RC-18-247, 1284 NE 94th St (2)BUILDING
PERMIT APPLICATION
Miami Shores Village
hi
Building Department artment RECE-iVL_'
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 c
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �' 1
F C 201--
Master Permit No. R(�C 18`-247
fzSub Permit No. _� \I I(9 _'�W (0 -`
❑ BUILDING ❑ ELECTRIC ❑ ROOFING 0 REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1284 NE. 94th St.
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3205-010-0140 Is the Building Historically Designated: Yes NO
Occupancy Type: SFR Load: Construction Type: CBS Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Suzanne J. Glller f/k/a Suzanne Jacobs
Address: 1284 NE. 94th St.
City: Miami Shores State: FL
Tenant/Lessee Name: N/A
Email
CONTRACTOR: Company Name: Owner
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
te:
Phone#:305-754-4482
Zip: 33138
Phone#:
Phone#:
Zip:
Certificate of Competency #:
hone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 3500.00 Square/Linear Footage of Work: Approx 85 sq ft
Type of Work: ❑ Addition ❑■ Alteration ❑ New X1 Repair/Replace ❑ Demolition
Description of work: Update 2 existing bathrooms along West exterior wall (SW & Middle baths) per Plan
by Replacing/recover existing tile, remove and replace vanities, remove and reset toilets,
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ io S ' 03 CCF $ G ` Y 0 CO/CC $
Scanning Fee $ Qj O Radon Fee $ 0 . CO • DBPR $ 2 • GO Notary $
Technology Fee $ .. % 2 Training/Education Fee $ (so Double Fee $
Structural Reviews $ 44t:� � cyz� Bond $ —
TOTAL FEE NOW DUE $ ( 6 F
(Revised02/24/2014)
Bonding Company's Name (if applicable)
N/A
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
N/A
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
OWNE or A ENT
The foregoing instrument was acknowledged before me this
2 day of LCeM [D( 20 18 , by
Suzanne J. Giller who is personally known to
me or who has produced FL Driver's License as
identification and who Nitake an oath.
wYP '' MAHARAI K. GONZALEZ NOTARY PUBLIC: =°•• �,-. i;
*. MY COMMISSION # GG 044602
a EXPIRES: November 2, 2020 I
Bonded Thru Notary Public Undenvnters
Print
Seal
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 by
who is personally known to
identification and who did take an oath. .
NOTARY PUBLIC:
Sign:_
Print:
Seal:
as
APPROVED BY V� Plans Examiner Zoning
Structural Review
(Revised02/24/2014)
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APPR
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