REV-12-20-2805, 77 NE 106th StBUILDING
PERMIT APPLICATION
❑BUILDING 0 ELECTRIC
Miami Shores Village'�`��
Building Department jE, o � 0J 0
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 2a---t U-�L
Master Permit No. RC-10-19-2608
Sub Permit No. I,jev�
[-1 ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 77 PIE 106 Street
City: Miami Shores County: Miami Dade Zip:
Foiio/pa;11 2136-006-0310 Is the Bullding 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: N/A Phone#: N/A
Email: tomas.e.castellanos@gmaii.com
6
CONTRACTOR: Company Name:
Qualifier Name:
State Certification or Registration fl4--,�
certificate of Competency #:
349-4rcAb0C�
.._
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ElAddition El Alteration [—INew ❑ Repair/Replace ❑Demolition
Description of Work: New location water heater
Specify color of color thru tile:.
Submittal Fee $ Permit Fee $ CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CD/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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. 1 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.
SignatureT �)
OWNER or AGENT
The foregoing instrument was acknowledged before me this
23 day of kd0fJe,,1M be,? . 20 ZJ . by
rnO5 00S4-d/ywtcn-s , who is personally known to
Signature '
NTRACTOR
The f regoing instr/u�nt was ack owledged before me this
day of { v 20d•� , by
.��1 who is personally known to
me or who has produced - as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC; J
r
Sign:
Print:
Seal: " . ALEJANDRO FABIAN PONTI
v MY COMMISSION 8 GG 979445
m+i�.o co EXPIRES: May 8.2024
APPROVED
identification and who did take an oath.
NOTARY
Print:
W8&VWTfflUN*&Puhbumwwih,-
EMIOUELDELACRUZ
Seal: MYCOMMMION8GO077878
WIN& Wy 12,2021
Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)