PL-05-19-1106, 1234 NE 94th StR-ECF Ijvz
Miami Shores Village MAl 162019
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY�°
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. epy_ d1 r i
PERMIT APPLICATION Sub Permit No,- — cjs;- �4�-T`
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: a. Z 9Mf ire
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): E It JS G T l-rbW J Phone#: 145fa— -;I
Address: 1s3'• 2j E7 qq _<-�+ npoe4
City: I►%♦ eL ■-% Jc ce S State: Zip: �3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: F-0-et ey, Po O` S Phone#: —7e6
Address: O� Ce S S /-V e. S Cy 41a �c�. S— 4l�
&
City: Co r4mI C!;&`ec State: 9— zip:331
Quail
State Certification or Registration #: ' t D C- f #T�Q Certificate of Competency #:
706- 3 w) -a'i3s
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 00 Square/Linear Footage of Work: 3G4 5
Type of Work: ❑ Addition ❑ Alterat on New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Permit Fee $
CCF $ CO/CC $
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Notary $
Double Fee $
Structural Reviews $ Bond $ /
TOTAL FEE NOW DUE $ 1
(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 be charged.
Signature_ 7-1' I I1 j / L--
OWNER or AGENT
The foregoing instrument was acknowledged before me
this
—si— day of %Tim' 24 L , 20 by
1,7D—sa Z�`A ho is pZeV175W
ally known to
me or who has produced F1 ; as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: +' ComRAsion # FF 991880
=;E�:� My Comm. Expires May 13. 2020
Bonded Ihrou 1 !,
G Na nnai Hoary Assn,
Signature
CONTRACTOR
The foregoing instrume was acknowledged before me this
b day of. O L' 20 117 by
who is personally known to
me or who has produced �/� as
identification and who did take an oath.
NOTARY PU
Print:
y ruujlcf-tate of Florida
Seal. _ Commissi n # FF 991880
MY Comm. Expires May 13, 2020
Bonded throU h
9 National Notary Assn.
***************************************************************
APPROVED BY �/ AL Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
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
Business: 3054481517
Inspection Requests:
Description: NEW POOL Valuation: $ 2,200.00
� 3�z
I
Total Sq Feet: 360.00 rJ';
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Plumbing - Pool - Residential
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$163.15
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$163.15
Credit Card
08/20/2019 $163.15
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
regulating construction and z—onVg. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent
ao
Date
vl
August 20, 2019 Page 2 of 2