CC-02-21-337 CanceledRIECEIVED
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
FEB 08 2021
BY:
-�Tlk
CANCELLED FBC 20JL0
BUILDING ��P�atad by Master Permit No. Cc-o2 21-33�
PERMIT APPLICATION CC-05- Zi Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: 1550 NE 105th Street
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
U t'.1 l T "B I
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2230-053-0190 Is the Building Historically Designated: Yes NO X
Occupancy Type: RES Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee simple Titleholder): Jennifer Powers and Martin Maguth Phone#: 7865666298
,,,,,, .1550 NE 105th Street
City: Miami Shores
Name:
Email
State: FL
33138
CONTRACTOR: Company Name: Jennifer Powers and Martin Maguth Phone#: 7865666298
Address: 1550 NE 105th Street
City: Miami Shores State: FL Zip: 33138
Qualifier Name:
State Certification or Registration M
DESIGNER: Architect/Engineer: N/A
of Competency #:
Address: City: State: Zip:
Value of Work for this Permit: $ 4,800 Square/Linear Footage of Work: 1,257
Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition
Description of work: Remove/replace popcorn ceilings with non -popcorn ceilings, replace
kitchen cabinets, enlarge pass through, remove mold/repair dry wall, reattach tiles
Specify color of color thru tile:
Submittal Fee $ 'OI `A Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
`Notary $.
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable) NSA
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Zip
Mortgage Lender's Address
City State 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: 1 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 wi be approved and a reinspection fee will be charged.
Signature t Signature
OWNER AGENT CONTRACTOR
The foregoing Instruwas acknowledged before me this The foregoing instrument was acknowledged before me this
C)�men_ day of � A 20 22A , by day of , 20 , by
NHS 1 �t+�G�s personally known to who is personally known to
me or who has produced �-�l� as me or who has produced as
identification and who did take an oath.
NOTAR UBLIQ
Sign:
rint:
identification and who did take an oath.
NOTARY PUBLIC:
Sign .
Print:
Seal: Seal:
SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: Sege
�Raw
APPROVED BY
Plans Examiner
Zoning
(RevisedO2/24/2014)
Structural Review
Clerk