REV-19-2411�R�v�a� Z�tl/
r�
ENTERED
BUILDING
PERMIT APPLICATION
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
OCT 0 019
BY:
FBC 20t_�
Master Permit No #05-10-1079
Sub Permit No "V _ 10 - P ^lc(Il
ABUILDING
❑ ELECTRIC
❑ ROOFING
10 REVISION
❑ EXTENSION
❑RENEWAL
❑PLUMBING
[:]MECHANICAL
❑PUBLIC WORKS
❑ CHANGE OF
❑ CANCELLATION
❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 420 NE 95th Street
City Miami Shores County: Miami Dade Zio 33138
Folio/Parcel#:11-3206-014-0461 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder);Alberto and Maria Carvalho phone#:754-234-4235
Address:420 NE 95th Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: Phone#:
Email: maria@miachic.com
CONTRACTOR: Company Name: Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency M
DESIGNER: Architect/Engineer, Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration /_I,�❑ New . ❑Repair/Replace
� _ ❑ Demolition
Description of Work: A' �119A _//1l ill !y � 6 111 UU Q1' IN r / Y,11 �1� �l 111
Specify color- of color thru tile:
Submittal Fee $
Scanning Fee $
Technology fee $
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
CO/CC $
Notary $,
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
(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 oppro/v�d and a reinspection fee will be charged.
/ 1. /,--)
Signature " VV^'-1 " n Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CONTRACTOR
The foregoing instrument was acknowledged before me this
8 day of October 12019 , by day of , 20 by
WAh 61 C0NA I hO who is personally known to who is personally known to
me or who has produced as me or who has produced
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
v Print:
es a YCvn ,
Sweee thro- gh !+aU ra', Notary Assn. Seal:
as
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)