EL-18-1387CONTRACTOR: Company Name:
BUILDING
PERMIT APPLICATION
❑BUILDING Q 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
04.1
F�BDC20 k
Q
Master Permit No. 1.J` I s - \3^ 1 l
Sub Permit No. € L tg-' �� )
❑ ROOFING ❑ REVISION
❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: 9929 NE 4th Ave Rd.
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores
Folio/Parcel#:11-3206-017-1280
Occupancy Type: Load:
County: Miami Dade
Zip:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone:
BFE:
33138
NO X
FFE:
OWNER: Name (Fee Simple Titleholder): Marvin RList / Maria T Manerba Phone#:
Address: 9929 NE 4th Ave Rd.
City: Miami Shore State: FL
Tenant/Lessee Name:
Email: /
d'cilec L
Address: 55 / % 3 j/ 5r
City: AtleA4 State: / L
Qualifier Name: ,i44' /
State Certification or Registration #: Re/eao7,26,9
DESIGNER: Architect/Engineer: Aquadynamics Design
Address: 5000 SW 75th Ave Suite 103
Phone#:
Zip: 33138
Phone#: 3 05 — 71 Vol 51
Phone#:
Zip: 530/3
Certificate of Competency #:
Phone#:
City: Miami State: FL Zip: 33155
Value of Work for this Permit: $ 1UGfJ
Square/Linear Footage of Work:
Type of Work: ❑ Addition n Alteration Q New ❑ Repair/Replace ❑ Demolition
Description of Work: Electrical work for pool
Specify color of color�thru tile:
Submittal Fee $ J 0 ea; a Permit Fee $ 7609/.0 G CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
(Revised02/24/2014)
t� %G
TOTAL FEE NOW DUE $ ILLO
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, o 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 AiLl_J
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of
OWNER or AGEN
, 20 "? , by
Mir/ n•'1 4-rs f" , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Allan Gonzalez
Commission o FF969034
• Expires: March 8, 2020
Bonded thru Aaron Notary
( /� day of VA.
, 20 �. � , by
t'Ut �4LVtG9X.fe2-;who is • o
me or who has produced
identification and who did take an oath. ,‘%% i rrTrr�
`• Ce•-`' EN GgRk,/i "
•• NOTARY
• PUBLIC _
My Comm. Expires
NOTARY PUBLIC'
Sign: w
Print:
Seal:
as
TO OF
F1 0'
************************************************************************************************************
APPROVED BY
(Revised02/24/2014)
oecrt. le Plans Examiner
Zoning
Structural Review Clerk