RC-16-2753BUILDING
PERMIT APPLICATION
Miami Shores Village C F I VIE—
Building Department OCT 12 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
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FBC 2/0lq
Master Permit No. pc
Sub Permit No
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 750 NE 97 St.
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: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): InVestinghouse, LLC
Address: 2061 NW 112 Ave., Suite 131
City: Miami State: FL
Tenant/Lessee Name: N/A
Email:
hone#: 786.521.2276
zip: 33172
hone#:
CONTRACTOR: Company Name: Adanac Development and Construction Services Phon
Address: 100 NE 84 Street, Suite 200
City: Miami state: FL m
Qualifier Name: David Harder
305.987.2995
_zip: 33138
e#: 305.987.2995
State Certification or Registration #: CGC 1506482 Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ c� , �-O Square/Linear Footage of Work: 2,468
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition
Description of work: patch interior walls, remove paneling and install drywall, replace bathroom fixtures,
install new kitchen cabinets, install new flooring, paint interior MiA11161m, install new light fixtures,
install new GFCI and smoke detectors,
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Specify color of color thru tile:
Submittal Fee $
Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF
CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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
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 notbe approved and a reinspect' n fee will be charged.
Signature Signature
OWNER or AG T CONTRACTOR
Th me'JIN
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was acknowledged before me this The foregoing instrument was acknowledged beforemethis
L 20 by _ day of Q� .20 O by
��who isnpersonally known to
� Q j�t��� who i personally known1t0
me or who has produce 8`'r�`� rile or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: ISABEL PASTOR Neo_
Henry PWlio - sate of
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Comool" Off 45711E
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Sign:
Print
Seal
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �A,r N
Seal
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APPROVED BY (/`y/ Plans Examiner
Structural Review
(Revised02/24/2014)
KANoWry Public State of FbAde
Brenda Bello
"1 EMy xt �� 987882
4
Zoning
Clerk