WS-19-2127BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Ito t 4,-83s,
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 11
..M1asterPerm1tN07W8;;11 �_�
Sub Permit No.W13__0q —161
fS-IBUILDING F-1 ELECTRIC ROOFING REVISION F-1 EXTENSION [MRENEWAL
r-1 PLUMBING F-1 MECHANICAL [:]PUBLIC WORKS [:] CHANGE OF CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10317 N MIAMI AVE
City: Miami Shores County: Miami Dade Zip: 33150
Folio/Parcel#: 11-2136-013-0920 Is the Building Historically Designated: Yes — NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): EDUARDO CARRERA Phone#:
Address: 10317 N MIAMI AVE
City: MIAMI SHORES
Tenant/Lessee Name: N/A
Email: N/A
State: F
—Zip: 33150
one#: N/A
ri'�
FHIA,LLC 1 9547924415
CONTRACTOR: Company Name: Phone#:
Address: 3044 SW 42 STREET
HOLLYWOOD FL�W& 33312
City: State: —Zip: 7.
Qualifier Name: WAYNE THOMAS BURNETT Phone#:
State Certification or Registration M CGC061890 Certificate of Competency#: N/A
DESIGNER: Arch itect/E ngi neer: N/A Phone#: N/A
Address: N/A City: N/A State: N/A Zip: N/A
Value of Work for this Permit: $ 19, 742 Square/Linear Footage of Work:
-1 Repair/Replace
New N
Type of Work: El Addition El Alt ti F
,ra ton F El Demolition
Description of Work: OS- I L 13 -.3 63J6
Specify color of color,
Submittal Fee
Scanning Fee $
Technology Fee
Structural Reviews $
(Rev1sed02/24/2014)
tile:
nit Fee CCF $ CO/CC S
)7f �ee� $ DBPR $ otary
Training/Education Fee Aouble Fee
Bond $
TOTALFEENOWDUE$
I . I
N/A
Bonding Compa-,iy's Name (if applicable)
Bonding Company's Address N/A
City N/A State N/A
Mortgage Lender's Name (if applicable) N/A
-Mortgage- Lender'
City N/A
State N/A
Zip N/A
N/A
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 AFFID"IT: 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 approve and a reinspection fee will be charged.
u
Signature Signat G
� 74 NERorAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
01
10 day of 20 by
EJUot"Ab cot/fIlf-I �n to
., who is Ke�rso�n�all
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
The foregoing instrument was acknowledged before me this
day of 20 by
who is(��
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Se
Plans Examiner
M1ftEL A MERCADO
MY COMMISSION # Gro93745
EXPIRES April 19, 2021
as
Zoning
(Revised02/24/2014)
Structural Review
Clerk