CC-5-18-1372 CanceledMiami Shores Village
\2\ 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
FBC 200
BUILDING CANCELLED Master Permit No. I 13-7Z
PERMIT APPLICATION `t /`1 ZOzz Sub Permit No.
BUILDING ❑m ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
QPLUMBING 0 MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
108 ADDRESS: 180 NE 99th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-2230 Is the Building Historically Designated: Yes NO no
Occupancy Type: A Load: 50 Construction Type: II -A Flood Zone: n/a BFE: FFE:
OWNER: Name (Fee Simple Titleholder): MIAMI SHORES CENTER LLC Phone#: 305-864-8885
210 71 STREET #309
City: MIAMI BEACH
State: FL
33141
Tenant/Lessee Name: Phone#:
Email: orit@elyseeinc.com �/
CONTRACTOR: Company Name: V�� �%✓� `-�. Phone#:
Address: 313 Ala- 2 "' -SJ 0-/l/0 L—
City: - 6A.0 State: J'` zip: 33 3y!
Qualifier Name: SiQw/+y L �.✓�.G.+ Phone#: 7a4-1gTd—C'A;P-4'W
State Certification or Registration #: 0 r-2 T' Certificate of Competency #:
DESIGNER: Architect/Engineer: Bruce & bruce, Inc. (Victor Bruce) Phone#: 305-310-5030
Address: P.O. Box 530019 City: Miami Shores State: FL zip: 33153
Value of Work for this Permit: $ 250,000 Square/Linear Footage of Work: 2,581 square feet
Type of Work: ❑ Addition ❑ Alteration ❑� New ❑ Repair/Replace ❑ Demolition
Description of work: New construction of single -story shell building for future commercial tenant
Specify color of color thru tile:
Submittal Fee $
Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $
Training/Education Fee $
Structural Reviews $
_
(��
(Revised02/24/2.014l A (,t�! go
.�1
CCF $ CO/CC $
DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
M
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 th bsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER orAGEN
CONTRACTOR
The foregoing instrument was acknowledged befor me this The foregoing instrument was acknowledged before a this
day of yy �� 20 l�� day of 20 . by
who is p rsonally known S( _ ' who is personally known to
me or who has produced as me or who has produced k163�!�2"`�� - f as
identification and who did take an oath. / iden tificati n and o did ake an
NOTARY PUBLIC: NOTAR� BLIC:
Print: Print: LA VtV r WLo
Seal: •' •••.. •`- ORrr Seal: .rrr
'.€ MyCM/MOury YANAD PRIETO
fob • a ? EXP/ UMS10 # :lam h = MY CDMMISSION k FF 214031
OGf tubeXPIRE .
r l4 202 >'••... •. ,a, aoEdsdmNuoiMaP h'"ndddMlteo
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)