PLC-03-18-825 CanceledMiami 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
FBC 20 17 6+4%
BUILDING Master Permit No. PLC S —OZS
PERMIT APPLICATION Kt-10-/9-2S-q Sub Permit No.
FE�BLIILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [—]MECHANICAL ❑PUBLIC WORKS [—]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9710 NE 2nd Avenue
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3206-013-2350 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: X BFE: FFE: 11,03
OWNER: Name (Fee Simple Titleh
714 NE 59th Street
City: Miami
Tenant/Lessee Name:
Email: gladysmatz@aol.com
Gladys Matz
State: Florida
305-525-8816
33137
CONTRACTOR: Company Name: Rodrigo Garcia h ®C K .to+ 1 I V AhlAne#: 305-264-3609
Address: 11325 SW 46th Street
City: Miami State: Florida Zip: 33165
Qualifier Name: Rodrigo Garcia Phone#: 305-264-3609
State Certification or Registration #: CFC1428827 Certificate of Competency M
DESIGNER: Architect/Engineer: Richard B. BOchnoylch Phone#: 305-378-5555
Address:10700 N Kendall Drive, Suite 400 City: Miami State: FL Zip: 33176
Value of Work for this Permit: $ 7,500 Square/Linear Footage of Work:
Type of Work: ❑ Addition A Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of work: Septic Tank Abandonment
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR$ Notary:
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I q 6 • 43
(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 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 on 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, o 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 Signature
OWN Ror AGENT CONTRACTOR
The foregoing instru /me,not was acknowledged before me this
.29 day ofJ14A �20 /8 by
iv/oche Ab l who is personally known to
me or wlWhas produced as
identification and who did take an oath.
NOTARY PU
Sign:
Print:
Seal:
YY•4r Y1Y•�iil�Y
APPROVED BY
IBev1sed02/Z4/2014)
Notary Public -`Slate of Florida
My Comm. Expires Jul 27, 2018
Commission # FF 145250
The foregoing InstrumeR/t was acknowledged beforres me this
�day of MQ� ,20�Y .by
�— , who Is personally known to
me orwh has produced as
Identificationandwho did take an oath.
NOTARY PUS
Print:
Seal:
Plans Examiner
V BERG
My Comtd. Expires Jul 27. 2018
Commission # FF 145250
Bonded Through National Notary Assn.
Zoning
Structural Review Clerk