BPP-05-19-1105, 1234 NE 94th St (3)Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
1234 NE 94TH ST, Miami Shores, FL 33138 1132050100210
Contacts
ELI BRAVO Owner FOREVER POOLS Contractor
1200 NE 97 ST, MIAMI SHORES, FL 33138 FERNANDO MORALES
Other: 3054942371 2655 LE JEUNE RD 905, MIAMI, FL 33134 j
Business: 3054481517
Description: NEW POOL Valuation: $ 36,000.00 Ins ectton Requests:-4
949Jr
;
TotalSq Feet: 360.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$21.60
Certificte of Completion for Single Fam
$50.00
and Duplex
DBPR Fee
$16.20
DCA Fee
$10.80
Education Surcharge
$7.20
Permit Fee
$1,030.00
Planning and Zoning Review Fee
$35.00
Scanning Fee
$12.00
Structural Review ($45)
$45.00
Technology Fee
$27.00
Total
$1,304.80
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$1,304.80
Credit Card
08/12/2019 $1,304.80
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regula4ng constMgtion and zoning. Futhermore, I authorize the above named contractor to do the work stated.
/ Applicant / Contractor / Agent Date
August 12, 2019 Page 2 of 2
A
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
BUILDING
PERMIT APPLICATION
rBUILDING ❑ ELECTRIC ❑ ROOFING
EDD
RECEIV
M Y 15 2019
14\1
FBC 20 t: - _
Master Permit No �&�y— (s-(�� _ 1 I
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 14 E !!Jy DNre
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:,
Occupancy Type: Load: Construction Type:
the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1 t(50 b 4C 'Gd
6O Phone#: [ a 6
Address: 1 4 1 le"L ^`'^ t S'''kned\
City: M t Q m , !*CN aYC g. Stater Zip: '33 a 1l-
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: L
City: cl-�
Qualifier Name: -I i
ne#:
State Certification or Registration #: L` Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:• S(=
Type of Work: ❑ Addition ❑ Alteration New ElRepair/Replace ❑ Demolition
Description of Work: wec, Rock
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
r
TOTAL FEE NOW DUE $
>S
3,;
(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. 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will tie charged.
Signature y 111-y ;,>! l L—
OWNER or AGENT
The foregoing instrum nt was acknowledged before me this
d day of :el L 20 by
r ,5 w o is personally known to
me or who has produced Jr%7 as
identification and whadid take an oath.
NOTARY PUBLIC:
Signature
_ A
CONTRACTOR
The foregoing instrume t was acknowledged before me this
day of_ � 20 , by
(% E'//• i*"t� G� who is personally known to
me or who has produced , L/C as
identification and who did take an oath.
NOTARY
Sign: Sign:
Print: Print: LA ES
01PR °�e�•,, MO$ ,zo 30 ''.= Notary Public S e o Florida
Seal: 'r;°'s_ Notary Publi -State of Florida Seal:
. ; ; • Commission FF 991880
:' • . •; Commission +� FF 991880 ' a d My Comm. Expires May 13, 2020
My Comm. Expires May 3, 2020 •'%FP`,;,`.�•, Bonded through National Notary Assn.
Bonded through Nahon3i Nu ,rry Assn.
************** ** * *******************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY
t ld
pr
STATE OF FLORIDA
DEPARTMENT OF BUSINESS OFESSIONAL REGULATION
/ y
CONSTRUC ING BOARD
'7
77
THE COMMERCIAL P RTIFIED UNDER THE
PROVI y' LUTES
/
TA
/i ¢ r
t/
EXPIRATIF 31, 2020
. x
Always verify licenses online at MyFloridaLicense.com
121 r. 0
Do not alter this document in any form.
�This is your license. It is unlawful for anyone other than the licensee to use this document.
----- - _ - _ __ __ -_ -------- _:____Lj
l
00411
rt30, 2011
Fi of i
CORAL GABLES FL 33134 Pursuant to Countyd
Chapter art,
OwrNIEIR SEC. irypE OF BUSINESS
SPECIALTY PLUMBING CONTRACTORBY TAX TO
CPCI457459
5,007/19/2018
Worker(s) 3 FPPU09-18-007235
This Lucas Business Tax Receipt only confirms pay .. t of the c t Business Tax. The Receipt is not a license,
Permit, r certification f the holder's uaiif ate ,to . fal ar to c f � any o arna nta
r ongov rnm ai regulatory, laws an requirements which tQ the usihes .
The RECEIPT NO, above must'be displayed on al l ommo" c-f 1 vehicles mi-bade Code Sec ga-276.
For more information, visit iamidad ev aii 1
� 3 �
WE
JIMMY PATRONIS
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 2/25/2019
PERSON: FERNANDO MORALES
FEIN: 204795247
BUSINESS NAME AND ADDRESS:
FOREVER POOLS,LLC
MARQUINA & LACK CONSULTORES
2655 LE JEUNE ROAD SUITE 905
MIAMI, FL 33134
SCOPE OF BUSINESS OR TRADE:
Swimming Pool Construction -
Not Iron or Steel -& Drivers
EXPIRATION DATE: 2/24/2021
EMAIL: FERNANDO1MORALES@AOL.COM
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609