EL-16-2754Miami Shores VillageRFCET PFD
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
❑BUILDING ❑■ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 750 NE 97 St.
OCT 12 2016
FBC 201y
Master Permit No. G 1CO " 25
Sub Permit No. / (0' ?':45 q
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: 11 -3206-014-2220 Is the Building Historically Designated: Yes NO X
Occupancy Type: SF Load: Construction Type
OWNER: Name (Fee Simple Titleholder): Investinghouse, LLC
Address: 2061 NW 112 Ave., Suite 131
City: Miami State: FL
Flood Zone: BFE: FFE:
786.521.2276
p: 33172
Tenant/Lessee Name: N/A
Phone#:
Email:
CONTRACTOR: Co any Name: J �`,C cv 'C_, �c�l • C
Address: �f y P1�
�v 1 T i'"
City: ,�O -If� "I ✓ �S, Stater
Zip: l
Qualifier Name: �� �`�ZS'r�� r tih�
Phone#:
State Certification or Registration #'.t- �_
�0 Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ I� .�
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
❑ New ■❑ Repair/Replace ❑ Demolition
Description of work: install new light fixtures, install new GFCI and smoke detectors,
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
CCF $ CO/CC $
Scanning Fee $ 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)
N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) N/A
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 reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
Theforeg 'n 17
instrum was acknowledged before me this The foregoing instrumentwas acknowledged beforemethis
day of 20 by 3 day of 20 l0 by
who is personal kn w to ti .t, /� `� u' -1-, 13 who i ersonally known o
me or who has produced Q —�j as m or ho has produced as
identification and who did take an oath.
NOTARY PUBLIC: s""` ISABEL PASTOR
Notary Public - stab of FlorlU
My Comm. ExPIM No. s, 2017
COMM". Obms
Sign:OWN
low ft" ML
identification and who did take an oath.
NOTARY PUBLIC:
Sign:r I/-66
Print:
Seal: Seal:
Notary PUM SUto or Flalds
d. Brenda Bello
MY Commisition Mt' RVIMS 000Y27/2020F 987802
***************************************************************** ************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)