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)
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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
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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