RC-17-2310 (2)9
BUILDING
PERMIT APPLICATION
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: (305) 762-4949
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SEP 11 2017
L3Y: _ GUI
FBC 2014 Sfi"
Master Permit No. RC 11- 231 d
Sub Permit No.
OBUILDING 0 ELECTRIC ❑ ROOFING
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑■ PLUMBING 0 MECHANICAL ❑ PUBLIC WORKS
❑ CHANGE OF CANCELLATION SHOP
CONT DRAWINGS
J06 ADDRESS: 1276 NE 93rd Street
Nde
City: Miami Shores County:
is Zi :
Folio/Parcel#: 11 -3205-027-0230 Ist B Historically ignated:Yes NO X
Occupancy Type: R-3 Load: Construction Type: Flood Zo J�E-9 BFE: +9'-0�� FFE: +10'-0"
OWNER: Name (Fee Simple Titleholder): Seymour Kantor
Phone#: i305) 336-7100
Address: dd NO T
City: L� fl!!j Polo Sta
Zip:
Tenant/Lessee Name:
Phone#:
Email: seymourkantor@gmail.com
CONTRACTOR: Company Name: t
Phone#:
Address:
City: Stat
Zip:
Qualifier Name:
Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor J. Bru
Phone#: (305) 310-5030
Address: 370 NE 101 st Street it
City. Miami Shores State: FI Zip: 33138
Value of Work for this Permit: $ 700,000
Square/Linear Footage of Work: +/- 4,125
Type of Work: ❑ Addition ❑ A ration ■❑
New ❑ Repair/Replace ❑ Demolition
Description of work: New two-story residential project
Specify color of color thru tile:
Submittal Fee $ eW 0 s� Permit Fee $
CCF $ CO/CC $
Scanning Fee $ Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee
$ Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
L4
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 c1ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved PVd a reinspection fee will be charged.
Signatu
OWNER or AGEN
The foregoing inst ment was ac went before me this
2-7 th day o Cor IA YI-6 20 by
( 4-�' Mik r !� , who is personally known to
me or who has produced bri wl.i
2y CQM`' as
identification and who did take an oath.
NOTARY
Sign:_
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
, who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
as
Seal: Seal:
tar'Py�,, YANADY PRIETO
MY COMMISSION k FF 214031
.• '; EXPIRES: March 25, 2019
Bonded Thru No ublic Urderw Mfs
APPROVED BY U Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)