REV-18-2132BUILD!
PERMIT APPLICAT
BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: 5NE 107 ST
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
SPECTION LINE PHONE NUMBER: (305) 762-4949
❑ ROOFING
440
FBC 20l i6
Master Permit No. DS-3-18-590
Sub Permit No.
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
12.�►11��2,t�
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type:
OWNER: Name (Fee Simple Titleholder): TIMOTHY A. WILLIAMS
Address:5NE 107TH STREET
Flood Zone:
BFE: FFE:
Phone#:9173449032
City: MIAMI SHORE State: FL Zip: 33161
Tenant/Lessee Name: N/A Phone#: N/A
Email: N/A
CONTRACTOR: Company Name: GNDD LLC
Address: 1500 BAY ROAD APT 228
Phone#: 7867778447
City: MIAMI BEACH State:
Qualifier Name: ALBERT E. CABARROCAS
FL Zip: 33139
Phone#: 7867778447
State Certification or Registration #: CGC1525005 Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A
Address:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Phone#: N/A
City: State: Zip:
Description of Work: REMODELING OF PATIO; DRIVEWAY AND ENTRANCE
CbArJ6€ 4)4VE41_ 7Q TILES
Specify color of 1 r thru tile:
Submittal Fee $ Permit Fee $ 440L. oc.J CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ <4 9 - C'
(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 se • (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a rein pection fee will be charged.
Si
OWNER or AGENT
The foorreg• t?"strument was acknowledged beforemethis
G day of M. as f l3 by
TI molly f W t t L(01, who personally nown to
me or who has produced as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Signature
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Notary Public State of Florida
Agostino Pezzatini
My Commission GG 220522
'A>. e Expires 05/21/2022
##########################
APPROVED BY
The foregoing instrument was acknowledged before me this
n
p day of Pun Usr , 20 ( , by
AL —oto pQC.tu L
Sign:
nown to
as
�••- r
Print: irlja Ara
Seal.
Notary Public State of Florida
Agostino Pezzatini
yy
' My Commission GG220522
* a'
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)