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PL-05-22-1373
Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-05-22-1373 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date:06/24/2022 Expiration: 04/24/2023 Location Address Parcel Number 375 NE 94TH ST, Miami Shores, FL 33138 1132060136120 ontacts - v lames and Summer Williams Owner PSG PLUMBING SERVICES, INC Contractor 375 NE 94 ST PEDRO GUZMAN Home: 9044025787 schaferl0@yahoo.com 3892 NW 125 ST, OPA-LOCKA, FL 33054 i Business: 3057967304 yaniazamora@yahoo.com BATHROOM #1: ONE SHOWER, ONE TOILET, ONE Valuation: $ 10,200.00 Ins ection Requests: SINK, BATHROOM #2 ONE TOILET, 2 SINKS, ONE SHOWER 305-762-4949 Total Sq Feet: 131.00 Fees Amount Application Fee - Other $50.00 CCF $6.60 Change of Contractor $145.00 DBPR Fee $5.36 DCA Fee $3.57 Education Surcharge $2.20 Permit Fee $307.00 Scanning Fee $3.00 Technology Fee $8.93 Total: $531.66 Payments Date Paid Amt Paid Total Fees $531.66 Credit Card 06/24/2022 $386.66 Credit Card 10/24/2022 $145.00 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. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws , �gulatingkonstruction and zoning. Futhermore, I authorize the above named contractor to do the work staled. Authorized vMYVIYYlerw / Applicant / Contractor / Agent le) /24v 2 Date October 24, 2022 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 201P Master Permit No.Z6 ~ Q6-4U- 13 7/ Sub Permit No. PL - 45-" 2,2 - 13 73 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL [ PLUMBING ❑ MECHANICAL CHANGE OF ❑ CANCELLATION ❑ SHOP ONTRACTOR DRAWINGS JOB ADDRESS: 37!-L' /(�G' Ze4 S4i City: Miami Shores County: Miami Dade Zip: 5313e Folio/Parcel#: //'(.` - O/?Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �� SUM&t pl- (A)r I1, Cr ti S Phone#: Address:37S /UF i City: 114i ms S"S State: Zip:33%3 Tenant/Lessee Name:- ),& Phone#: Email: CONTRACTOR: Company Name: ..>/AOM0,1±2 Phone#: Address: S /ate D r gwsy Email: ,�Y I l�'� �,� ln-� c� ��CLo a, Co •,r.�_ Qualifier Name: .5-yz m'W Phone#: ,Yg6 ZZZ 3 3 X3 State Certification or Registration M ez-"-c 141240-Y Certificate of Competency M DESIGNER: Architect/Engineer: �_ A- 4AerS , P, 4 Phone#: 3)S - 92N - 3 5 38 Address: 2" AM /Y�a 6f M_529 City:/I,(I'ay ` La&L_ _State: _ Zip: t Co Value of Work for this Permit: $ 10 Z-CX>. Oc- Square/Linear Footage of Work: 131 -5 t Type of Work: ❑ Addition ❑ Alteration ElNew f 50 Repair/Replace ❑ Demolition Description of Work: !?son,, -N I : (')Ae SLwer{ 04e 4n► -e+ , DAe _ !1k- Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Technology Fee $, Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ (Revised04/05/2022) Bonding Company's Name (if applicable) &;—I Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address 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 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 on 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. qy,7 abse of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �� Signature &== L u. OWNER or AGENT The foregoing instrument was acknowledged before me this 11. day of 0 cact . 20 ZZ by .Sk r1i& VVI LLfi o I sonally known to me or who has produced DOU ✓Ki' as identification and who did take an oath. CONTRACTOR The foregoing instrument 1 was acknowledged before me this day of �o by 17d,2? 6y4 Z *0J wl is personally known t me or who has produced as identification and who did take an oath.' NOTARY PUBLIC: NOTARY Sign:' Sign:_ Print: .....++<�-,: Print: Seal:='a" Spry �. •••tr MY COMMISSION#GG950477 Seal: E%PIRES:march 6,2024 ,;; r ;q,:. Bondad ITN Not#ry Public Undenvdlets #i#iii###i#######ii ZL 'Plans APPROVED BY Examiner KEVIN A ROBLETO Notary Public • State of Florida Commission # GG 962673 Ay Comm. Bxplres Feb 26, 2024 id through National Notary Assn. Zoning Structural Review (Rev1sed04/0S/2022) Clerk Permit Number. P/- - os aa- 13 93 ,jL,U s4,t.,4,- {n,1' CC -G;�- Zz--/37j Owner's Name (Fee Simple Title Holder): Me-2 A SumrA&,r)A1'% g o Phone: 90+qos-599? Owner's Address: 37 I-)y- City: 61 M i S ffe. State : FIL Zip Code: 33 l 3 9 Job Address (where work is being done): 3 7S A) gq'-'�x S+ City: Miami Shores State: Florida Zip Code: 3 3 13 8' Contractors Company Name: fexA coce- Phone: Address: 8 a () N E /19.s sr - City' /`'Uar Qualifier's Name: WX Architect/ Engineer of Record Na Address: City Describe Wa& &kk " 1 . GAP sh, State: State:_ CL Zip Code: 3 3 16 1 I Tic. Number: CSC I y 2-'7s9 Phone: Zip Code: 5,-)* s , 6W Sh" 1 hereby certify that the work has been abandoned and/oar the contractor/architect is unable or unwilling to complete the contract. I hold the Building official and the Miami Shores harmless of all legal involvement. A W1 Wzp .L�P� Owner / Agent The foregoing instrument was aknowledged before rrre this �tday of Q1.1 .202�by &"M(.A. W'k LLINPO is personally known to me or who has produced jaL, v e ?4 % n. as indeMificatton. Notary Pub Sign and Seal: Contractor / Architect / Engineer The foregoing instrument was aknowledged before me this ____ day of .20 , by Who is personally known to me or who has produced Notary Public Sign and Seal: as indentification. 11062020 - Change of Contractor Form Page 2 of 2 1:J Lke !ic j I kl rq s co To: Epoca Corp M1 David Bradley ti Im 800 NE 1251h St, North Miami, FL 33: o 0 ti RE: Permit # PL-05-22-1373 N Address: 375 NE 941h St, Miami Shor rl- This is a letter of notification that as legal owner(s) of subject property, I/We have requested a change of contractor and are removing you and your business from the permit referenced above, permit issued to EPOCA CORP whose mailing address is 800 NE 125th St, North Miami, FL 33161. The Permit was issued on 06/24/2022. I/We requested a change of contractor for the following reason: A new general contractor will be taking over our project and permit and prefers to use a different plumber of his choice. I/We no longer authorize the previous permit holder, Epoca Corp., to proceed with any further work covered by this permit. Z3 Zz James Williams - Date Summer Williams- Date MIAMI SHORES 9825 NE 2ND AVE MIAMI, FL 33153-9998 (800)275-8777 09/23/2022 12:26 PM Product Qty Unit Price Price First -Class Mail® 1 $0.60 Letter Miami, FL 33180 Wei girt : 0 lb 0.40 oz Estimated Delivery Date -11= Mon 09/26/2022 Certified Mail® $4.00 Tracking #: 70212720000279584174 Return Receipt $3.25 Tracking #: 9590 9402 6882 1104 8912 93 Total $7.85 First -Class Mail@ 1 $0.60 Letter Miami, FL 33161 Weight: 0 lb 0.50 oz Estimated Delivery Date .r Mon 09/26/2022 Certified Mail® $4.00 Tracking #: 70212720000279584167 Return Receipt $3.25 Tracking #: 9590 9402 6882 1104 8913 09 Total $7.85 Grand Total: $15.70 Credit Card Remit - $15-.70 Card Name: AMEX Account #: XXXXXXXXXXX1009 Approval #: 829783 Transaction #: 398 AID: A000000025010801 Contactiess AL: AMERICAN EXPRESS PIN: Not Required Text your tracking number to 28777 (2USPS) to get the latest status. Standard Message and Data rates may apply. You may also visit www.usps.com USPS Tracking or call 1-800-222-1811. Preview your Mail Track your Packages Sign up for FREE https://informeddaiivery.usps.com All sales final on stamps and postage. Refunds for guaranteed services only. Thank you for your business. Tell us about your experience. Go to: https://postalexperlence.com/Pos or scan this code with your mobile device, a J-P-L rLyL' 13 or call t-$Q0-410-7420. t trK1- 11 rRSK-Al 12 STATE OF FLORIDA '', DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION t �4 f3.. r F 2601 BLAIR STONE ROAD .. .TALLAHASSEE FL 32399-0783 Congratulations! With this license you become one of the nearly one million Fiondians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we wurk to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you t-an find inure infunnatiull about uur divisions and the regulations that impact you. subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! STATE OF FLORIDA DEPARTMENT dbprROF BUSINESS EGULATION AND PROFESSIONAL Cr C1426257 ISSUED: 05/10/2022 CERriF(D PLUMOr4C CONTRACTOR GU1MMr. PEDRO S P5G RUGIEINO 7tRW F nu i 31 2024 STATUTES Ron DeSantis, Governor Melanie S. Griffin, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER: CFC1426257 EXPIRATION DATE: AUGUST 31, 2024 THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489. FLORIDA STATUTES GUZMAN. PEDRO 5 PSG PLUMBING SERVICE INC 17225 NW 49 CT OPALOCKA FL 33U55 ISSUED OS/10l2022 AMaYI . ify Excuses Wine at MyFlorWUcensec m Do rot alter this donsnent w arty form. This is you kerne. It is unlawful for anyone oMN Man the Gcrn to use this document. Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 5352612 BUSINESS NAME/LOCATION PSG PLUMBING SERVICES INC 17225 NW 49TH CT MIAMI, FL 33055-4109 OWNER PSG PLUMBING SERVICES INC C/O PEDRO GUZMAN PRIES Worker(s) RECEIPT NO. RENEWAL 5590170 SEC. TYPE OF BUSINESS 196 PLUMBING CONTRACTOR CFC1426267 EXPIRES SEPTEMBER 30, 2023 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 BY TAX COLLECTOR 78.00 10/04/2022 0229-23-000046 This local go dr aae Tn Receipt only confirm payment ofthe Local Badness Tn. The Receipt is no a Srxnss, permit or a codifica ion al the holdds IlmliBceOons, to do hesineaL Holder most comply with any gor mmanUI or norrporoneamal regulatory, laws ced requir mom which apply to the husinm. The RECEIPT NO. above must be displayed on all commercial vehicles -Mimi-Dade Coda Sec go-=. H" Form rs hdomm0on, risk ACORE® CERTIFICATE OF LIABILITY INSURANCE 11%.� °�("�"`°°'M'"' 09107/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlRcate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. 0 SUBROGATION IS WAIVED, subject to the berms and conditions of the policy, certain policies may require an endorsement~ A statement on this certtkate does not conger rights to the co M eate holder In lieu of such endomement(s). PRODUM Excellence Insurance, LLC W01 SW 107th Ave Miami FL 33165 AdriM L Clavilo Maurl N Ed): (305) 226-3897 ADDRESS: a •corn WSURMs) AFFORD= coVERJM NAIL s OURRER A: Ubca First tnsurarm Company 15326 INSURED PSG Plumbing Service, Inc. 3892 NW 125 Street UNIT: C3892 Opa Locka FL 33054- e : United States Uabilityy Insurance Company 25895 namm c : NorGUARD Insurance Company 31470 INSUR©t D : INSURER E : INSURER F : COVFRAGIRS CERTIFICATE NUFARFR, RFVISIf M NJ JURRR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. um LTR TYPE OF INSURANCE POLICY NUMBER09%LgiIIT8 A GENERAL LIABILITY CLAIM4S4MADE I X I OCCUR Blanket Additional Insured X X ART 5157919 00 04/27/2022 04127%2023 EACH OCCURRENCE $1,000,000 ! coaxrer>ce $100,000 X MED W one ) $ 6.000 X Blanket Waiver of Subrogation AGGREGATE LIMIT APPLIES PER: POLICY I I u LOC ctot Primary and Non Conlrtb PERsoNAL s ADv INdLRY 0,000,000 GEML GENERAL AGGREGATE s 2,000,000 PRODUCTS - comp OPAGG s 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED!ED ONLY �� HIRED NON4)WINED AUTOS ONLY AUTOS ONLY UPAFT $ BODILY INJURY (Per person) S BODILY INJURY (Per &o M $AUT WAMAG eod $ $ B aMeRo .LA iAB UW'R" L OCCUR CLAIM -MADE XL 1616790 OS30/ M 06/30/2023 EACHOCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I I RETENTION s s C WORKERS COLVENSATIDN AND EMPLOYERS' LIJUMM Y 1 N ANY PROPRIETORIPARTHEIVMCUTNE OFFICERNEMBER EXCLUDED? �Y (UanddW to KH) U PTiON OPERATI Ns bebw NIA PSWC115698 11/19/2021 11/19/2022 E.L. EACH ACCIDENT 51,000,000 E.L. DISEASE - EA BUUM S 1,OK= E.L DISEASE - POLICY uMTr s 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS J VEHICLES (ACORD 101, AddMand Rw arb Sabeduk, may be athched N mae spare Is required) CFC1428M ll�iili�L�1s11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave, Miami Shores, FL 33138 AUTHORM ED REPRESENTATIVE All rights ACORD 25 (2016(03) The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 375 NE 94TH ST, Miami Shores, FL 33138 Contacts . ... Permit NO.: PL-05-22-1373 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date: 06/24/2022 Expiration: 12/26/2022 Parcel Number 1132060136120 James and Summer Williams Owner Arco Construction Corporation Applicant 375 NE 94 ST LESTER JENSEN Home: 9044025787 schaferl0@yahoo.com 1665 NE 137 TER, MIAMI, FL 33181 Business: 3058926507 arcoconstruction@aol.com Other: 3058926507 EPOCA CORP Contractor DAVID BRADLEY ! 800 NE 125 ST, NORTH MIAMI, FL 33161 Business: 3057785103 Info@bradleyplumbers.com Description: BATHROOM Hl: ONE SHOWER, ONE TOILET, ONE Valuation: $ 10,200.00 Ins ection Requests: SINK, BATHROOM #2 ONE TOILET, 2 SINKS, ONE SHOWER 305-762-4949 Total Sq Feet: 131.00 Fees Amount Application Fee - Other $50.00 CCF $6.60 DBPR Fee $5.36 DCA Fee $3.57 Education Surcharge $2.20 Permit Fee $307.00 Scanning Fee $3.00 Technology Fee $8.93 Total: $386.66 Payments Date Paid Amt Paid Total Fees $386.66 Credit Card 06/24/2022 $386.66 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. 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 zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent June 24, 2022 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 375 NE 94TH ST, Miami Shores, FL 33138 Contacts Permit NO.: PL-05-22-1373 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved issue Date: 06/24/2022 Expiration: 12/26/2022 Parcel Number 1132060136120 James and Summer Williams Owner Arco Construction Corporation Applicant 375 NE 94 ST LESTER JENSEN Home: 9044025787 schaferlO@yahoo.com 1665 NE 137 TER, MIAMI, FL 33181 Business:3058926507 arcoconstruction@aol.com Other:3058926507 EPOCA CORP Contractor DAVID BRADLEY 800 NE 125 ST, NORTH MIAMI, FL 33161 Business: 3057785103 lnfo@bradleyplumbers.com Description: BATHROOM #1: ONE SHOWER, ONE TOILET, ONE Valuation: $ 10,200.00 if Inspection Requests: SINK, BATHROOM #2 ONE TOILET, 2 SINKS, ONE SHOWER 305-762-4949 Total Sq Feet: 131.00 Fees Amount Application Fee - Other $50.00 CCF $6.60 DBPR Fee $5.36 DCA Fee $3.57 Education Surcharge $2.20 Permit Fee $307.00 Scanning Fee $3.00 Technology Fee $8.93 Total: $386.66 Building Department Copy Payments Date Paid Amt Paid Total Fees $386.66 Credit Card 06/24/2022 $386.66 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. 1 understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOLwork. 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 zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date June 24, 2022 Page 2 of 2 Miami Shores Village ENTERED BUILDING 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 MAY 3 1 ZUZZ BY: T:101411 Master Permit No. rc C -65 - 22 - i3-7! PERMIT APPLICATION Sub Permit No. F--0s - 22- - 13 73 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: %-1657 N E� 94, S-QgVT- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I ( - 3Z0 to - CA - (p 1 Zo Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple BFE: NO L�' FFE: Address: City: If art I State: FL Zip02S_ Tenant/Lessee Name: Email: CONTRACTOR: Company Name: F� PAC ok re-) 2 Phone#: �Zi0 ,> 991- 7 Address: Roc) k 1 ,�— (%c� 6r E T �L City: U., I AM ( State: L Zip: 01,6I Qualifier Name Phone#: �Ws-) 7 State Certification or Registration #: C F]C: 1 Zj? 073 6!R _Certificate of Competency #: DESIGNER: Architect/Engineer Vii, &9,a � , `,�}1%i 625> �Phone#:,��0� Address: Q 1) ig W AC9 �Z+- t54 City: tl I A l%State: Zip: ';JO 1 Value of Work for this Permit: $ io 'ln 0 • o5— Square/Linear Footage of Work: ' Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $_ Scanning Fee $ _ Technology Fee $_ Structural Reviews Permit Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Notary' Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City Si 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. 7 Signature Chen ��111X(Llinn Q� Signature OWNER or AGENT The foregoing instrument was acknowledged before me this T day of 20 tt by who is personally known to me or who has produced f :*f— n(, - as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: AWN` Seal: 1,7 I Notary Public, Slate of Fkrdda Commissions GG 273249 + ". Comm. 9Mpires Oct. 31.2022 CONTRACTOR The foregoing instrument was acknowledged before me this day of IR 20 7 ,L , by 'I G� 15r4J 4e4 who is personally known to me or who has produced n/ f,4 as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Plans Examiner Zoning ( 1 Structural Review Clerk (Revised02/24/2014)