REV-18-159 (2)Miami Shores Village
Department P\ E_ Eo
Building p ,2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JAN 22
05 795-2204 Fax: (305) 756-8972
Vi
� L� TION LINE=PHON.5)762-4949 +�
-XM.�UEZ
FBC 20N
BUILDING aster Permit No.(P
PERMIT APPLICATION Sub Permit No. f2�FV —I �c]
❑BUILDING ELECTRIC ❑ ROOFING ® REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [-]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1201 NE 96th st
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-014-3830 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): BKT HOLDING LLC
Address:2691 E OAKLAND PARK BLVD STE 201A
BFE: FIFE:
Phone#: 305 904 1608
City: FORT LAUDERDALE State: FL zip: 33306
Tenant/Lessee Name:
Email: AB@BURKMIAMI.COM
CONTRACTOR: Company Name: Ad& 4nd &�^ Cl C7 0 64 - Phone#: 7h_ yly_ q
Address: 7MY 14-W - 36.1 J -
City: N"9,- State: ���Zip: 133.4-'
Qualifier Name: cJog7�;e, L r031+erti Phone#: 3Dy "�4S 3i3�1
State Certification or Registratio-nowt 4�-OV-6 1�TCertificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
ne#:
State: Zip:
Value of Work for this Permit: $ / Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: 4mr,� "_Vj'1"'o- .
Specify color of color thru tile:
Submittal Fee $ Permit Fee CCF $
Scanning Fee $
Technology Fee
Structural Reviews S
Radon Fee $
Training/Education Fee $
DBPR $
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 9"4, 00
R
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 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 Signature 0jev�
0 R or AGENT CONTRACTOR �:..
The foregoing instrument acknowledged before me this
A/ day of ot I Aj yt 20 6 by
/01e um , -141 I�/ �r o is ersonally know o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
The foreWng instrument was acknowledged before me this
" day of �Ck 4 20 1 f3 , by
�O lA fb�-1 � who s personally known to
as me or who has produced
Sign: /
Pr'
l �P0.V `Uq �,'
Seal: ;_�
JAMIE RITTER
State oir'lurida-Notary Public
Cor ,missron # GG 148095
My Commission Expires
......
October 21, 2021
*****************
APPROVED BY 077/�/i/>VZ ZZ
identification and who did take an oath.
Sign:
Print:
Seal:
as
*********************************************************
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review _ Clerk