RC-11-18-3558 Canceled4N
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
BUILDING �tQICANCELLED
iP.c-ol-zo-lyz
PERMIT APPLICATION
NOV 9 2 18
U{V,
FBC 2W1
Master Permit No.V-C'1-IV -`ssa
Sub Permit No.
QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS [:]CHANGE OF
CONTRACTOR
JOB ADDRESS: 17 NW 110th Street
CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: 3� 1 (.,2
Folio/Parcel#: Isthe Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Did! Devallon/ Luc Pierre Pho
.aa.... 17 NW 11Oth Street
City: Miami shores
Tenant/Lessee Name:.
rrIMB
State: Florida
202-384-3400
33168
IT41f -.1Ar- J3:71C- C44.
CONTRACTOR: Company Name: DMG Construction Co. Inc. Phone#: 954-706-8624 _ r9k
Address: 4080 SW 61 Ave # 7 % WaF qs - 60S - 8SS 4
City: Davie state: FI Zip: 33314
Qualifier Name: Alejandro Davila Phone#: 954-706-8624
State Certification or Registration #: CGC# 1510860 Certificate of Competency #:
DESIGNER: Architect/Engineer: Fermin A Martinez Phnne#- 305-298-3216
e,1,1,e«-8340 SW 6 Ave. # 3
Value of Work for this Permit: $ 4,500.00
Type of Work: ❑ Addition X Alteration
Description of Work: INTERIOR ALTERATION
_City: Miami State: F1 Zip: 33145
+
Square/Linear Footage of Work: ty 0
❑ New ❑ Repair/Replace ❑ Demolition
KITCHEN RENOVATION)
Specify color of color thry tile:
Submittal Fee $ I 4 Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $ 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
Application is hereby made to obtain a permit to do the wtidk 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. 1 the absence of such posted notice, the
inspection will not be approved and a�nspection fee will be charged.
Th�oregy'pg trumentwas acknowledged before�jmethis
�` fia �'�L� 20 %i% by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
APPROVED BY
The foregc..Wtnstru not wa?acknowledged before me this
day of 20 6P , by
r
who is personally known to
m or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Plans Examiner
MY COMMISSION # GG 118930
EXPIRES: June 26, 2021
Bonded Thru Notary Public Undenmei
(Revised02/24/2014)
Structural Review
Clerk