REV-19-2104OWNER: Name (Fee Simple Titleholder): 9801 Park LLC
gECEIVEL)
Address: 4141 NE 2nd Ave. Suite #204A
Miami Shores Village SAP i�419
City: Miami State: FL
Zip: 33137
Building Department BV:
Phone#: 9543944140
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (30S) 795-2204 Fax: (305) 756-8972
Phone#: 305 742 3199
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 (A
BUILDING
Master Permit No. CC -11-188-3517
PERMIT APPLICATION
Sub Permit No. aQ+ bq -P - u V
❑BUILDING ❑ ELECTRIC
❑ ROOFING M REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION Q SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9801 NE 2nd Ave
City: Miami Shores
County Miami Dade Zip
Folio/Parcel#:11-3206-013-4380
Is the Building Historically Designated: Yes NO X
Occupancy Type: A"2 Load: 150
Construction Type: III Flood Zone: X BFE: FFE: 10.35'
OWNER: Name (Fee Simple Titleholder): 9801 Park LLC
Phone#. 305 455 1800
Address: 4141 NE 2nd Ave. Suite #204A
City: Miami State: FL
Zip: 33137
Tenant/Lessee Name: AMARANTHINE RESTAURANT
Phone#: 9543944140
Email: yiannikg@gmail.com
CONTRACTOR: Company Name: JC & Associates Group
Phone#: 305 742 3199
Address: 7741 SW 122 Ave
city: Miami state: FLZip:
33183
Qualifier Name: Juan Carlos Lago
Phone#: 305 742 3199
State Certification or Registration #: CGC 057500
Certificate of Competency #:
DESIGNER: Architect/Engineer: The Architects Group
Phone#: 305 740 0150
Address: 8000 NW 7 Street City: Miami state:
FL zip: 33126
Value of Work for this Permit: $ Square/Linear Footage of Work: 2580 SF
Type of Work: F1 Addition Alteration ED New F-1 Repair/Replace F-1Demolition
Description of Work: Missing Fire Dept Approval Stamp on Revised A1.01 Floor Plans for Final Inspection
Previously approved revision including MEP for Restaurant & Walk in Cooler/Freezer shoo drawina as hitilt
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $
CO/CC $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24J2p14)
Bonding Company's Name (if applicable)
Bonding Company's Address N/A
City
N/A
State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address N/A
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. /1 -
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of
120 I by
who is personalty lown to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:``. ANAYS LAGO
• .�. Notary Public • State V Fiorieg
:pf Commission 9 GG 2,1655.3 My Comm. ExpiresOct 26. 202,
APPROVED BY
(Revised02/24/2014)
as
The foregoing instrumentw—awledged bef'orree me this
1
to day of � 20 by
J C`^ who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
Y ►:'. V
ANAYS LAGO
?� "1�^': Notary Public • State o° E;orica
COmmi
ion #GG 246553
oYttY�" My C mm. Expires Oct 26. 2022
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Plans Examiner
Zoning
Structural Review Clerk