REV-19-1555a 1
�-0'3-ICI- /555
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
BUILDING
PERMIT APPLICATION
QBUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
JU 0f 2019
FBC 201-:�
Master Permit No.
Sub Permit No.
® REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 89 N E 102 ST
City' Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 -3206-013-1690 Is the Building Historically Designated: Yes No NO
Occupancy Type: R-3 Load: Construction Type: VB Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): PALOMA TEPPA Phone#: 786-208-4005
Address:89 NE 102 ST
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N.A. Phone#: N.A.
Email: yair@plantthefuture.com
CONTRACTOR: Company Name: V- // l� /� (�=� y-`� � � '� � T� Phone#: oo,-
Address: K �� >� Y
City: � r� e / Statt/e: u / �L Zip: x 3.3%��
Qualifier Name: 1 'CB 4� /���✓ Phone#:
State Certification or Registration #: x l� 2 ��� Certificate of Competency #: _
DESIGNER: Architect/Engineer: CESAR M. CANO Phone#: _
Address:4906 CAMPO SANO CT City: CORAL GABLES State:
Value of Work for this Permit: $ 2 01 UC 0 . CIO Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑� Alteration ❑ New ■❑ Repair/Replace
FL Zip:33146
❑ Demolition
Description of Work:v�g�o� "� ��-�� TIC> ben�t:X'-
Vr,IAlOWWONc cottcN N-%e`-e .
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CD ' C�D CCF $ t 2. GO CO/CC $ 0
60
Scanning Fee $ 41 C� Radon Fee $ DDBPR $ CT, Ck3' Notary $ zo
Technology Fee $ (� Training/Education Fee $ T c-0 Double Fee $ 10
Structural Reviews $ U " CO Bond $
TOTAL FEE NOW DUE $ �iJ '
(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 mutt 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 Signature x
OWNER or AGENT
The foregoing instrument was acknowledged before me this
4 day of -TL%-`I 20 141 by
1?04-064A ___,who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 (°1 by
�/ -v ¢! who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:_
Print: Print:
Seal: HARRY SANGHEZ Seal:
r; MY COMMISSION # GG094929
EXPIRES April 17, 2021
***s*s**** / �g *sssssssssssssss�
APPROVED BY Plans Examiner
0"'a-•�' HARRY SANCHEZ
MY COMMISSION # GG094929
'�A•,, EXPIRES April 17, 2021
as
` Zoning
Structural Review
(Revised02/24/2014)
Clerk