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Location Address
Permit No.: DS-01-1946
Miami Shores Village -y- Permit type: Driveways/Sidewalks/Slabs
10050 NE 2 Ave
Miami Shores FL 33138 Work Closslfcation: Addition/Alteration
305-795-2204 Permit Status. Approved
Issue Date:01/15/2019 I Expiration: 07/09/2019
Parcel Number
10000 BISCAYNE BLVD, Miami Shores, FL 33138 1132050200010
Contacts
Miami Shores Village Owner
ARCO CONSTRUCTION Contractor
LESTERJENSEN
1665 NE 137 TER, MIAMI, FL 33181
Business: 3058926507
Description: SEALCOAT/ RE -STRIPE TO REPLACE Valuation: $ 12,385.00 r
5 7Inspectrt2 ion-4949 Requests:
PERMIT#DS17-737
TotalSq Feet: 100,000.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$7.80
Concrete/asphalt/pavers, slabs, dways,
$321.55
swalks
DBPR Fee
$5.57
DCA Fee
$3.72
Education Surcharge
$2.60
Scanning Fee
$9.00
Technology Fee
$10.40
Work Without Permit 1st Offense
$371.55
Work Without Permit 1st Offense
$100.00
Total:
$882.19
Payments
Date Paid Amt Paid
Total Fees
$882.19
Check # 77452
01/15/2019 $882.19
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futh �Iauthorize the above named contractor to do the work stated.
Aut on ignature: Owner / Ap icant / Contractor / Agent Date
January 15, 2019 Page 2 of 2
i3wiaing uepartment '` '1"
Af Ct D 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �A 1 0 2019
.1�i Tel: (305) 795-2204 Fax: (305) 756-8972
l ( � INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY:
4_1�
FBC 20 CW4
BUILDING Master Permit No.:ur,-
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): � (-AM ,S409,6S Q 11 U ocG e Phone#:
Address: �. Q�stO IJ Z I'd �J
City: State: L Zip: 5
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: n&a( in r_A17 SI 't� C Phone#: J � 2 — 6�
Address: 1 Z 4 a1 QJ (04 c>f 2
City: F _ State: — (_ Zip:
Qualifier Name: 6NI Se N-) / 2 Phone#:
State Certification or Registration #: C(�4-- G t6Dq5 I ill ? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �City: State: Zip:
Value of Work for this Permit: $ 0 , 'p Square/Linear Footage of Work: 1 QD, �0
Type of Work: ❑ Addition ❑ Alteration ❑ New 0"'Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $M Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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: 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.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day ofp`)� 20 �l by
�6M-�; ` ,who is personally known to
me or who has produced Ckas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: !S�i_KrE> lL,���
Seal: SINDIA ALVAREZ
+: MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
Fods�Q. Bondedpru Notary Public Underwriters
*******************
APPROVED BY
Signature
CONTRA OR
The foregoing instrument was acknowledged before me this
day of UUA L? 20 � � by
.LkSSl - �� '—� who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PU LI :
Print:
Seal: .io"" °., SINDIA ALVAREZ
MY COMMISSION # GG 238273
^ e EXPIRES: September 3, 2022
••.Foo F ��: Bonded Thru Notary Public Underwriters
**********************
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk