REV-19-90Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
I ONE NUMBER: (305) 762-4949
BUILDING ?qvisP rrr
PERMIT APPLICATION
❑BUILDING Q ELECTRIC ❑ ROOFING �EVISION
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FBC 20n
No. RCC-12=17-2993
No. �VI'at --qa
❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1234 N.E. 94th ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132050100210 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): MARIA GABRIELA CONTRERAS
Address:1200 NE 97 ST
Phone#: 305-949-2371
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: VOLT ELECTRIC CORP
Address: 831 W 53RD TER
hone#: 305-205-3420
City: HIALEAH State: FL Zip: 33012
Qualifier Name: ODONIS RODRIGUEZ Phone#: 305-200-7967
State Certification or Registration #: ER13014936 Certificate of Competency #: 13E000539
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ V
Type of Work: ❑ Addition A Alteration
Description of Work: �p 0151 V-A t --f `b �(
Phone#:
City: State:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
Net-4 C-C -('Z-- (7- Z`l �y
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 43,
(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 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. n
Signature CWNER or AGENT
The foregoing instrumen was acknowledged before /me this
r3 day of � 20 % �( by
l i A C (k5 who is personally known to
me or who has produced
identification and who did take an oath.
as
Signatu
CONTRACTOR
The foregoing ii'fstrument was acknowledged before me this
day of 20 !g by
ex:C P&4yi�itArj?, who is personally known to
LJ
me or who has produced H�%%�' as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign: Sign:
Print- iC.4 2G-' Print:
Seal: _,..�,.� Seal: ; o�.aTPu;�
JESSIICA D MCISRUDER : r
My COmMISSI/O�N X FF96SUi
K+KRP1k7R' ##K 2M OFc
APPROVED BY
MAGALY MARCANO
Notary Public - State o1 Florida
Commission # GG 044353
My Comm. Expires Nov 2, 2020
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk