REV-17-648 (2)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
PERMIT APPLICATION
F-IBUILDING ❑ ELECTRIC ❑ ROOFING
_ A
MAR Qg2017
FBC MIA
Master Permit No. RC 6 16 1684 R
Sub Permit No. Y q —(0,49
❑x REVISION ❑ EXTENSION EJRENEWAL
❑x PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1201 NE 96 STREET
City: Miami Shores County: Miami Dade Zip: 33138-2553
Folio/Parcel#: 11-3206-014-3830 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: L49
OWNER:Name (Fee Simple Titleholder): BKT HOLDING LLC Phone#: l%
Address: 2691 E Oakland Boulevard Suite #201A
City: Ft Lauderdale State: FL Zip: 33306
Tenant/Lessee Name: _ Phone#:
Email:
CONTRACTOR: Company Name: ALDAN PLUMBING INC Phone#: 239-603-3153
Address: 2527 AMBASSADOR AVENUE
City: COOPER CITY
State: FL Zip: 33026
Qualifier Name: ALFERDO CARMONA JF
Phone#: 239-603-3153
State Certification or Registration #: CFC1428171
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 e ❑ emolition
Description of Work:
LA40
�r'1:1,tAVI j
I
'1'1Gi0
Specify color- of tco1& thruaile::
c�
"
! 501 0 11 rsaizzimm ? ,�•
y�
Sub�`mittal+Fee,$°,i—')w'c"ll,"l'�' � " Permit Fee $
cJ CCF $ CO/CC $
Scanning Fee $ 45 Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
Bond $
— -
TOTAL FEE NOW DUE $
(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 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 occks seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve n a reigspection fee will be charged.
Signature Signature—f--'-'�
OWNER Vr AG T CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of WQ 020 � by 08. day of- MARCH 20 17 by
rVOQa +o is personally
�kn`ow'n to ALFREDO CARMONA JR who is personally known to
me or who has produced PI(QZbMtX CA"`A e or who has produced as
identification and who did take an oath. identification and who did take an oath.
N NOTARY PUBLIC:
Sign: Sign:
,s. r
Print: MY COMMISSION # GG 044602 Print: LIBAN PERE
Seal: ";F o? ` Bonded Thru Notary Public Underwriters gjo�� °°ice ; LIVAN PERE1
;; Notary Public - Stat
e of FloridaSea I:
y" My Comm. Expires Dec 2, 2017
'%oF��d;•�'� Commission # FF 074071
*********************************************************************** * ** * * ** * * * * * *
APPROVED BY —( —/ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)