REV-18-158Miami 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 12
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5-4
FBC 20`i
1
Permit No. P-C. I (P — I L &I
Permit No. Phu (y' is,
❑ EXTENSION RENEWAL
❑PLUM BING `MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1201 NE 96th st
City: Miami Shores County Miami Dade zip:
Folio/Parcel#:11-3206-014-3830 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): BKT HOLDING LLC Phone#: 305 904 1608
Address:2691 E OAKLAND PARK BLVD STE 201A
City. FORT LAUDERDALE State: FL Zip: 33306
Tenant/Lessee Name: Phone#:
Email: AB@BURKMIAMI.COM
CONTRACTOR: Company Name: �� +�D��i�►�J�+�v aL�,�/�i phone#:- � S � �� J
Address: O �7 tow— � T
City _� !1+f�3t State: /-1 Zip: 3 G QualifierName: 14-4,v% Phone#: C~j�
State Certification or Registration #: _ e- GCiS� (!i Certificate of Competency #:
DESIGNER: Architect/Engineer:
"""'C33 v City: State: Zip:
Value of Work for this Perffiii~.$ �'i= Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: .0 .yo^.
Specify color of color' thru tile:
Submittal Fee $ Permit Fee $� 1 CCF $ CO/CC $
Scanning Fee $ �i �� Radon Fee $ - G� DBPR $ L Notary $
Technology Fee $ Training/Education Fee $ 0 ` E's 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)
Zip
Mortgage Lender's Address
city State �; w' Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 approv d and a r 'nspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
Theforegoing instrument was acknowledged before me this
day of 20 , by
o is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
essssss fRD3)►�R�Q
APPROVED BY
(Revised02/24/2014)
The foregoing inArumeJnt was acknowledged before me this
day of ,�/f1(�Q� 4Je4 . 20 ��_ by
who is personally known to
me or who has produced as
identification and who did take an oath.
jNOTARY PUBLIC:
Sign: 1pdilt'-01, , 1_kd Print
ISABEL VALDES Seal:
' ISABEL VALDES
MY COMMISSION #FF101662
MY COMMISSION #FF101662 ;'�.,.-..•_-: EXPIRES March 13, 2018
EXPIRES March 13. 2018 ""
(407) 398-0153 FloridallotaryService.com
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v 'Plans Examiner Zoning
Structural Review _ Clerk