EL-18-351 and REV-18-3752Miami Shores Village 1'r;-
4
Building Department DEC 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �Y`��
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. RC,--12 -i7-3001)
PERMIT APPLICATION Sub Permit No. t.L- z - It - 3s1 k-31z
❑BUILDING ('Qf ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL 7PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
// CONTRACTOR DRAWINGS
JOB ADDRESS: 10 N6 t02 "�T.
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: 11- 3204v - O13 - 1490 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ 6AT LLC Phone#:CSbI 2S4 4057
Address: 10 1)T-, 10L �t • _
City: MA p K; G- a�S State:
Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: !_� 6 d &T.L`lal C., h�C,• Phone#: C�DS� 4j28 - 52(i5
Address: IN-52 )Jv) 7 g %P-4•
City: M I Ne-eS State: Fl_ Zip: 330 I
Qualifier Name: 42ie.-IjI)eS Q749�-> k1,3 Phone#: _C3o5)$26- 6205
State Certification or Registration #: Eo- 0001?2r6 Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Repla
ce ❑ Demolition
C. 0
Description of Work: .- F � to e A P %9I c .6 n. , -r rn Q r? p-A \1` I n &A C
Specify color T
lor thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ z43, n
(Revised02/24/2014)
19
Abnding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 TORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT "
Notice to Applicant: As a condition to the issuance of a building permit with estimated value ceeding $2 0, the applicant must
promise in good faith that a copy of the notice of commencement and constr ction lien law b och re will be livered to the person
whose property is subject to attachment. Also, a certified copy of the recor d notice of co mence ent must be e at the job site
for the first inspection which occurs seven (7) days after the building pe mit is issue In the Bence of s h post d notice, the
inspection will not be approved and a re' cti i fee will be charged.
Signat e Signatur
Owner or Agent Contractor
The foregoing instrument was a nowl/Ie,d ed before me this The foregoing instrument was acknowledged before //m��ee� this
day of t e Q , 20 L, by/A �1 Trcivtm" day of at C 20 �, by f�Rj n ass {''�q;S -
�,��i 0^1
who is personally known to me or who has produced who is personally known to me or who has produced ►� p
As identification and who did take an oath.
NOTARY PUBLIC: oOR pu4�
a o AMBER CORDOBA
* * My COMMISSION # GG 0(13399
Sign: li �l of f` �� : January23.2021
Prins: (� 1`1 dZ a 6�cam` n1p {�
My Commission Expires:
-as de tifica n nd who did take an oath.
NOTARY PUB I
HERMINIO D. GARCIA
MY COMMISSION # FF 951819
`*` EXPIRES: January 19, 2020
Sign: •,, ;F n Bonded Thru Notary Public Underwriters
Print: R Ct�•
My Commission Expires: O1 %14 12a e,
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APPROVED BY % / / Plans Examiner Zoning
Structural Review
(Revived 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk