DEMO-03-21-556 CanceledMiami Shores Village RECIFYVED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B.X.,��
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 /-
CANCELLED FBC 201-4 "
BUILDING Master Permit No. t1Q 03-2-(-5 S3
PERMIT APPLICATION Sub Permit No mm -O�-'' 2 (- SS('
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
❑PLUMBING ®MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 29 NE 95 ST
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:
OWNER: Name (Fee Simple Titleholder): J.A. ROD ENTERPRISES INC Phone#:305 742 8285
Address:955 NE 98 ST
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: FLORIDA ATLANTIC AC & REPAIR CORP
Address: 11740 SW 110 LANE
City: MIAMI state: FL
Qualifier Name: ALBERTO DAVID PAEZ
State Certification or Registration #: CAC1817595
DESIGNER: Architect/Engineer:
7864455852
33186
Certificate of Competency M
Phone#:
City: State: Zip:
Value of Work for this Permit: $ I (J:) C.v Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work:
Specify color of color thru tile:.
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR S
CO/CC $
Notary
Double Fee $.
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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 AFFIDAVITS 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 copyof the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to atta ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w ich oc rs seven (7) days after the building permit is issued. !n the Bence of such posted notice, the
inspection will not be oppved d a reinspection fee will be charged.
Signature J Signature
OWNER or AGENT CONT CTQR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 420 by day of X&VQ200 by
60 AD Q ""'who is o w o is. rsonally kno n to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PURL G1aALWK NOTARY PUBLIC:
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Sign: 8a'b°a1M� iud�ww. Sign:
Print:
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Seal: Seal:
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APPROVED BY Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)
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