FW-18-1705JOY
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village RECEIVED
Building Department JUN 21 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
VBC 20F'
CANCELLED
Master Permit No. V �► v ` s
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9801 - 9845 NE 2nd Ave
City: Miami Shores County: Miami Dade Zip: ��✓ 1 ;:3,
Folio/Parcel#:11-3206-013-4380 Is the Building Historically Designated: Yes NO
Occupancy Type: B Load: Construction Type: ( Flood Zone: X BFE: n/a FFE: 10.35'
OWNER: Name (Fee Simple Titleholder): 9801 Park LLC
Address:4141 NE 2nd Ave #204-A
City: Miami State: FL
Tenant/Lessee Name: multi -Tenant
Email: schemtov@cmgcapital.com
CONTRACTOR: Company Name: JC & Associates Inc.
Address: 7741 Sw 122 Ave
City: Miami State: FL
Qualifier Name: Juan Carlos Lago
State Certification or Registration M. CGC 057500
Phone#:305 455 1800
Zip: 33137
Phone#:
_Phone#: 305 742 3199
Zip: 33183
Phone#: 305 742 3199
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
//..
Value of Work for this Permit: $ Square/Linear Footage of Work: ` 01
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 1 �l � � �" N ,� Nj C-42;
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ l ' Cb CCF $ CO/CC $ _
Radon Fee $ �-• b DBPR $ (0, Vol Notary $,
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 42—J . 23
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 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.
Signature .J
OWNER or AGENT
The foregoing instrum nt was acknowledged before me this
day of 20 lr by
C�ncl who is personally known to
me or who has produced as
identification0whdke an oath.
NOTARY P
Sign:
Print: i ,LL ,YP CAROLINAR. HERNANDEZ
Seal: MY COMMISSION # FF 928131
EXPIRES: October 15. 2019
Bonded Thru Notary Public Underwriters
Signatu
The foregoing in
s acknowledged before come this
ne . , 20 by
is personally known to
me or who has produced as
identification and o did to
NOTARY PUBLIC: n i
Sign:
Print: pni IMA M1
MY COMMISSION # FF 928131
Seal: EXPIRES: October 15.2019
5 I z
t?� ° k3onded Thru Notary Public Underwriters
APPROVED BY �V Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
Clerk