EL-20-1194A
RECEIVED
Miami Shores Village Ju X
I,,
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 -T{�
INSPECTION LINE PHONE NUMBER: (305) 762-4949 r
FBC 2017R
BUILDING Master Permit No. RC-4- C)(9—JC'
PERMIT APPLICATION Sub Permit No. EL-144-288-7 n6-Zo- j �-
BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION QRENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS FE-1 CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 78 NW 106th St, Miami Shores FL. 33150
City: Miami Shores County: Miami Dade Zip;
Folio/Parcel#:1121360050230 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Alejandra Gutierrez and John Southerland Phone#: 305-799-0822
Address: 78 NW 106th St, Miami Shores FL. 33150
City: Miami Shores State: Florida Zip: 33150
Tenant/Lessee Name: Phone#:
Email: f / t
CONTRACTOR: Company Name: 7iuppC inset G�e&fkc� Phone#: ,3D5-'33V' V6 �o
Address: 197-7 o S 220 57
City: M , ' 1 State: Vk- Zip: 33110
Qualifier Name: L,5% 5y teA r, Phone#: 3U5- S g A 1 3 4
State Certification or Registration #: Certificate of Competency M
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $_ (n00:'- Square/Linear Footage of Work:
Type of Work: ❑ Addition ►Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 3 G7,C-I' S I,, -\,�e k,k�Ne,n
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014.)
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 o'building permit with on estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low 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 apwpVdd and a reinspection feerwill be charged.
Signature
�J uvyj y" or AUM I
The foregoing instrument was acknowledged bore me this
day of —�y `11 20 -ZC3 i by
Jk± iwho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
V-1 dayof 3ure— ,203UCby
t 5%s � te: a, , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ` / Sign:_
Print: —C �—A Print:
Seal: : ` Notary PLtliC - State ofFlorida
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tom; h Y Comm. Expires Jan 27, 2022
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APPROVE 6��/4—rlep ZbPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)