REV-19-2461BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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
t()-11.24,6
❑ ROOFING 0 REVISIOI
RAC V D
ll`CT17201
BY:
FBC 20
Master Permit No.'OPP 406 —1 q— �4
Sub Permit
❑ EXTENSION ❑RENEWAL
❑PLUMBING §ff MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 601 Grand Concourse
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-017-2140 Is the Building Historically Designated: Yes NO
Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Carlos Felipe Lemos Phone#:
Address: 601 Grand Concourse
City: Miami Shores
State: FL Zip: 33138
Tenant/Lessee Name: NA Phon
Email: NA
CONTRACTOR: Company Name: Aquatic Environments Phone#: 786-390-9029
Address: 11767 S. Dixie Hwy Suite #203
City: Pinecrest state: FL Zip: 33156
Qualifier Name: Luis Espinosa Phone#: 786-390-9029
State Certification or Registration #: CPC057282 Certificate of Competency M
DESIGNER: Architect/Engineer: Vicente Franco Phone#: 305-305-5631
Address: 8690 NW 109th Court ` City: Doral State: FL Zip: 33178
Value of Work for this Permit: $
Type of Work: M Addition ❑ Alteration
Description of Work: At>r> I N —1 f
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $.
Structural Reviews $
Square/Linear Footage of Work: _
❑■ New ❑ Repair/Replace
tFA - e i2 't"O vz>n L-
Training/Education Fee $
❑ Demolition
. Gl U 1 100
CCF $ CO/CC $
DBPR $ Notary
Double Fee $ .
Bond $
TOTAL FEE NOW DUE $ 43. 00
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address NA
City State -
Mortgage Lender's Name (if applicable) NA
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 on estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law broc a will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of men a -Lent must be posted at the job site
for the first inspection which occurs se en f7J days after the building permit isr
d. In t e �fsence of such posted notice, the
inspection will not be approved and a r i spection fee will be charged. /
Signature
R or AGENT
The for oing instru IEM—
r—AaW; ledged beforemethis
The for
day of 20 I -) , by
eY ,4; , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print, Elena A Sadler
Seal:
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APPROVED BY
(Revised02/24/2014)
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My Comm. Expires Dec'13. JW
sss
as
The foregoing instru nt was acknowledged before me this
I day of �TG , 20 19 , by
l�J S �iOSGI , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: WV`
Print:
0.Y PV
Seal: ;i°i, ;`�= Notary Pu=of Florida`Commis4095
My Comm.3, 2019Bonded throary Assn.'sa
Plans Examiner Zoning
Structural Review Clerk