REV-19-2473Miami Shores Village RrTTJXjjnD
Building Department OCT
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
BUILDING Q ELECTRIC ❑ ROOFING
QPLUMBING Q MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 89 NE 102 ST
FBC 2011
Master Permit No. R_- � 1
Sub Permit No. �-�li-�y 19 —7`� 13
❑ REVISION ❑ EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-1690 Is the Building Historically Designated: Yes 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: Phone#:
Email
CONTRACTOR: Company Name: 1 M �"a ` `w�� 1�� Phone#:� 3� 04
Address: 2_-1*) S:,J Z�e -,7E�, <b0 2>.
City: State: �� � � Zip:
3 3133
Qualifier Name: P�z--o 6j z `A (o ��'� � Phone#: � �' �`�3� C���q•
State Certification or Registration #: L G C � SU , Certificate of Competency #:
DESIGNER: Architect/Engineer: JOAQUIN MONTESINO Phone#. 786-252-2768
Address:6219 SW 131 PL UNIT 102 City: MIAMI State: FL Zip:_
Value of Work for this Permit: $ 8,300
Square/Linear Footage of Work: 600
Type of Work: El Addition F Alteration ❑ New ❑ Repair/Replace El Demolition
Description of Work: REVISION TO PLANS FOR RELOCATION OF LIGHTS AND A/C GRILLS
NEW WATER HEATER AT BATH# 1 &2
Specify color of color thru the
Submittal Fee $ Permit Fee $ 24-�1 '' Q� CCF $ S 'Tv CO/CC $
Scanning Fee $ Z - CA Radon Fee $ 2 4 — / DBPR $ �• :3 Notary $
Technology Fee $ (27 • 2 Training/Education Fee $ 9� Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 0
(Re,Ased02/24/2014)
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 approved and a reinspection fee will be charged.
Signature _ Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
11th day of OCTOBER 20 19 by
PALOMA TEPPA who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Print: H)21Y SANC Z
`��p"""•dm ,: HARRY SA,NICHEZ
Seal:
MY COMMISSION # GG09492
EXPIRES April 17, 2021
APPROVED BY
CONTRACTOR
The foregoing instrument was acknowledged before me this
�I V""� day o�fn 0!r"t"atEr 20 k `t • , by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
�'pY PU
Seal: '''
• _ MY COMMISSION # GG094929
+` EXPIRES April 17, 2021
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Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk