REV-18-3675Miami 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
OFcI-9
FBC 20(44
BUILDING Master Permit No. 1 C-�- too— 3�1
PERMIT APPLICATION Sub Permit No.M-4 �� S
❑BUILDING ❑o ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS:10125 BISCAYNEBLVD
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#:1 1-3205-019-01 90 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): BISCAYNE1 01 25LLC Phone#:7863903177
Address:1680 MICHIGAN AVE SUITE 910
City: MIAMI BEACH State: FL Zip: 33139
Tenant/Lessee Name: Phone#:
Email:
SOUTH FLORIDA ELECTRICAL ENGINEERING 7865238879
CONTRACTOR: Company Name: Phone#:
Address: 979 NE 36 AVE
City: MIAMI State: FL Zip: 33033
Qualifier Name: RODRIGUEZ JORGE A Phone#:
State Certification or Registration #: 14E000085 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State
Value of Work for this Permit: $ Square/Linear Footage of Work:
Zip:
Type of Work: ❑
Addition ❑
Alteration
❑ New
❑ Repair/Replace
❑ Demolition
Description of Work:
LAC,(-t-T
t'-K i v <— S
E� w10- 3
C ,y,vR f w�
A— %--k;t
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ �' ®p CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ A J
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 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
ZO� ?O�N aGENT
The foregoing instrument was acknowledged before me this
day of L2CP8..i_ber 120 19- _, by
' (I0 //!�
E'Y)8c�P7�/ ,who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
P
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
�__ day of -bore 1Ler .20 /� by
E'_Sc,�, who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
as
Seal: _*; ;,f=
--r- 1-I"111m
COMMt Seal:
SSION OFF922657
EXPIRES: September
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COMMISSIONIFF922657
EXPIRES: SePICIT1 r 30, 2019
30, 2019
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APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)