DEMO-03-21-553 CanceledBUILDING
PERMIT APPLICATION
Q BUILDING ❑ ELECTRIC
Miami Shores Villag.
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
PII iCE_t :Tt n
BY:
1"`
'WAA N CELLEDMaster Permit No. J)'E" Q -03- ?A
❑ ROOFING
❑PLUMBING ❑MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: 29 N.E. 95th ST
Sub Permit No
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-0690 Is the Building Historically Designated: Yes NO X
Occupancy Type: SFR Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Tith
955 N.W. 98th ST
City: Miami Shores
Tenant/Lessee Name: N/A
Email:
J A ROD ENTERPRISES INC PhnnPs: (305) 742-8285
State: FL Zip; 33138
CONTRACTOR: Company Name: HOREB Construction Corp.
Address: 5901 N.E. 151 St Suite 211
City: Miami Lakes State: FL
Qualifier Name: MR. EDUARDO I CUADRA SR
State Certification or Registration q: CGC1519890 Certificate of Competency p:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ �v 0 - c/o
Type of Work: ❑ Addition ❑ Alteration
Description of Work: DEMOLITION
Specify color of color thru tile:
Submittal Fee $� Permit Fee $
Scanning Fee $ Radon Fee $
WM
(305) 467-4751
33014
(786) 200-8582
Zip:
—Square/Linear Footage of Work: Inn o
❑ New ❑ Repair/Replace K Demolition
Technology Fee $ Training/Education Fee $
CCF
DBPR $
CO/CC $
Notary $
Double Fee $
Structural Reviews
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ t�
fO"N
!40%1
Bondi ng*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 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 a94 reinspection fee will be charged.
Signatu
NER or AGENT
The foregoing in#urffent wb
aas acknowledged before me this
_ day of � �20 7-1 , by
who is personally known to
V.
me or who has produced T as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day off 1� �J p'�-`� , 20 Z. , by
50VA41,'-ft •1 e JAW&ho is personally known to
me or who has produced T`;Ilu -1: ' , as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: t 17 1-/1 Sign:_
Print: S r ` Print:
�.•�' ►� p'%, ANAiS ARAWN
Seal: 'J' `�=i Notary Pubic . State of Florida Seal:
s
Capp # FF 207214
my Comm. -Expires Apr 25, 2019
********************
APPROVED BY
Plans Examiner
wt
Notary Public -State of Floridell
Commission • HH 78394
My Commission Expires
January 07. 2025 11
Zoning
(Revised02/24/2014)
Structural Review
Clerk
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