RC-17-1879 (2)BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village RECEIVED
Building Department JUL 217017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 QO �—,
INSPECTION LINE PHONE NUMBER: (305) 762-4949 54-1
FBC 20 rA
Master Permit No.
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
F-IPLUMBING ❑ 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 NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): FILPO PROPERTIES Phone#: 9147140878
Address: 600 NE 27TH STREET TH-101
City: MIAMI State: FLORIDA Zip: 33137
Tenant/Lessee Name:
Email: MONICA@ESSASPORT.COM
.L Phone#:
t
�► Cu: r
CONTRACTOR: Company Name: MIAMI SKYLIN CtION + hon�#: 3058999696
Address: 12864 BISCAYNE BLVD UNIT 176
City: NORTH MIAMI State: FLORIDA Zip: 33181
Qualifier Name: CLAUDIO RODRIGUEZ // Phone#: 3052162224
State Certification or Registration #: 1 2• (G' O 1F' Certificate of Competency #:
DESIGNER: Architect/Engineer: ►' Phone#:
Address: 1 Q (� (�� _u 1-( City: a r • State:� Zip:
Value of Work for this Permit: $ 2 2C;�� cs Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration _ ❑ New
Q ❑I Repair/Replace ❑ Demolition
Description of Work: e— kyj4 dt E �--x T S t �JO► h 4ti I1 t '�- �. E,.r, C I H i��,��,•IF
e"— , -L 1 (- z " c v ,-4 c;a
Specify color of color thru tile: 7-
Submittal Fee $ ')C) • 0� Permit Fee $ Q CCF $ CO/CC $
Scanning Fee $--12 Radon Fee $10 • G DBPR $ I h. 3 Notary $ OU
Technology Fee $f e • 40 Training/Education Fee $ 4.60 Double Fee $ too
Structural Reviews $ Bond $ (c_ �
` C ��AL FEE NOW DUE $ 81 J�VJ
(Revised02/24/2014) 1 J ��() I,3r5�06
2 (D g (P .
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
WE
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 inspe tion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
ection inspwill note approved and a reinspegion,fee will be charged. INZ�
Signature Signature
OWNER or AGENT CONTRACT®
The fore oing instru e`ntt was acknowledged before me this
Clay of v \l 20 I A by
who is personally known to
me or who has produced _rLbL_ as
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of Pp 20 I by
Iris ersonally known to
me or who has produced ?�q t fCeV1as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Si"
Print:
Print: MAHARAI K GONZALEZ
Seal: ps
MERCEDESESCANDON
MY uummloo
"' '`� EXPIRES: November2,2020
t";
Notary Public -State of FloridaSeal:
Bonded Thru Notary Public Underwriters
'=Commission
R GG 072303
_
My Comm. Expires Feb 12, 2021
APPROVED BY :r 1�2 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)