REV-19-671r
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BUILDING
PYERMIT APPLICATION
BUILDING
PLUMBING
Building Department MAR
10050 N.E:2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949,
FBC 201-:1-
Master Permit No. RC 17-1482
Sub Permit PIRO.
ELECTRIC ROOFING Q REVISION EXTENSION RENEWAL
MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10007 NE 4th Avenue
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): John & Cristina Butler Phone#: 305.970.9419
Address: 10007 NE 4th Avenue
Miami Shores FLCity: State: Zip: 33138
Tenant/Lessee Name: N/A Phone#: N/A
Email: cibutlerl02@gmail.com
iCON TRACTO :Company Name: to
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Phone#: Ube Ll 0 <I d -
Address: -3-Too &pf- r l
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City: '(-Wt51 State: Zip: 3 "?!i
Qualifier Name: E e
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Phone#: '3 0-'-i0 el Lt
State Certification or Registration #: CFC L Li 2`L rL Certificate of Competency #:
DESIGNER: Architect/Engineer: Dan Owens Phone#: 305.610.9490
Address27OO-N: Miami Avenue # 408 city: Miami state: FL Zip: 33127
I Value of Work for this Permit: $100.00 Square/linear Footage of Work:
Type of Work: Addition M Alteration New Repair/Replace Demolition
s.
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Description of Work: Minor Adjustments due to field conditions
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Technology Fee $... Training/Education Fee $
Structural Reviews-.$
Double Fee $
Bond $
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Bonding Company's Name (if applicable) N/A
r
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address
City
Zip
State 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 ' ection which occurs seven (7) days after the building permit is issued. ^In the ab ce of such posted notice, the
inspection ill n be approved aroma reinspection fee will be charged. y l l
Signatures AJ\J" VVW-%/-- :
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of Y '20 l G , by a 6 day of 20 by
YCYh"CA njUt 1 Uho is personally known to a-.-- r`ffi who is personally known to
me or who has produced l iCQXI as me or who has produced -F Z61 -V3 - 67-2 10-/ as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
MA ARAI K. GONZAl t-+ Print: , • ,?;Pv R" .•. . _—,.erc110N # GG 044602 c Print:
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Seal: *
IRES: N ryem of ter ,pN, MARTHA RODRIGUEZ
ter •oQ;.'
7hNNo;a. PublicU,
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Seal: `,,/
mss MY COM' 115S!ON tt GG42566FORE;.• %
j":Y EXPIRES Qctc)W 2b. 2020
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APPROVED BY Plans Examiner Zoning
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Structural Review Clerk
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