MC 07-20-1432, 77 NE 106th StRECE1VEL)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-7204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
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ly. - - --
FBC 20 `
BUILDING Master Permit No.ze
T
PERMIT APPLICATION Sub Permit No., me-0- - 432-
7BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING FE-1 MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 77 NE 106 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2136-006-0310 Is the Building Historically Designated: Yes NO NO
Occupancy Type: RES Load: Construction Type: CBS Flood Zone: X BFE: FFE:
OWNER: Name (Fee Simple Titleholder):TOMAS CASTELLANOS Phone#:305-323-0481
Address:640 NE 72 TER
City: M[AM I state: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email: tomas.e.castellanos@gmail.COm
CONTRACTOR: Company Name: M.G EXCELLENT SERVICES CORPORATION Phone#: 7862477067
Address: 1031 E 52 ST
City. HIALEAH State: FLO Zip: 33013
Qualifier Name: MICHEL GARCIA Phone#: 7862477067
State Certification or Registration #: CAC1816067 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $ 3500 Square/Linear Footage of Work:
Type of Work: ❑ Addition i❑ Alteration ❑ New ❑ lace Re air Re p / p ❑Demolition
Description of work: INSTALL NEW MINI SPLIT, NEW EXHAUST FAN
Specify color of color thru tile:
Submittal Fee $ 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. 1 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 i I / o Signature "
OWNER or AGENT
e foregoing instrument was acknowledged before me this
o� day of �JU he 20 -1J by
MOS , vyrho is personally known to
me
NT CTOR
The foregoing instrument was cknowledged before me this
O�- day of �U U I✓ , 20 Z O , by
t` l d (l AV G t A' , who is personally known to
as me or who has produced
as
identification and who did take an oath. identification and who did 006,ob oath. i,t , 1 �, CF'1.�-
NOTARY PUBLIC: NOTARY PUBLIC: - ��
0-.E£ J..
6 I r� •-crrzNo[ra YSrr_
-7U
Sign: Sign:
Print: iA e- a f / Print:
Seal: ; �. R:�tr JACQUELINE PORTAL Seal:
MY COMMISSION # GG 064595
_w p EXPIRES: January 92, 2021
;Zo; vtR.• Bonded Thu Notary Pubic Unddwftm
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)