CHANGE OF CONTRACTOR (3) i� i h r s i[I
� � u i I i n e p a rt n t }���F� �� €. �t� �
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10050 N.E.2nd Avenue, Miami Shores, Flarida 33138 ��3 ��
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I(dSP�CTI�N CtRVE PHONE IVUMBER:{3Q5)762-4944 � �� �
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PERIVIII' APPLICATIC}N sub P���,Et Na. ���� �,���� ������"m��.x��
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�g�E����� � ��Ec-r��c ❑ ��o���� � �Eves�o� ❑ Ex-r�r�sao� ��E��wa�
�]PLUMBING MECNANICAG �PUBLIC WORKS �`��CHA�IGE OF �] CANCEL��1'I�N ❑ SNQP
� �CONTRAGTaR DR�aWlNGS
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JOB I�DDRESS: �� <, ��
Citv: Miami Shores Countv: Miami Dade Zip: ����� " ����
FolioJPareei#: Is the�uilding Histaricakly Designated:Yes NQ '��
Occupancy Type: �oad: Constructian Type: Flaod Zone: BFE: FFE;
OWNER: Name(Fee Simple Titlehalder}:� ��,�� ��f„, ��� ���� t;:e'� Phone#:
Addr�ss: ��. �� ��
City: ��� f � f�� State: Zip: �� ��
TenantJLesse2 Name: Phone#:
Email:
CQNTRACT{�R;Company Name: ��,����t���.� Phone#:���_�_�____�
Address: �� � �""� ��
7—
City: �� E State: Zip: �����
Qualifier Name: 5��� ����`�' Ph€�ne#:
State Certification ar Registratian#: � ��� � Certificate of Campetency#:
DESIGNER:Arcnit�cY/Engineer: Phane#:
Address: City: State: Zip:
Value of Wark for this Permit:$ Square/I.inear F�otage of Work:
Type of Wark. � Addition [� Alteration ❑ New [� RepairJReplace ❑ Qemolition
Description af Wark: �� � �� � �" ��tt5�` �,� � �E �`
i� � �� �� �, � � r.��,` ��� �' �" �� ��.�"��,'"�
�t , c E r '�
a
. . . . � �� .� ,.
Specify c+�lar of ca/or thrc� tile:
Submittal Fee$ Permit Fee$ CCF$ CO/C�$
�canning Fe�$ Radon Fee� DBPR$ Notary$
Technalogy Fee$ Training/Education Fe�$ QoubEe Fee$
Structural Reuiews$ Bond$
TOTAI FEE RIOW DUE$ ���° ��� ' �'
(Re��seaa2/za/2o�4)
� � ��
� N
�onding Company's Name{if applicable)
Banding Company`s Address
City State Zip
Mort�age Lender's Name(if applicable)
Nlart�a�e Lender`s Addr�ss
City Stat� Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that na u`ork or installation has
commenced prior ta the issuance of a permit and that all wc�rk will be perfarmed to meet the standards of all laws regulating
tonstruction in this jurisdiction. ! understand that a separate permit must be secured for EIECTRIC, PLUM�INCa, SIGNS, POQLS,
FEJRNACES, 6UILERS, HEATERS,T�f�KS,�ER CONDITEQNERS, ETC.....
OWNER'S AFFIC�AVIT: I certify that all the faregoing information is accurate and that a!I work will be done in compEianee with all
applicable laws regulating construction and zoning.
"WARNINC TO �WNER: YQUR FAILURE TO RECt?RD A NOTICE 4F CaMMENCEMENT MAY
RESULT IN YQUR PAYING TWICE FC)R I�/IPRQVEMENTS TO Y�UR l�RC?PERTY. IF YQU INTEND
TQ QBTAIN FIIVANCING, C�NSULT WITH YaUR LENQER QR AtV ATTQRNEY BEFARE REGARDINta
Y�UR NOTICE OF CQMMENCEMENT."
Not�ce to ApplicanP: As ca condition to the issuonce caf a building permit with an estimated va/ue exceeding$25€�QF the applieant must
promise in g�od faiih that ca copy of the notice of corrrmencement and eonstruction (ien taw broct�ure wiN be delivered to the person
whase property ts subject attac(�rrrent. A/so,a eertified eapy af the recordec�notice af commencernent must be posted at the job site
for the first inspection,�{vl�ich oecurs seven (7) days ofter the building permit is issued. !n tMe absence vf such posted notice, the
inspeetior� wilt noc b�rap raved and a reinspection fee�vilt be eharged, � �
f � �� { d g.
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Signafure� � �'"`� Si�nature
��QWNER or AGE(�T �� CQNT ��CT�,`
The foregaing instrument was acknowl�d�ed before me this The foregoing instrument was acknowled�ed befare m�this
�� � day c�f �����€ 20 �� , bY ���� day of �` �e���� 20 �� , by
� �{�� ����`��� ,who is personally known to � ��t�"� ,whca is personally knawn to
me or who has pradueed :� as me ar who has praduced as
} �� r.�. �
identification and who di take an oath, identificatian and who d�ake an oath.
��
NOTARY PUBUC; � _� NOTARY PUBtIC: �
� �� � '�t�
� � �a e
!
Sign: -�- ""�� Sign: . "�„�
Print: ���� � � Print: a� � 1. �
Seal: ��������`{��,� � �� � �� � � � Seal: ��������� �` � � ��`�
�� �� ���, 1��20�9 � � � r���5,2f}�9
��*�����*��**�g�,������� ��* �����* �:**�****,� ����*�*�**��*���*�**� f "����**�������*��*��*���#*����*��
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APPROVED�Y �`� � � PI ns`E iner Zoning
Structural Review Clerk
(ReV�se�o2/2�/zo14)
1��x���� �
,�' `��� iam� hores illag�
,�,t � ���r�� L#I' '1 1 R 1 i�
t• ' �&
�`�'��Rt'U�'`� 10050 N.E.2nd Avenu�
Miami She�r�s, Florida 3313�
'�'el: {3Q5} T9S.2204
Fa.ac: (305) 756.8972
F �" 7� / � 1 T T
P�rmit N.
f�wner's Name (Fee Simple Title Holder}: �� � i�a� �r���t� �1���� �� Phone #:
C�}wner's Address: x`� �" ��
�ity: �� � �r�-� Stat� : Zip Code: �����4
��b Address {Of where work is being done}: �� �� ��
City� Miarni Shares Stat�:�Fbri�a Zip CQde: ���'�� ^
�antraet�r's Company Name: � � r� �� � Phon�#: �� ��� �
Address: �� 1"� � �`� �
City: � � State: �ip Code: �� �.�
Qualifier's Name : '�� �.��t� � I�ic. Number. � �� �� �
Architect/ En�ineer e�f Record Nam�: Ph�n�#:
Address:
City: State: Zip Code:
Describe Wor�: t� �� ��1.��C ��1� t���.
I h�re y eertify �hat �h� �rk as ��n a �n or�� an /�r t e ��ntr�et��l��+chite�t
i� unable or unwilling t+� co pfete the contract. 1 hald th� uilding fificiai �.nd tMe
ia i h�res har less �f all fe�al inva►Ive �n�.
�
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S�gnatur � �" "� -'Signature
Qwner oe Agent Gontraetor or Arehitect
The foregoing instrument was aknowledged befare The foregaing instrument was aknowledg,ed before m�
this�day of ,2(��,by �� �D� ��, �..5 this day of , 20 by
Who is personally known to me or wh�as��roduced wha is p�rsonally knc�wn to m� �ar wh� has produced
<�;,
as indentificatian. as �ndentification.
Notary �u�tic: �� i`� Notary Public.
Is, .
Sig�� � �' _. ,.�..;,' Sign:
S�ak �� �������� �� � � � Seal:
, •�� �[ss�on � 771
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� �r�` Bitii�t,�ICl� Q�pa.YtPt��'ltt
�,C� ��Q�Q .�. �N� �Y@C1tJ�
�•�E• ••��•� Miarr�i �hores, Florida 33 t 38
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� Tel: (3QSj 745.2204
�'���,r�����°``� Fax: (305) 756.l�972
�'�,�R A'
Chan,�e of ContractarlArchitect or En �neer
A chan�e of contractor, architeet or engine�r must be done under a per�mit number. Ther� is a $75.00 ehar�e
for a change of contractor. The owner will submit a Chan�� of Contractor Form eompleted with natariz�d
signatures. If the signature of the previous cantraetor cannat be obtaEned the ewner must send a certified
(etter/return receipt notifiying the pr�vious cantraetar, archit�ct or engineer the reason for the change. The
own�r must allc�w 10 business days fcar the contractor, arehit�et ar en�ineer ta r�sp�nd. A permit applicatian
must accompany the chan�e �f cantraetor form, with the information and si�nature af the new
cantractor. The nevv cc�ntractor must be re�ister°ed w�th the ViHage ar must subm►t the required documents
to r€�gister with the Villag�.
I, Change af Cantraetar farm cc�mpleted, signed and notariz�d.
2. Perrr�it applic�twan by new contraetor.
3. Required fees.
4, Copy af original lett�r sent via �ertified mail along�vith th� return�d receipt.
In additi�n ta the req�airements abave the architect or engineer of record must �uthorized the new ar�hit�et
or en�in�er to r�praduc� his dact�ments. `fh� autharization must be in writin� and must b� sign�d and sealed.
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METRQPC�LET�f� A/C INC
ATT RIC��ERT�3 C�CIN�AE�EZ
6917 RIW 50 S1"
MIAMi
Dear Sir
This I�fit�r is tc� infarr� y�u th�t I am r�r�ovin�ya� arrd yc�ur c€�mp�ny as subc�ntractors fc�r th�
c�nstr�action �f my hc�t�se a� Mi�mi Sh�ar�� 1270 �IE 97 51�. I am repl�cfr��yvu by an�th�r
c�ntrac��r.
Sinc�r�ly
,� �,.,
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VICTC? IA�11LLECaI�S