RC-16-1984BUILDING
PERMIT APPLICATION
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
RECEIVED
JU 1 5 2016
BY: ��► ��
FBC /2Ot'4
Master Permit No.W..-(G ` [- f 9
Sub Permit No.
*BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS CHANGE OF ❑ CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1296 99th Street
City: Miami Shores County: Miami Dade Zip: 33 I! b
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Filpo Properties/Monica Filpo
Address: 600 NE 27th ST Apt 2904
City: Miami State: FL
Tenant/Lessee Name: N/A
Email: monica@essasport.com
Phone#: 914.714.0878
CONTRACTOR: Company Name: ill; eV kC Phone : 3o 5,Z I L _Z Z 2 L/
Address:
City: A)/, t �(n /1 ; ✓2
Qualifier Name: C
O
State:
ids—;
c2C,
State Certification or Registration #: C: c.. Certificate of Competency #:
DESIGNER: Architect/Engineer: 1.s., V r- I P.i le., Phone#: -3-A, S (— I S 4,
City: 1$ C. Pa r- State: -( Zip: 3 3 / d (
Square/Linear Footage of Work: 3. So S. , Ft
Type of Work: ❑ Addition ❑ Alteration L❑/ New ❑Id Reppair/RRrplace n�Dem/olition
Description of Work: l9 1 �1 2 �€ ! / !% c (� f l �r� 1 f"7` �vciT . $
) C j>y r? :l /Uol iG.�C ; S S C. - S._ /0_ /G.
Zip: 3 3 /
Address: I ( cam
/ (4 Si
Value of Work for this Permit: $ eV�/ 2 CC'
Phone#: 05,Z/G 2Z2�i
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $ GO • GO
Scanning Fee $ Radon Fee $ DBPR $ Notary $ 5: 00
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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
promise in good faith that a copy of the notice of commencement and const
whose property is subject to attachment. Also, a certified copy of the recorde
for the first insp • tion which occurs seven (7) days after the building perm
inspection will n be approved and a rein ction ee will be charged.
Signature
cal`
OWNER or AGENT
The foregoing instrument was acknowledged before me this
.7—ten day of __� , 20 1 Sr , by
7 ho is personally known to
me or who has produced 1,,./t �-1( as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
144*110
Tralailfie.
N I,,1 .0
Notary ublic - a e of Florida
,, �. My Comm. Expires Dec 25, 2016
oF%ki Commission # EE 860167
4nunl.
timated value exceeding $2500, the applicant must
lien law brochure will be delivered to the person
of commencement must be posted at the job site
issued. In the absence of such posted notice, the
ITEM
Sig Irk
nature
CONTRACTOR
The foregoing instrument was acknowledged before me this
(5 day of Jt1 —personally
20 (� , by
)• 1 A\1�1 0 �i O'>��'vho is personally known to
me or who has produced 2 �CC�
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
NAV\1 4c,i
************************************************************************************
APPROVED BY
Plans Examiner
Structural Review
° l Ru® Notary Public State of Florida {
;r `, Sindia Alvarez t
Y1
a .y or My Commission FF 156750 {
N
',or e�L° �k Expires 0y9�,'031^<018
*
Zoning
Clerk
(Revised02/24/2014)