EL-12-22-3109 CanceledELATE . D
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
CANCELLED
BUILDING
PERMIT APPLICATION
❑BUILDING FE-1 ELECTRIC ❑ ROOFING
DE 1 3 [(i22
PT, (?rk(,.
FBC 20L6 - -74h
Master Permit No. C L - 12 ZZ - 31 O i
Sub Permit
❑ REVISION ❑ EXTENSION MRENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1285 NE 94 ST
City: Miami Shores County Miami Dade Zip, 33138
Folio/Parcel#: 11-3205-010-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): JAY ANDREW YAGODA WESLEY CHASE PEARCE Phone#:
Address: 1285 NE 94 ST
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#: 573-790-4314
Email: NONE
CONTRACTOR: Company Name: Art Plumbing A/C & Electric Phone#: (954) 752-1282
Address: 4151 NW 124 Ave
City: Coral Springs State: FLORIDA Zip: 33065
Qualifier Name: Edward Lammers Phone#: (954) 526-2099
State Certification or Registration #: EC13006731 Certificate of Competency #:
DESIGNER: Arch itect/Engineer:-Qv-''^t'i3�0�--��or�-yc:-�. C.o �,,.-, Phone#:
Value of Work for this Permit: $ $2,399.40 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace
Description of work: install two dedicated circuits 20 A with two GFI's all ran in pvc
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 50 Permit Fee $ E::�D • Ct.3 CCF $ (_90 CO/CC $
Scanning Fee $ aL .Do Radon Fee $ Z.O0 DBPR $ Z .Gb Notary $
Technology Fee $ to -CA-? Training/Education Fee $ ,(Ro Double Fee $
Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 7
r) - 70
(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 bey approved and a reinspection fee will be charged.
Signature
OWNIIRIor AGE
The foregoing instrument was acknowledged before me this
6 day of OCT
120 22 , by
WESLEY CHASE PEARCE
,rr o
, who is e�%%"'"'„DL
me or who has produced
`��'•' M SS%''.'
r
F.
NUMBE�:
identification and who did take an oai��R
: HH 272670-�
NOTARY PUBLIC:
••.• d�RE I ES pr
• o
��''�b��C,•Sta�e'��.�'��
Sign•
Print: \l Lh,
wly-10N
Seal:
Signature eL
CONTRACTOR
The foregoing instrument was acknowledged before me this
6 day of OCT . 20 22 by
Edward Lammers , who is persQi1fi!�;�%
p Personal) Known ,.•GoMMISOVU
�, F
me or who has produced y
y.,
identification and who did take an oath. = p : yH �72670
NOTARY PUBLIC: EXPIRES?.•,,• Me 6, 2076 I-C�
State
Sign: .,;c r00%0 Print: \ ,ail ffir UAV-f
Seal:
APPROVED BY -4Fans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)