REV-18-2264Miami 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 ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL PUBLIC WORKS
RECEIVED
AUG 2 3 1018
Q-4 T I
O�- FBC 20 (4
Master Permit No.i 1RC4-18-929
Sub Permit NoR _ \/ ( E
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 701 Grand Concourse
City: Miami Shores County: Miami Dade Zip: 33191
Folio/Parcel#:11-3206-017-2230 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Olga Nadja Zubrik Phone#: 954-608-9543
Address: 701 Grand Concourse
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ORONI Inc Phone#: 305-685-0412
Address: 14040 NW 6 Court
City: North Miami State: FL Zip: 33168
qualifier Name: Orlando Iglesias Phone#:
State Certification or Registration #: CBC1251654 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zi
Value of Work for this Permit: $ `� Square/Linear Footage of Work: c7
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: New floor the in bedrooms and resurface kitchen cabinets.
Specify color of color thru the:
Submittal Fee $ Permit Fee $ Q CCF $ 1-' CO/CC $
Scanning Fee $ Gt-) Radon Fee $ O DBPR $ t 1 Notary $
Technology Fee $ ? r) Training/Education Fee $ °� rx> Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ G I ]j ]25
(Rev1sed02/24/2014)
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: 1 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 104 Signature
OWNER or AGENT CONTRACTOR
Theforegoinginstrument was acknowledged before me this The foregoing instrument was acknowledged before me this
14 day of AW iAS+ 20 IR by I J day of 20 (0 by
061 k6f'A Z-br i l - who is personally known to ari�rjo IeshS who is personally known to
me or who has produced bL or fiQt as me or who has produced DL c h - (1_ as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print. z Print: 1,01 VOL
Seal: e�:�i;,e�, uyapa T. Vasquez Seal:! �.� = Suyapa T. Vasquez
Commission FF942611 Commission # FF942611
.'�
Expires: December 9 2019 "= Expires: December 9, 2019
-` d� a"'' �o�'' Bonded thru Aaron Notary
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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ERMIT_#_�___s' RECEIVED
Miarr, S'icr�s Village AUG 2 3 2018
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