FW-2-18-396 CanceledMiami Shores Village
U� Building Department FEB 2018
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
1 Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
�^NCELLED ���9 ���6
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
FM_jBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL I—] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5 NE 105 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO X
Occupancy Type: SF Load: Construction Type: CBS Flood Zone: 8FE: FFE:
OWNER: Name (Fee Simple Titleholder): Group 10 Capital Phone#: 305-479-9857
Address: 1480 Michigan Ave
City, Miami Beach State: FL Zip: 33131
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: AJ Fulton Contractors Phone#: 305-970-8802
Address: 440 s dixie hwy
City: Hollywood state: fl Zip: 33071
Qualifier Name: Hugo hernandez Phone#: 305-970-8802
State Certification or Registration #: CGC1512815 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work forthis Permit: y (Po Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
' chain link fence with 6privacy fence
Description of Work: Replace p y t1`%Oc�r�
Specify color of color thru tile:
Submittal Fee $ Ci i Permit Fee $ CCF $ CO/Cc $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ 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 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 and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
14 day of fabruary
Sam Soriero
me or who has produced
20 18 by
who is personally known to
identification and who did take an oath.
NOTARYPUBUC:
Signature
tgNTRACTOR
The foregoing instrument was acknowledged before me this
14 day of february 20 18 by
Hugo Hernandez who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: I ........,...,. Si
r b• I
Print: FFF77 i394 Pflrtfi.
Seal:
!�,;,,e EXPIRES November 23, 2018 �\7��? EXPIRES November 23, 201B
Seal:
407) M-0163 FlurldaNOtaryServlm.c (40n 398.0153 FlorldallotaryService.wn
APPROVED BY (3/ (171 r
(Revised02/24/2014)CA \ 1A\1
as
Plans Examiner Zoning
Structural Review Clerk
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