reviews $
(Revised02/24/2014)
Permit Fee$ i 00 CCF$ Z . -o
Radon Fee $
7, 39
2_
__()________
DBPR $ 2. Notary $
Training/Education Fee $ a . Bo Double Fee $
Bond$ Soo
TOTAL FEE NOW DUE$ 10 I •4o
CO/CC $
�,d4.4o
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 or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before
me this The foregoing instrument was acknowledged before me this
I I day of f-4I, �.0 (il� , 20 i ?s , by day of , 20 l n , by
'Q%1 CO- �L RCA ha 2- (,',who is personally known to it II 0 ( who is rsonally known to
me or who has produced Dte i V-& - t ((C41 < as (;)or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
S t,V ii 4- ki5 14 //`'—b 7 D
****s*s***s
APPROVED BY
Silvana Kishimoto
�= Commission 1 GG035453
Expires: I Heber 3, 2020
*ed d" 5'
4► .
Sign:
Print:
Seal:
*********************sib,
Plans Examiner
Structural Review
9."0,1,16 Silvana Kishimoto
�' = Commission 1 GG035453
•��— " Expires: October 3, 2020
quads AN
Zoning
Clerk
(Revised02/24/2014)
Arlenis Silvera
From: Arlenis Silvera
Sent: Wednesday, August 15, 2018 3:10 PM
To: jessf820@gmail.com'
Subject: 5 NE 105 Street
Attachments: 5 NE 105 ST.pdf
Please see attached the concrete driveway sketch provided for permit DS18-1330.
I have also attached a screen shot showing the current hold on the permit.
If you have any question please call me at 305-795-2204.
Best Regards,
Arlenis Silvera
Permit Clerk Supervisor
Miami Shores Village
10050 NE 2 AVE
Miami Shores, FI 33138
305-795-2204
www.miamishoresvillage.com