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MC-10-19-2547, 335 NE 101st StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 335 NE 101ST ST, Miami Shores, FL 33138 1132060135211 Contacts Ins ection Re uests: Description: A/C VENT ALTERATIONS, EXHAUST FOR LAUNDRY Valuation: $ 1,500.00 AND KITCHEN Total Sq Feet: 0.00IEw q Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Payments Date Paid Amt Paid Total Fees $111.10 Credit Card 11/25/2019 $61.10 Credit Card 10/25/2019 $50.00 Amount Due: $0.00 Building Department Copy 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. a OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and th�a .,all -work: Will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above nam�d.oanfr'actor o do the work stated. Authorized Signature: Owner / Applicant / Contractor \4 fAgerif J _ Date November 25, 2019 Page 2 of 2 Miami Shores Village TERED ✓ Building Department OCT 25 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30S) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. V-'DlR 3S ly PERMIT APPLICATION Sub Permit No. M C- ) D- IGl - a,54-+ ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MeECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 33s Nf_ `(3, ST 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)f-QXC uSAf Phone#: Ncs)-Az�,>A Address: tJ f- \©\ S? City: h S))GK State: -- kl- Zip: Tenant/Lessee Name: Phone#: Email: �KbX -)CG RClAf @ i�1yi�C� -CtSt1 CONTRACTOR: Company Name: Ye►-,� S�crv� �� C�� r I1� Phone#: `3OS Address: 2 q 36 i`e e--y elCity: )t/ki'C'CH State: F� Zip: Qualifier Name: 0 e \ S 0h LL ay-e- \a Phone#: 306 State Certification or Registration #: C A C 1'R IC, O a ( Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: Phone#: Zip: Value of Work for this Permit: $ 1 ) ( ) C) Square/Linear Footage of Work: Type of Work: ❑ Addition [`Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: WC Uo „-r &Tr—P,�T(cK r Tx yACs—r Fci L ku inn e � SRC i}F K-) Specify color of color thru tile: Q � Submittal Fee $ `A' Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (• 0 (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 o rvenIctJodra ys after the building permit is issued. In the absence of such posted notice, the inspection will not be approv an a ern efee will be charged. Signature, The foregoing instrument davof me or who has produced AGENT acknowledged before me this 20 J01 by who is personally known to identification and who did take an oath. NOTARY PUBLIC: as Signature CONTRACT R The foregoing instrument was acknowledged beforemethis day of `-C ,20 7 by lS'C�(i tPLc2 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: CZI^ , 416G4%/ !!G'w Print: / ��;V 2 ,'111--05 Mam trot ►� Mijares Seal: r'�T Seal: ; �• �k+'z *. Commission 0 GG099300 Commission # GG099300 -" Expires: April 30, 2021 = •�,•• , Expires: April 30, 2021 Bonded thru Aaron Notarya'� Bonded thru Aaron Not ary APPROVED BY P ns x iner Zoning Structural Review Clerk (Revised02/24/2014)