RC-4-17-1097 Cancelediviiaiiii Jiivrc--) v111a8C
Building Department (APR 0 2017
J �� n (��� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
0N INSPECTION LINE PHONE NUMBER: (305) 762-4949
Z1�Il�zq FBC14. .
BUILDING ^ A ster Permit No. C 11 — 1,
PERMIT APPLICATION %..^NCELLEU Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
1155 NE 104th St
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
11-2232-029-0020
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type ,�,� nFlood Zone: BFE: �J J�FFEE:)
OWNER: Name (Fee Simple Titleholder)- 14,1"1 %� (S/ &�)C A Phone#: °' C� " rS
Address: /1(A A�i
City: dic9gd 5State:
Tenant/Less;TXUE7P—P—A
e ame:
Email:
iG- Co/-"
Perfection Roofing and Construction FI., Inc.
CONTRACTOR: Company Name:
1221 Stirling Rd. #112
hone#:
305-233-1316
hone#:
Address: �- c-�� I
City:
Stirling Rd #112 State: I Zip: 33004
Qualifier Name:
Michael Wattner Phone#: 954-609-2277
CGC-1519100
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: N/A Phone#:
Address: City: State:
Value of Work for this Permit: $ 3,000.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: Excavation of rear of property 10' x 75'
Specify color of color thru tile:
Submittal Fee $_ E3QQ!j1_ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $_
DBPR $
Zip:
❑■ Demolition
CO/CC $
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE S
-
Bonding Company's Name (if applicable)
N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
0.
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
OWN r AGENT
The foregoing instrument was acknowledged before me this
day of A Pr20 �- by
A who is personally known to
me or who has produced �ct pnvc� L: r as
identification and who did take an oath.
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of AQc� \ , 20 1 - by
JAC(,,Ae( 0- WCl Kn-e-� , who is personally known to
me or who has produced GEC as
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
�—� ``���\��- VAR ii�i `-- `�J OP�•11 E 1 • V'9 ire
•�NOTgq 9�
Sign:
OP'•��TARy•;9�,+Sign: �/z,it
My Comm. Expires i
Print: 11� •�1 d V�i Q Cc S — Nouembor 27, 2020 : :Print: 1 �/1 % i� 1f�ac S C2 S � T4 As
No. GG 50250 : 7 p
Seal: .+N'9•�'jO BL �♦ .`Seal: ++;Cc� euc
APPROVED BY Plans Examiner Zoning
�� Structural Review Clerk