REV-18-1910::� a; 1 c6
46-1- �1 vr�-
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: 11300 NE 2nd Ave
A)
JUL 16 ZD1B
o4 j'-�
FBC 201Q
Master Permit No. �"C /2 —/% -26Yq
Sub Permit No. 2 V is— I q 10
M REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ? p C
OWNER: Name (Fee Simple Titleholder): /'- (✓i! -s'I Phone#: 305'_�1 ) / /�
Address: t90 F
12a ✓� GtrN/ , U
City: ,�� �Gir9r�?1' State: �� `4 Zip:
Tenant/Lessseeeen1 Name: Phone#:
tJ � Email: /0 l� %� Gi rC\Z
CONTRACTOR: Company Name: Ventura Architecture Development, Inc. Phone#: 954 423-1362
Address: 11870 state Road 84, C14
City: Davie State: Florida Zip: 33325
Qualifier Name: Mike Ventura Phone#: 954 937-1850
State Certification or Registration #: CGC060048 Certificate of Competency #:
DESIGNER: Architect/Engineer: Ramzi Yahya Phone#: 954 263-9318
Address:5516 NW 58th Ave. City. Coral Springs state: FL Zip: 33067
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: site drainage as -built
Specify color of color thru tile:
Submittal Fee $
Permit Fee $ �-J-ff . cx-_� CCF $ CO/CC $
Scanning Fee $ Cl Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ act, 0D
-
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 deliver d to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commenceme ust be p ted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. in the abs of s h posted notice, the
inspection will not be approved and a reinspection fee will be charged. I
OWNER or AGENT
I ONTRACTOR
The foregoing instrument was acknowledged before me
this The foregoing instrume t was acknowledged before me this
`
12 JUly $
ddaay of 20
by day of 20 by
�J�
a&W IGV e W" _who is personally kn
Mike ventura who is personally known to
m.,e,or who has produced
as me or who has produced L DL as
identification and who did take an oath.
identification and who did ake an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign•
Sign:
Print:
Print:
Seal: Notary Public State of Florida
Seal: „' �� MARJORIE SAAD-VENTURA
state of Florida -Notary Public
$P
Jeffry J Yao
• Commission # GG 149806
p� My Commission FF 168481
i y+� My Commission Expires
ay�c9� Expires 1111212018
October 09. 2021
APPROVED BY d 3
Plans Examiner Zoning
S ural Review Clerk
(Revised02/24/2014)