REV-18-1424Miami 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 M ELECTRIC ❑ ROOFING
Y 24 218
FBC 20
Master Permit No.RRC-3-18-542
Sub Permit No.0, VXU 18 ' �1_r
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING [-]MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
1080 NE 92ND Street
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: 33138
11-3205-027-0400
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): GUCo Holding LLC Phone#: (786) 712-6806
Address: 2700 Sw 3rd Ave Suite 2F
Miami FI 33129
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
Juan@cpcoin.com
CONTRACTOR: Company Name:
SOS Electrical Contractors Inc Phone#: (305) 226-8400
Address:
3005 Sw 99 Court
Miami FI 33165
City:
Qualifier Name:
State: Zip:
State Certification or Registration #: - Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
o. C.. k.�t U L I nQ! Ear (QyyV 4 11a),C=S Q.S
Specify color o color thru tile:
Submittal Fee $ Permit Fee $ �U CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee
Training/Education Fee $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 3 - 9)
1 —-
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
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. 1 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 a reinspection fee will be charged. n
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
Sul day of 20 12)_, by
uq'A A • C who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: °' ���'= Commission # GG077310
Expires: Feb. 27, 2021
Bonded thru Aaron Notary
The foregoing instrument was acknowledged before me this
" !1 dc 171ay of Q>� 20 c`1� by
97-
Car t0S . A - St-4A , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: ' ' Commission # GGOM10
Expires: Feb. 27, 2021
Bonded thru Aaron Notary
as
APPROVED BY ,2L1"k"'AY CS Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)