REV-09-27-2250, 1020 NE 92nd StMiami 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
Pam: .NEED
SEP 0 2 ' 022
BY:
FBC 202ZrV�
BUILDING Master Permit No. k,.- IQ I1 --2,531
PERMIT APPLICATION Sub Permit No. e4V- 00f-27— 22fJ
❑BUILDING Y] ELECTRIC ❑ ROOFING 14 REVISION ❑ EXTENSION ❑RENEWAL
[--]PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: t (''JJ �)o t" E 012 V\ A
Folio/Parcel#: , i J�®� Q 1 ®®Z.6 is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: % Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple
,Tiitleholder): 1-7 W l'L Phone#: ®� — �^6�3
Address: � ®� � N � G2 wl.s�
City: t a SL State: Zip: �i I1�1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Premier Electric LLC Phone#: (305) 254-7000
Address: 13321 SW 124th St, Miami, FL 33186
Email: premierelectricilc@yahoo.com
Qualifier Name: Fernando Loza Phone#: (786) 486-8260
State Certification or Registration #: EC-13004481 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: E� Addition ❑ Alteration ❑ New ❑ Repair/Re lace p ❑Demolition
Description of Work:
Specify color of color thru tile. -
Submittal Fee $ Permit Fee $
Scanning Fee $
DCA Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $.
DBPR $
Notary
Double Fee $
P&Z Review $ Bond $
TOTAL FEE NOW DUE $ ' � 7
(Revisedo4/05/2022)
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 an estimated value exceeding $2500, the applicant must
promise in good 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 recorded notice of commencement must be posted at the job site
for the first inspection which ccurs seven (7) days after the building permit is issued. In ft
absence of such posted notice, the
inspection will not be appr nd a rpidspection fee will be charged.
Signature
Signature 0- V
R or AGENT
C NTRACTOR
The foregoing instrum n as acknowledged before me this
The foregoing instrument was ackno ledged before me this
I
day of V ^� 20 -Z - by
2t day of A, Q 1; jl 20 Z-� by
&4r \40 S �Y�i who i personally k wn to
f 11 Darn C3 166who is rsonally kno n to
me or who has produced as
me or who has produced as
identification and who did take an oath.
identification and who did take an oath.
NOTARY P L
NOTARY PUBLIC: ;�" "�; DAVID PUPO
MY COMMISSION # HH 138844
' EXPIRES: June 2, 2025
'' �f
Sign:
Oi cif.•
WOW TIw Notary Public Urklerallm
Sign:
Print: AA L"
Print:
Seal: <wY4.4.9 .; DAVID PUPO
Seal:
-'., MY COMMISSION # HH 136844
.0. EXPIRES: June 2, 2025
'•'scc w?p:' BorKW Ttw Nobly Public UndeMrtBen
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revisedo4/05/2022)