EL-18-550t
Miami Shores Village
BUILDING
PERMIT APPLICATION
Building Department R 015 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY•
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
Master Permit No. RC-5-17-1288
Sub Permit No. F-7-L. t�) - S JC)
❑BUILDING YELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [-]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 910 NE 99th Street, Miami Shores FL 33138
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-014-3410 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Hans -Joachim Krause Phone#: (786) 554-6128
Address:4720 North Bay Road
City: Miami Beach State: FL Zip: 33140
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A 1 l� °�Y2` ✓'l/%' 1. C Phone#: 7b L 7 qY�L
Address:`' 3 W S( W '7 S T J Y
City: YVX k y v v►
Qualifier Name: � L fl
' o' zip: 3 3 k Z Io
Z— Phone#: ?S4 - 4 7- 0 0 4-
State Certification or Registration #: 6 6- I Oct ,3 L SZ Certificate of Competency #:
DESIGNER: Architect/Engineer:
v
n e#:
Address: 2-&1 'TWA City: '
Value of Work for this Permit: $ 2.1 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
Description of Work:
L" 0 CItc�e( ca.k 1�0✓ S (OJ4 I,- rr-F
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 1FDO Permit Fee $ q �'7 O CCF $ G CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ l Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ C) �8 • Z�
(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 appro d and a reinspection fee will be charged.
Signature Signature
or AGENT
The foregoing instrument was acknowledged before me this
day of �'TIoYU(,[� 20 1J by
�(J, who is personally known to
me or who has produced 71'�P(Je-r L % C C S-A- as
identification and who did take an oath.
NOTARY PUBLIC: DL;w X-idL0gy0395t3b
CONTRACTOR
The foregoing instrumme�n�t�rw/a acknowledged before me this
day of 20 t ' by
r e i—eci ' L Oil who is ersonall known to
G1 � y
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print: "\C-.Y \P 11e-- Print: _
Seal: Seal:
�.►�'r � Notary Public State of Florida
Michelle Toste
My Commission GG 076930
of n Expires 02 A2021
************ ****************
APPROVED BY /LM40- /8 Plans Examiner
s
GELSYS M SARGENTON
Notary Public - State of Florida
Commission N GG 093420
My Comm. Expires Apr 11, 2021
***************
Zoning
Structural Review
(Revised02/24/2014)
Clerk