REV-19-2561 (2)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: (30S) 762-4949
BUILDING
PERMIT APPLICATION
OBUILDING rM--1 ELECTRIC ❑ ROOFING
RNTXRXD
OCT 2 2019
8Y:
FBC 20 F+ LP+'l
Master Permit No. RC-7-18-2036 I
Sub Permit No.�eV ' ^ �� 015L I
Q REVISION ❑ EXTENSION ❑ RENEWAL
]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1158 NE 99 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-018-0130 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SUSAN PINNAS Phone#:
Address:1158 NE 99 STREET
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: PRIMUS CONSTRUCTION SERVICES, INC. Phone#:
Address: 16536 NW 22 STREET
City: PEMBROKE PINES State: FL Zip: 33028
Qualifier Name: RAFIU JINADU Phone#: 954-817-2132
State Certification or Registration #: CGC 1507774
Certificate of Competency M
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New [
Description of Work: ADDITIONAL LIGHTS TO THE PROJECT
Specify color of color thru tile:,
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Zip:
Repair/Replace ❑ Demolition
PLC rn 61A1 Cr • v F3 cmftwrto To
ZR- 06-OL-
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 9 ct . Go
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State 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.
Signatures Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was, ack wledged before me this
day of _ 20J by
:S�� �60 - who is personally known to
me or who has producedJ)Z f,�.�so
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of JU 20 / i , by
ZA012 A1210dy47 Ji7rioly, who is personally known to
me or who has produced Roty&- Drner-41 e as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: _
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11 Sign:
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Print:
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JE� E S: May 11, 2021
Print:
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'•.,p�,�,t� •` Bon ed I nrU NOWrY IN0110 uncerwn
Seal:
Seal:
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Notary Public -State of Florida
Commission # GG 061484
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My Comm. Expires Jan 10, 2021
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APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)