REV-19-2724BUILDING
PERMIT APPLICATION
Miami Shores Village ENTOg2ED
NOV 14 2 19
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949V,
FBC 20 ��-
Master Permit No. BPP-09-19-2126
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 1158 NE 99TH ST
Sub Permit No. 'eV- 11 - 19 9424
Q REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City' Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132050180130 Is the Building Historically Designated: Yes NO
Occupancy Type: SF Load: Construction Type: SF Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):SUSAN PINNAS Phon
Address:1158 NE 99TH ST
City: MIAMI SHORES
State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: MELO CONSTRUCTION GENERAL CONTRACTOR LLC Phone#: 305-251-3999
Address: 7405 SW 158TH PL
City: MIAMI State: FL Zip: 33193
Qualifier Name: FERNANDO MELO Phone#: 786-516-5142
State Certification or Registration #: CGC1524738 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ �mo Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: REVISION TO POOL
Specify color of color thru tile:
Submittal Fee $ P Permit Fee $ (� CCF $ G' 60 CO/CC $ t9r
Scanning Fee $ 00 Radon Fee $ 2- ' Gb DBPR $ 2 - 60 Notary $
Technology Fee $ - 2. _':z: Training/Education Fee $ n Double Fee $ X�
Structural Reviews $ Bond $ �h
TOTAL FEE NOW DUE $ l rr- t ' 30
(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
Zi
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 attach so, ified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which curs seven s er the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and nspectio fe ill be charged.
r �
Sig tur Signatur
0 R or AGE CONTRACTOR
The foregoing instrument was acknowledged beforemethis
da f A(M � 20 / , by
l IA111 HMO , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: 3 #90
dr Bard Thm Anon
APPROVED BY
as
The foregoing instrumei t was acknowledged before me this
1 day of 201 ? by
�/ZQ'11Q10 6m1ho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
F Seal:
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Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk