FW-01-20-221 CanceledBUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ( l L4
Tel: (305) 795-2204 Fax: (305) 756-8972,r
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20?�
CANCELLED ter Permit NoTW bl` 20-7Zl
Sub Permit No
®BUILDING I3 ELECTRIC ® ROOFING ® REVISION E3 EXTENSION ORENEWAL
PLUMBING 0 MECHANICAL [3 CHANGE OF N CANCELLATION I3 SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: l (t qE f�e V�D
City: Miami Shores f County: Miami Dade Zip:J�`3 O
Folio/Parcel#: tl" & - D -T ` 11 (01--) Is the Building Historically Designated: Yes NO
Occupancy Type:9'"nh`RLoad: Construction Type: 2> S Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
City: Y\r'%ate"", State: Zip: ?n_7.5\ 5
Tenant/Lessee Name: ��.( /� ��tn Phone#:
Email: �_.J�t/J'✓'V •t�`ir t t-) A 0 OA6DY- . 60w/
com
CONTRACTOR: Company Name:
Address:
Email:
Qualifier Name:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: I3 Addition 0 Alteration I3 New ® Repair/Replace I3 Demolition
Description of Work: r IqN C-Ct-�La^i
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
DCA Fee $
Training/Education Fee $
CCF
DBPR $
Co/CC $
Notary
Double Fee $
Structural Reviews $
(Revised04/05/2022)
P&Z Review $ Bond $
TOTAL FEE NOW DUE $.
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..... _.,
W
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 aril 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
day of , 20 , by
me or who has produced
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of .20 , by
, who is personally known to , who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign:
Print:
Print:
Seal: Seal:
APPROVED BY
Plans Examiner
as
Zoning
(Revised04/05/2022)
Structural Review
Clerk
yvb� IIIAS
V\`tt�1 v�A'toYF�I
tW-OI- ZC7 -ZZ�
1ae� (�(d2�jn1
BUILDING
PERMIT APPLICATION
1`F! 7 E n E D
Miami Shores Village mw JaN 3 o 2020
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
FBC zo t-1
Master Permit No Fw-01" ?-D- 22l
Sub Permit No.
QBUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
❑ EXTENSION
❑RENEWAL
❑PLUMBING
❑ MECHANICAL
❑PUBLIC WORKS
❑ CHANGE OF
❑ CANCELLATION
❑ SHOP
CONTRACTOR
JOB ADDRESS: 9950 NE 4th Avenue
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-017-1160 Is the Building Historically Designated: Yes No no
Occupancy Type: ResirstW Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholde�Amanda McGovern Phone#: 305-582-4244
Address:9950 NE 4th Avenue
city: Miami Shores state• FL Z;p: 33138
Tenant/Lessee Name: Phone#:
Email: Amcgovern@riveromestre.com
CONTRACTOR: Company Name: Highend Intl. Construction Consultants INC Phone#: 954-366-1802
Address: 3040 NW 25th Avenue
City. Pompano Beach State: FL Zip: 33069
Qualifier Name: Rosangela Sanches Phone#: 561-239-9193
State Certification or Registration #: CGC1520966 Certificate of Competency #. General Contractor
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $24,000 Square/Linear Footage of Work:
189' S�� d��
Type of Work: ❑ Addition ' ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition
DeAcription of Work: Replacetxisting gates and fence with new gates and fence.
�t ku "-4 ALAM
Specify color of color thru tile:
Submittal Fee $ 50.00 Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ ((L
IN RE:
AMANDA McGOVERN 2017 REVOCABLE TRUST AS AMENDED AND
RESTATED MAY 29 2020
ACCEPTANCE OF SUCCESSOR CO -TRUSTEESHIP
The undersigned, GABRIEL JOSEPH ORTEGON, who was nominated as Successor Co -
Trustee under Subparagraph B of Paragraph TWELFTH of the AMANDA McGOVERN 2017
REVOCABLE TRUST AS AMENDED AND RESTATED MAY 2, 2020 (the "Trust"), hereby
confirms that I have accepted my appointment as Successor Co -Trustee as of April 22, 2023.
Signed as of April 22, 2023.
GABRIkOOSEPH ORTEGON
WA4801-1\wp\Trust - Revocable Trust\Acceptance of Successor Co -Trusteeship (Rev. Trust)(Gabriel).wpd