RC-10-19-2531, 1020 NE 92nd St (4)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
FBC 20
BUILDING Master Permit No. RG—t®- lq- 2531
PERMIT APPLICATION Sub Permit No.
[—]BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
[—]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10 2do ►16- G 2 Sr
City Miami Shores County: Miami Dade Zia: 33139.
Folio/Parcel#: 11- 32or- cl 3 - o cZo is the Building Historically Designated: Yes NO
Occupancy Type: Sr 1 Load: Construction Type: ,,� _- 11 Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1160 nE L Lt- eaa4 ?%V, Phone#:
Address: do].O MG 91. Sr
µow s'-Wes 3313e .
Clty: State: �'i Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: . Phone#: .3!5 zsqp-
Address: 1 7-3t.o 50
City: M'o^ + State: IPA Zip: 33114
Qualifier Name: FanJo d Phone#:
State Certification or Registration #: E�' 13� 1 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
Value of Work for this Permit: $ Z.0 1 -4-6 c Square/Linear Footage of Work:
Type of Work: ❑ Addition a Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �5 � Ili L - 111 kr%.4 ! D^ �+w+ C" (^► %Y,e J �� d ` -�
#%..+y b c.yv.r -a tki, sp Qe -no :3 A.-- ELF'
Specify color of color thru tile:
Submittal Fee S Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lenders 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 goad faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recordedSotire of commence ent must be posted at the job site
for the first inspection which occurs seven (7) days otter the building permit 1 'ss d. In the ObSence of such posted notice, the
inspection will not be ar and a reinspection fee will be charged.
Signature �— Signature
oft r AGENT CO A OR
The foregoing instrumprIt wsis acknowledged before me this The foregoing instrument was �cknowl'edged before me this
y of_NW 20 I by _� day of �f 2020 , by
who is personally known to who is personally known to
me or who has produced
as
identification and who di t c
y?, JOSE ATfWtN
NOT PUBLIC: �y Notary PubOt state o1 Florida
co -mission 0 GG 244069
� a rv?_ My Comm, Expires �P 26, I022
-- gp throu4l►twimal Notary fin•
SI
Print• � �--'
Seal:
me or who has produced as
identification and W.1% �r&W ce an oa SE A TUU AN
;p°. Y; Notary pabllc • State of Florida
NOTARY BLIC: �:l Commisslon ® GG 244069
a, V yy Comm. Expires Sep 26. Z022
Bonded thr Netimal Notary Assn.
$I '
Print: c`�J
Seal:
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ADPROVEN)CHAEL
12/03/2020
(Revised02/24/2014)
DEVANE 41ansExaminer
12:59:19 PM
Review
Zoning
Clerk
Premier Electric, LLC
12360 SW132 Ct, Unit 107
Miami, FI 33186
(305) 254-7000
lozaelectric@gmail.com
Date: November 11, 2020
State of Florida
County of Miami -Dade
Before me this day personally appeared .u� �ho, being duly sworn,
deposes and says:
he or she will be the only person working on the project located at:
Sworn to (or affirme ) and subscribed before me this Y
JOSEATILLAN
•t Notary Public - State of Florida
Commission 9 GG 244069
My Comm. Expires Sep 26, 2022
""" Bonded through National Notary Assn,
day of Iy / 209=1�, by
Personally know
OR Produced Identification
Type of Identification Produced
Print, Type or Stamp Name of Notary
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