REV-06-21-1608, 970 NE 100th StMiami Shores Village RzCP-11[VF'13
Building Department JUN 21 2021
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY:
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2020
BUILDING Master Permit No. RC-12-20-2899
PERMIT APPLICATION Sub Permit NO.?PN -0(0-ZI- L008
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING 0 MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 970 NE 100th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 11 - 32 W-03q " 019 0 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Boris Arango Phone#: 305-218-4729
AdrfrP«. 6445 NE 7th Ave, N525
City: Miami
State: FL
p: 33138
Tenant/Lessee Name: Phone#:
Email: borisarango@gmail.com
CONTRACTOR: Company Name: '� "T �� K / '" `' �r ��'�'��G4 Phone#: 9
Address: / &0 `// �"M �, /,j /3 l ✓ce
City: old- 44 fl • 4a-4'161 State: ` Zip: S 3 wav
Qualifier Name: / I^ [ 5 7%����i�/S Phone#: �C�/�— S-S' -?
State Certification or Registration #: �G�2 Certificate of Competency #:
DESIGNER: Architect/Engineer: JCD Architect Inc Phone#: 305-285-4343
Address.1385 Coral Way, Suite 207 City_ Miami State: FL Zip: 33138
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
CO/CC $
Notary $.
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 3
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 Signature i/—,, , n ,!� )(/
OWNER drAGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
re
day of �UA/a% 20 V1by
W�11 s a 1/01A o o is personally knowr} to
me or who has produced _ as
Seal:
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APPROVED BY
(Revised02/24/2014)
who did tal an oath.%�
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The foregoing instrument was acknowledged before me this
day of fln 20 2 / . by
Al who is personally knowri o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: —
Seal: � Notary Public State of Flonaa
Zion Hay Cohen
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Plans Examiner Zoning
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Structural Review Clerk