US-17-2079N24\
BUILDING
PERMIT APPLICATION
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
Master Permit
2ECEIVE]D
UG 17 017
IB
FBC 20
No. l
Sub Permit No.
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING [--]MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10642 NE 10th Court
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Christopher Avina Phone#: 786 488-6890
Address: 10642 NE 10th Court
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: Phone#:
Email: avinamaximus@bellsouth.net
CONTRACTOR: Company Name: AAA Garage Door Inc. V1111 W WleWL(805) 702-0113
Address: 19200 SW 106th Avenue
City: Miami State: Florida
Qualifier Name: ck ie (J / K L-1 Phone#:
p:
33157
State Certification or Registration #: Certificate of Competency t:3 s 002
DESIGNER: Architect/Engineer: Phone#: _
Address:cti : State:
Value of Work for this Permit: $ mear Footage of Work:
Type of Work: Addition Alteration New , Repair/Replace
Description of Work:
Zip:
Demolition
Specify color of color thru tile:
SubmittalCo,, Fee $ o , M Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Revised02/24/2014)
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
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.
Signatur
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 20 L by
o is personally known t
me or who has produced 1 DD%Z as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: 1 /y
Print: A—tba - Zee{u,a/
ro°, %B,o BARBARAZEEMAN
Seal: * * MY COMMISSION # GG 061186
9j \oe EXPIRES: February 15, 2021
FOf FN - g Bonded Thru Budget Notary Services
APPROVED BY
Revised02/24/2014)
Signature-`
CONTRACTOR
The foregoing
instrumeM-7
ledged before me this
l(/ day of 20 17 , by
YW [1,r%S// who is personally known to
o QQ
me or who has produced d wwlf ^ .
identification and who
NOTARY PUBLIC:
Sign:-
Print:
BVt N
Seal: 0,
00 P&,
SoOfRoft
My bion Expires 11124/2019
OF cm dow N0. ff 938912
Plans Examiner
Structural Review
Zoning
Clerk