EL-18-1238 (2)• 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
BUILDING
PERMIT APPLICATION
❑BUILDING Q ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 128 NE 94 ST
RECENEL
MAY-0 9 1018�
FBC 201_::�
Master Permit No. %�C/� _ q
Sub Permit No. t191 ( i) —.1236
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City' Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-2980 Is the Building Historically Designated: Yes NO X
Occupancy Type: residential Load: Construction Type: CBS Flood Zone: X BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SALVATORE INVESTMENTS INC Phone#: 305-778-5961
Address:6130 NE 4th Ct
City: Miami State: FL Zip: 33137
Tenant/Lessee Name: Phone#:
Email: alsba@bellsouth.net
CONTRACTOR: Company Name: RQ ELECTRICAL INC Phone#: 305-790-9169
Address: 92801 NW 123 TERRACE
City: HIALEAH GARDENS State: FL Zip: 33018
Qualifier Name: E 2)km QJ !n/Z�4 Phone#: 305-790-3769
State Certification or Registration #: 11 E000505 Certificate of Competency M
DESIGNER: Architect/Engineer: CARMEN T. DIAZ Phone#: 786-312-6060
Address: 5001 S.W. 74th CT # 100 City: MIAMI State: FL Zip: 33155
Value of Work for this Permit: $ 500 Square/Linear Footage of Work: 5,329
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
Description of work: TEMPORARY POWER FOR CONSTRUCTION
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ /0 U .4WD CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 12 <<A DBPR $ 2 Notary $
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
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
Zip
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 p reinspection fee will be charged.
Signature
OWNER
The foregoing instrument was acllinowledged before me this
day of 20 by
i
who is personally n to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Z! .r+
KARINA ALEJ/►NDRA LIINA
Sign: ;�'•° `�,i Commission I FF 950062
My Commission
Print „ ,,, Januory 12. 2020
Seal:
Signature J4
i CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
f-'C,(D 1Irti CV)P—rl�u !iwhoispersonaily_knownto
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Seal:
KARINA ALEJANDRA LUNA
hi ►y{y Commission Expires I(
:*sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss*ssssssss
APPROVED BYi(,/SQL % X6�L�y /Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)