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EL-16-2796 (2)A it Miami Shores Village Building Department R 0 A2818 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949j-- BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS JOB ADDRESS: l Z o � NI:- ot 6 S �C a FB.�.0 20 M Master Permit No. rC,` JG- ) Sub Permit No I L 1 6 r 6 ❑ REVISION ❑ EXTENSION ❑RENEWAL n/cHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ' i -12-o6 • 'D I `f' 3 %' 3 !� Is the Building Historically Designated: Yes NO i­� Occupancy Type: 7 Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): Address: / ZO( -� City: 016 M l lsVlb-4 C.s' State: F= n. ne#: 305 *?cf0 21 6'5 Tenant/Lessee Name: Phone#: Email: CAS a, .CC>M. t�s CONTRACTOR: Company Name: -F 20'O j LL ` Phone#: C(S It 5 t, - 5_z Address: < 7 1 N W City: 4'tfl I �1 W -7J C' Qualifier. Name: oW�s L Zip: 1302 `f — . State Certification or Registration #: E C-- 0o C> i S `'F � 'Certificate of Competency #: DESIGNER: Architect/Engineer: S1w5 h u„ cc; Jc r 4- A Phone#: -io5_ ZS 3 . 57y6 . Address: 13019 S S w 113 co oV '7 City: 1 4 i'V State:'- Zip: b G - Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteratioon ll ❑ New ❑ Repaid/Replace ❑ Demolition Description, of Work: f1'i I kA (� Specify color'of color thru the Submittal Fee $ Permit.Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ 1 TOTAL FEE NOW DUE $ ` (Revised02/24/2014) w Bonding Company's Name (if applicable) Bonding Company's Address City, f I` State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip CityL� 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 on estimated value exceeding $1500, 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 c the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) day er the bui ing permit is issue in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be c ged. Sign OWNER or AGE The foregoing instrum nt was acknowledged before me this day of CV'C L 20 r V by Pol Z� who is personally known to me or who has produced _!g/L- as identification and who did take an oath. Signature J �,�l —P,� CONTRACTOR The foregoing insrument was acknowledged before me this day of lt�4 u'C 120 _J J' by .J 1L ICJ -^a• s ;who is personally known to me or who has produced . Q L as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 6�1 Print: 3:n iiPrint: Seal: ************* APPROVED BY (Revisedo2/24/2014) !00 Notary Public State of Florida 4Dennis Lefton y� My Commission GG 073635 �iOF Expires 02/15/2021 r Seal row4"") °Notary P is State of FlOrida • Dennis Le on �- ExPiCommission res 2/15/2021 073836 ************************************************************** Plans Examiner Structural Review Zoning Clerk w Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (30S) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit IN, `zq- /N4 Owner's Name (Fee Simple Tide Holder): BKT HOLDINGS LLC Phone #:305-904-1608 Owners Address: 2691 E. Oakland Park Boulevard Suite 201A City: Fort Lauderdale State : FL Zip Code:33306 Job Address (Of where work is being done):1201 NE 96 Street City: Miami Shores ���� State:_FlIlorida Zip�nCode:33138 Contractor's��jompany Name: Naha 9I Ti%l.' Phone #: Address: 24 k. City: MiAr•i State: Ft Zip Code: * A5' Qualifier's Name: 5OQFf, L Psleft", Lic. Number. Qaeo00Z51 Architect/ Engineer of Record Name: SEBASTIAN EILERT AIA,LEED Address: 13063 SW 133 CT City: MIAMI State: fl Describe Work Phone #:305-253-5786 Zip Code: 33186 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to corna th contract. 1 holy thepuilding Official and the Miami Sho es harKless of all leeal/fnvoly{ rent. �� Signature J Z fl Z Owner or Agent V j` The foregoing inssiru�/ment aknowle ed efore me � l �Vday G �u ie this of 1 �/l ,by (' Who is personally known to me or who has pr uced as Indentificati Notary Publ' . Sign: 14-1 Seal: o�►aY ° Notary Public State of rida Dennis Lelton < P` � My Commission GG 073635 �oFnoP Expires02/15/2021 Signature The egosnstrument was aknowledgged before me thi _/� day of AAlQ4YV, 20/abyJ Arm &A who is personally known to me or who has produced as7indentificadon. Nota Sign Sign: Seal: z► ;�:;�� ANONleeUSENAS * * MY COMMISSION # FF 174698 w EXPIRES; January 30, 2019 '-f" nor`, Boded Thry Budget Notary Services