EL-18-551Miami 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
v
FBC 20N
BUILDING Master Permit No. RC-5-17--11288
PERMIT APPLICATION Sub Permit NOEL I CJ '
❑BUILDING XrELECTRIC ❑ 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 Zia:
Folio/Parcel#: 11-3206-014-3410 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): Hafts -Joachim Krause
Address:4720 North Bay Road
City: Miami Beach State: FL
Tenant/Lessee Name:
Email:
BFE: FFE:
hone#: (786) 554-6128
Zip: 33140
hone#:
CONTRACTOR: Company Name: A �Y1V 5�2 �.1c /�� i Phone#: 2 -467^ gg7(A
Address,: ^
City: 1� V l P9 W1 State: Zip:
Qualifier Name: L'�U,/��- Phone#:
i6
State Certification or Registration #: tC: ��0 A / `�' Z Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ �f--�C./ uy Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
em
❑ Alteration RF New ❑ Repair/Replace
Specify color of color thru tile:.
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
V,S't f? U c t v)-9
Zip:
❑ Demolition
Permit Fee $ CCF $ CO/CC $ _
Radon Fee $ G� Q�, DBPR $ 2, Notary $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ '�Y✓
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
Ir 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 a achment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whit ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv and a reinspection fee will be charged.
SignatureSignature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
��nj daayof�- e_�'i�lCi(V 20 �by � day of Mi0l 'C k 20 Iq by
I yt S F-`.4,Lk Q_ who is personally known to C :b L �� who is Personally kaawn to
me or who has produced 17{�Jt �S Lv-e-n� a as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
-DL# r�. (020$403$5$So
NOTARY PUBLIC: NOTARY PUBLIC:
S Sign: 'r' I
Print: Print: C,{
Seal; ipOw Notary Public State of Florida lrnvn GELSYS M SARGENTON
Michelle Toste Seal: NotaryPublic- StateofFlorida
My Commlaslon GG 076930 Commission k GG 09
q K Expires3420
02128/2021 ;��!; My Comm. Expires Apr 11' 2021
Banded through National Notar Assn.
APPROVED BY , aiV1,,XXA6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)