BP-12-18-2980, 830 NE 82 StMiami Shores Tillage
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
FBC 201-=f
Master Permit No. BP-12-18-2980
Sub Permit No. Pb_ 0-k 20 -kssSS
❑ REVISION ❑ EXTENSION CjRENEWAL
]PLUMBING
MECHANICAL
❑PUBLIC WORKS ❑ CHAIUGE OF [ CANCELLATION
.❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
830 NE 82 ST
City: _
Miami Shores
County: Miami Cade Zip:
33138
Folio/Parcel#:
11-3206-005-0160
is the Building Historically Designated: Yes
NO X
Occupancy Type:
Load:
Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): CAPITAL INTERNATIONAL FINANCIAL FUND LLC Phone#-.
Address: 170 SE 14 ST #1002
City: MIAMI State: FL. Zip: 33131
Tenant/Lessee Name: Phone#:
Email-,
CONTRACTOR: Company Name:? ) 3I� Clct6l L6 t` Phone#: c[
AddressA 20 `7i..,'o ;
-city' ' t- State Zip:
Qualifier. Name: �i e'��-C�j c � 1 � ?C�(`i •- Phone#:+�tc �� � �� ;` r7
State Certification or Registration # r, - < ,. Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ $3,400.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: POOL PLUMBING
Specify color of color thru tile:
Submittal Fee $ Permit Fee $,_.,,..,. CCF $ CO/CC $
Radon Fee $ DBPR $ Notary
Scanning Fee $ Y $
Technology Fee $ Training/Education Fee $ Double Fee $ _
Structural Reviews $ __ _._ Bond $
TOTAL FEE NOW DUE $
(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
Zip
City State 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 thatail 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 issuanceof 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 low 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 is' ed. In the absence of such posted notice, the
inspection Will not be approved and a re Inspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20V by j 1 `� day of 20#a--->-- by
CC(� who ersonali kna ��� ��-?U'•{1_,. who is pers kno+vn to
me or who has produced as- me or who has produced ,u-Petrticstate-f8t5ida
' RaIJ! Navarra
identification and who did take an oath. identification and who did khv t errmis ion GG 962e53
NOTARY PUBLIC: NOTARY PUBLIC: w Erp r e5 03t2012024
tart' public State or ft,. ±a
Sign: Sign:9111A�>t',ommission GG 9626 ."'Print; GC R _ Print: ammission YGGPSeal;, :My Comm. Expires MaySeal:c' '
..- ttt*t#*�r#tttasart**a*+�***#tt#t***#+k****t*#a�:**#**#**#A*x*�t**a+k*s+�*#c,x+A+k�.►*R***#*li.s*S*#�*+k*####.�krt�k**a.+�*#**##**
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)