DS-18-3607Permit NO.: DS=12-18-3607
Miami Shores Village ! �-'' 1, Permit Type: Driveways/Sidewalks/Stabs
10050 2 Averrlr
Miami Shores FL 33138 ,J Work Classification: New
305-795-2204 Permit Status: Approved
issue Date: 12/18/2018 1 Expiration:06/17/2019
Location Address Parcel Number
9301 NE 2ND AVE, Miami Shores, FL 33138 1132060133650
Contacts
MIAMI SHORES VILLAGE Owner CHAMPION CONCRETE Contractor
MIAMI SHORES VILLAGE JAIME BASILIO
10050 NE 2 AVE, MIAMI SHORES, FL 331382304 10280 NW 63 TER 105, DORAL, FL 33178
Other: 3057511271 Business: 3052528055
Other:7864024802
Inspection Requests:
Description: PAVER WALKWAY Valuation: $ 1,000.00 305 762 4949
TotalSq Feet: 170.00
WMERMENMONNEEMMEMM
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
Concrete/asphalt/pavers, slabs, dways,
$50.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Notary Fee
$5.00
Planning and Zoning Review Fee
$35.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total
$150.30
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$150.30
Credit Card 12/18/2018
$150.30
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WIN)JOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing infor ation i ccurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize ttee abovetamed contractor to do the work stated.
Authorized Signature: Owner / Applicant /
Agent
Date
December 18, 2018 Page 2 of 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: (305) 762-4949
BUILDING
PERMIT APPLICATION
UILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No
Sub Permit No.
RECEIVED
I EC 0 6 2018
FBC 20 r`l
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
r3 NjC- , (���O2 .K. CONTRACTOR �j �y DRAWINGS
JOBADDRESS: DPTIH�ST PAXPe- (60ttKl�'�- 2 �AO NO
City: Miami Shores County: Miami Dade Zip:
` Folio Parcel#: 0 ul �-3WS�
/ 3 2CxIs the Building Historically Designated: Yes NO
Occupancy Type: Load: -To(-(
Type: LM
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1 O Pl JgPIV fOK) d nMi s�7an+�y)�Je'
Address:JOOSy NL 2-41/
City: ti%,Ake M"Y%?-S State: Zip: 33 /31
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
ZS'ZA95 r
City: J42 14:1- State: Zip:
Qualifier Name: _ f i b r- hil'"y Phone#:
State Certification or Registration #: Certificate of Competency #: & 053S 04
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 10010 Ok1 -*J O Square/Linear Footage of Work: % 70 s f
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 1GWIiO "
A��►w 9c�� Grp 0AJ M1-,�&q;_c >M
Specify color of color thru tile:
Submittal Fee $_ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $ c17
TOTAL FEE NOW DUE $ ( � O
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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 d livered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must b posted at'the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of ch posted notice, the
inspection will not be approved and a reinspection fee will be charged. /
Signature
OWNER or AGENT v CONTRACTOR
The
%foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before methis
�V day of . 20 l� by day of ��` �— 20y , by
who is p<�n to y �— 13G.5 luowho is rsonal kno to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath. ����►►►►►►Illlllll��N
NOTARY PUBLIC: �j�bd10N llll �iii�NOTARY PUBLIC: ��\\d��u Naaun�•,j�¢
�N¢\ •
•tea '�c'o:v � _ �• eyy�
Sign: _ a I • p Sign: ..
Print: = ° P o A °' ��: z= Print:
Seal: %�c)•'•• S3a1dX ' ���� Seal: ,�`i`S'��*'
Z fib. r
LAPPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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