REV-12-20-2804, 77 NE 106th StRECE1VE]D
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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
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BUILDING Master Permit No. RC-10-19-2608
PERMIT APPLICATION Sub Permit No.Ke—y- IZ-2Q- 2864-
0j BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING MECHANICAL [:]PUBLICWORKS [:]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 X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): TOMAS E CASTELLANOS Phone#: 305-323-0481
Address:640 NE 72 TERRACE
City: MIAMI State: FLORIDA ZIP: 33138
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: NACHO AND SON CONSTRUCTION COMPANY phone#: 786-2993289
Address: 17820 SW 108 COURT
City: MIAMI State: FL Zip: 33157
Qualifier Name: IGNACIO BUSTAMANTE Phone#: 786-2993289
State Certification or Registration #: CGC1507926 Certificate of Competency #:
DESIGNER: Architect/Engineer:
n e#:
Address: City: State
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of work: NEW LOCATION WATER HEATER
Specify color of color thru the:,
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ '4q - ON
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. 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 A
The foregoing instrument was acknowledged before me this
—c�— day of ✓ 20 Zo by
fY�C:►f �� �, who is personally known to
me or who has
identification ancyjvho did take an oath.
NOTARY PU
Signature
_ Lt.,, iL, 0--:�
CONTRACTOR
The foregoing instru t was acknowledged before me this
(5q day of C 4� 20 00 , by
�J
CC tt%5 w o is personally known to
as me or who has
identification and whd did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
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EXPIRES: Alt®. 21, 2021
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APPROVED
BY L W -'
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)