MC-18-617Miami Shores Village RE, !Er
Building Department MAR 09 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FC2i"A
BUILDING
Master Permit No. RC-5-17-1288
PERMIT APPLICATION
Sub Permit No. -�-P I�
❑BUILDING ❑ ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
PLUMBING dMECHANICAL
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): Halls -Joachim Krause Phone#: (786) 554-6128
Address:4720 North Bay Road
City: Miami Beach
State: FL Zip: 33140
Tenant/Lessee Name:
Phone#:
Email:
eC hA-A c �`�►
CONTRACTOR: Company Name:
/ 0
Phone#:
Atf`"L_
Address: --3
/
City:
tate: Zip:.J 3 ° l�p/�
Qualifier Name:'Y—cmV
z U Phone#:
State Certification or Registration #Clk
l Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: / j� City: State:
Value of Work for this Permit: $ a/ V V Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratign New ❑ Repair/Replace
Description of Work:
Zip:
❑ Dem
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ -a . O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ E� ' SV DBPR $ E� • &Z Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 5 8 Z . c�/(7
n .
(Revised02/24/2014)
t
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 whin 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. /J
Signature
ER or AGENT
The foregoing instrument was acknowledged before me this
dayof �� Ir�iil l (�(� 20 13 by
V
hGtr� 1L'(GtiAS-t— , who is personally known to
me or who has produced 1 76\)'G(S bL e-r%J.Q as
identification and who did take an oath.
NOTARY PUBLIC:' 1L(�208403�5��
rry �Y►�lIGi►�L��'�l
�♦ , ■
Seal: OOP
APPROVED BY
Notary Public State of Florida
Michelle Toste
My Commission GG 076930
Expires 02/ W021
Sign
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of dAitAi , 20 V2 by
J()Je 7E MWWtN who ' ersonall n o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
r
Sign:
Print: FEW14 GIMV,4-: 2-
Seal: "!".; ERIKCHAVEZ
MY COMMISSION 8 GG 191199
P`= EXPIRES: Fedumy 28, 2022
''dos nQe'' Baled nru NoWy Pul fc Un wRli lim
as
V� �lan Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk