REV-19-19054. 1%
BUILDING
PERMIT APPLICATION
Miami Shores Village
Bidding Dejpartment
10050 N.E.2nd Avenue, (Miami Shores, (Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
[:]BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 20►04",
Master Permit 'NoTL "' 9- is -Z 4SS
:Sub Permit INo. �� — lc, - (q0S
REVISION ❑ EXTENSION [j RENEWAL
LUMBING ❑ MECHANICAL C]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
Nnn Al��JJ 'CONTRACTOR DRAWINGS
JOB ADDRESS: q �1�M & VS' o%e- A -
City: Miami Shores County, Miami Dade Zip: S' 313 6
FoliojP.arce'I#: it— 3 2 0` O N -- 0 I/i7 Isthe !Building Historically Designated: Yes NO A'
Occupancy Types. Fah Load: Construction Type: Ctls Flood Zone: &FIE: FFE,:
OWNER: Name(Fee Simple Ttle!holder):, J ^j. k i_ ; Phone#: C0)0 ( V
Address: a (lo') rj. 4,> :z7 5_H d,-e_ 4 /.
City: M1 A4_V_1- S (_%U(r S State: - c— Zip:
Tenant/Lessee Name: Phone#:
(Email
CONTRACTOR: Company NamA.Ii�J4
Address: / 9"D 0 1
City: Sta
Qualifier Name: �40,_IA
State Certification or (Registration #: �5
ti-one#: S��h c3d 4-i
_ Zip: 3 -91 b 9
yl Phone#:
770 b Certificate of Competency #:
DESIGNER: Architect/Engineer: &/- r%f% C cJ kUi4 / 4AA R- Phone#: 3 D S o6,y e =s 77�
Address: 7 D Soli 7,), City: f'i , !F U : State: � Zip: 3 _T/ s�
'Value of Work for this Permit: $:Square/Linear'footage of Work:
Type ofWork: ❑ Addition !❑ Alteration Q New❑ (Repair/Replace ❑ Demolition
Description of Work: t. e ili ,,� I'-Ovr 74) / !q M /`y r l -J _r
Specify color of color thru tile:
Submittal Fee $ Permit Fee
Scanning Fee $ Radon .fee $
Technology Fee $
Structural Reviews $
Training/Education (Fee $
CCF $
IDBPR'$
COJCC $ _
(Notary .$
Double Fee $ _
Bond '$
iRevised02/24/2014)
TOTAL FEE NOW DUE $
4 3. 00
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
2S
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.
Signature IV Signature.. / l' -lam• �w "
OWNER or AGENT CONTRACTOR
The foregoing instrument wa acknowledged before me this
AI k4A day of U 120J by
YV\ci- N Q_\ v` who is personally known to
._ a or who has produced
identification and who did take an oath.
NOTARY PUBLIC: �osP� F4,@<^ WENDYFRANCOIS
MY COMMISSION # FF 945526
EVIREES:: December 21. 2019
Sign: _ •FOF P_ aMQl1 Y%mSwiget Notary semces
Print:
as
The for ing instrument was acknowledged before me this
day of ST 20 IG1 ' by
�l4\Yl,,5 1. Aotx jhApin who is personally known to
me or who has produced � loAA4 6W , 11LP- ISG . as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: U
191
Seal: Seal: , , YahisleykPerez Marrem
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG249252
APPROVED BY Plans Examiner
Zoning
Structural Review Clerk
PERMIT REVIEW CRITERIA (REV-08-19-1905)
PERMIT ADDRESS:
9400 N BAYSHORE DR PARCEL: 1132050100110
Miami Shores, FL 33138
APPLICATION DATE:
08/19/2019 SQUARE FEET: 0.00 DESCRIPTION: REVISION FOR GAS FOR DRYER
EXPIRATION DATE:
02/15/2020 VALUATION: $500.00
CONTACTS
NAME COMPANY ADDRESS
Applicant AMINE DOUKKALI MARIELA B
ROVITO JTRS
AMINE DOUKKALI MARIELA B
ROVITO JTRS
Contractor HARRIS HAUGHTON
HARRIS HAUGHTON
Owner AMINE DOUKKALI MARIELA B
ROVITO JTRS
AMINE DOUKKALI MARIELA B
ROVITO JTRS
REVIEW ITEM
Plumbing v.1
ORIGINAL PLUMBING INC
ORIGINAL PLUMBING INC
801 N VENETIAN DR, 907
MIAMI BEACH, FL 33139
801 N VENETIAN DR, 907
MIAMI BEACH, FL 33139
18001 NW 2 PL
MIAMI, FL 33169
, FL
801 N VENETIAN DR, 907
MIAMI BEACH, FL 33139
801 N VENETIAN DR, 907
MIAMI BEACH, FL 33139
STATUS REVIEWER
Requires Re -submit Maykel Massanet email: pl@msvfl.gov
Comments: FBC FG 402 Provide total developed length and total BTU's of all equipment to be connected
August 23, 2019 _ 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1