RC-18-3485Permit NO.: RC-11-18-.W6
Miami Shores Village Permit Type: Building (Residential)
10050 NE 2 Ave
Miami Shores FL 33138 Work Classification: Alteration
305-795-2204 Pe4 tStatus: Awroved
Issue Date: 02/12/2019-1 Expiration: 05/20/2019
Location Address Parcel Number
9190 NW 1ST AVE, Miami Shores, FL 33150 1131010160030
Contacts
ADAM MUELLER ALAYNA MUELLER Owner
91901
HOME OWNER Contractor
HOME OWNER
Description: REPLACE FLOOR &WALL TILE WITH NEW REPLACE Valuation: $ 1,300.00 Inspection Requests:
PLUMBING FIXTURES BATH TO EXISTING LOCATIONS AFTER
NEW TILE INSTALLED. NO ELECTRICAL OR HVAC Total Sq Feet: 36.00
WORK MODIFICATIONS. TO REPLACE RC16-2449
Fees
Amount
Application Fee - Other
$50.00
Permit Fee
$50.00
Total:
$100.00
Payments
Date Paid Amt Paid
Total Fees
$100.00
Credit Card
02/12/2019 $50.00
Credit Card
11/19/2018 $50.00
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 AnstNction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant /
Contractor / Agent
2I IZ It
Date
February 12, 2019 Page 2 of 2
'2131��
BUILDING
PERMIT APPLICATION
Miami 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 ❑ ELECTRIC ❑ ROOFING
RECEIVED
RECE�`,9 101e
NOV 1BQ�
FBC 20 (-q
Master Permit No. r1E—�- %k
Sub Permit No. 12C 18 — ,���-�1��
❑ REVISION ❑ EXTENSION ;4RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS OCHANGEOF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: qod 0L, ( 4vr
City: Miami Shores County: Miami Dade Zip: 31s'w
Folio/Parcel#: 1 131 OIy 1 U cD O 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): AbAo µwC l,(_Cyz Phone#: '7186-4y2—V33 D
Address:' I 1 °1 6 00 ► AA19
City: MI AM I 5 V-�53 State: 'V L Zip: SS 1 S-0
Tenant/Lessee Name: -XI ) A Phone#:
Email: /k,1h3MIAA j �/A�1-r�J•��
CONTRACTOR: Company Name: Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
hone#:
Certificate of Competency #:
Phone#:
City:
Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition % Alteration ❑ New ❑ Repair/Re lace p ❑Demolition
Description of Work: L'J-%U— `T I L's t, , 1 tJ S'[ A-L L
a Az, %c -r 4�1 C 1 ST C1 c, L vc A� i 1 aJ .•A z � 2 Ti kE-
1113Y r(A-. P1y '5L_5 4-72(CA L cat *AV Ae-- (,4 04 tc
Specify color of color thru tile: !A O atmoC S PC (-r ' 2u �q
Submittal Fee $
Scanning Fee $
Technology Fee $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews S
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ "w
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
O ER rAGENT
The foregoing Z
ent was acknowledged before me this
IS dayof.SOu , 20 1B by
�/
amm � � oe l & who is personally knnzu to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:r»217p Drau1,rr4
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
as me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: "�` °' "". . . Seal:
u` Notary Public State of Iorida d
: Ximena Aguirre
y c My Commission GG 230848
?a�cF rwires06/20/2022
as
APPROVED BY / Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk