MC-19-637BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department MAR 25 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 ��C��
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�
Master Permit No. RC-3-18-716
Sub Permit No. m
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑■ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1296 NE 99th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
%V+i ilrR PJar� (Fec^ Sirnf�re Titfehoidt,i I.,:Eil�ia.Properties I.LC.-. Monic2 .F..ilpo... - Phone# 91.4.71.4.0078
Address: 600 NE 27th Street TH-101
City: Miami
State: FL
Zip: 33137
Tenant/Lessee Name: Phone#:
Email: monicacfilpo@gmail.com
CONTRACTOR: Company
r\ Company Name: DOL, �t,(�,/�_i �!'V(i Phone#: QStK -a6z- rf
Jc't Address: WS � W 7',j ,
City: VV 1 i � State: Fz, Zip: 33L-) 2-2
Qualifier Name: E: I-I-ry Phone#: -g6L-at-P
State Certification or Registration #: Cd/1 & I p 3 �a Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City:
Phone#:
Value of Work for this Permit: $ �5v v Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Iteration ❑ New Repair/RII epla e
Description of Work: 1 yj k
n., —I- .
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
CCF $
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Zip:
Demolition
Bond $
TOTAL FEE NOW DUE $ 1 `
(Revised02/24/2014)
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, COMMENCE.MFNT.". _ r
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 inspe ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will nol fe approved and a reinspection fee will be charged.
La
Signature LA
OWNER or AGENT
The fore oing instrument was acknowledged before me this
-_ day of (CV 20 , by
1, who is personally known to
me or who has produced -� ��oo�. as
identification and who did take an oath.
NOTARY PU
MAHARAI K. GONZALEZ
Si = MY COMMISSION # GG 044602
y,wA, 4o EXPIRES: ov
Pri n }'Fw, o? Bonded Thru Notary Public Underwriters
Seal:
0NTRACTOR
The foregoi�insument(y was acknowledged before me this
5 day of �t-�IQ I�}C� h .20 1 by
G 1"�i� V�I lse w t dvh� i� errsonna ley known to
me or who has produced � uC.t :�� as
identification and who did take an oath.
NOTARY PWOLIC:
#rint: =* MY COMMISSION # GG 044602
:9r P EXPIRES: November 2, 2020
Seal: , p °• Bonded Thru Notary Public Underwriter§
***************************** ****************************************************************************
APPROVED BY floas Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)