EL-11-19-2748, 1048 NE 99th St1
Miami Shores Village E. vrr1 RED
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (30S) 79S-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING C&ELECTRIC ❑ ROOFING
Nov 18 2019
$Y:
U+A_\
FBC 20�-�
Master Permit No. �B pp -
Sub Permit No. EL - I I - I q -
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS: W412) w`e.. cko�
1
S-f
City: Miami Shores
County:
Miami Dade Zip: '?>3
I Be
Folio/Parcel#: \\1 5m— MQ$ — Okso
Is the Building Historically Designated: Yes
NO
Occupancy Type: Load: Construction
Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder):
Address: Qb Ne q0t
City.
Tenant/Lessee Name:
Email: •
CONTRACTOR: Company Name: r�
Address: / w ®ice
City: l ! IState: F L__._ Zip: 3 j
Qualifier Name: 6- ry Phone#: 20
State Certification or Registration #: E C ( ) C) S�Certificate of Competency #:
C,oaaPhone#:i
State: Zip: ` D3
Phone#:
fl,11n l-12,- iha h) Qnv i i . MJ'77
hone#:�C�S
DESIGNER: Architect/Engineer: Phone#:
Ad d ress: City: State:
Value of Work for this Permit: $� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 14 New ❑ Repair/Replace
Description of Work: (A,iM M1 n Q PQn
Zip:
❑ Demolition
Specify color of color thru tile: ,?-)\V2
Submittal Fee $ �)Q ��
1 Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $ Notary $
Double Fee $ _
Bond $
(Revised02/24/2014)
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
Zip
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 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
%6' � day of ND(&I%I�i 20 / by
Nwc L �-�cua VIS, who is personally known to
1-3
me or who has produced CLkWL\% as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: G ,�-
Seal: MY COMMISSION # GG021933
A;3p, EXPIRES August 16, 2020
TO
Signature '�
CofTRACTOR
The foregoing instrument was acknowledged before me this
day of V V ' �i_ r- 20 I a by
1�V2.:ho is p rq sonally known to
��94
me or who has produced I \TD /' as
identification and who did take anMM,. P400rda Mtleo
NOTARY PUSIX
NOTARY PUBLIC: WA1E OF FLORIDA
Comm# FF9Y611Oa
Qi&2=
Sign
Print: 4D(-;A"(1)'1 V1 ��1M-�0
Seal:
wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)