RF-01-22-188Miami Shores Village
I, Z6� I�22 Building Department
rY101i l 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
...011111111111
'CA IV D
FBC 20 Zo -)
Master Permit No.e)c-- ri k-2,2 - � �'
PERMIT APPLICATION Sub Permit No.
BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION D SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
Folio/Parcel#: It - Z
I, i % - O 13
- (A ?-�, O Is the Building Historically Designated: Yes
_ NO
Occupancy Type:
Load:
Construction Type: Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder): 6VVrt/S 60029)t? Viti'JQ.t Phone#: 305- 1 S3
Address IUo Y.11, Srne_si
City: ntt)rn�l State:-RzDitc>Pt Zip:_33)3?
Tenant/Lessee
rMw4k,mr,
CONTRACTOR: Company Name: RQIi) Guffe—M So lu+lor) Inc Phone#:S0S—Z7S S7779
Address: 102 10 5 I R& S f ju S/S
City: A)'I ar n " 11 state: t) Zip: 33 15 7
Qualifier Name: "SQSV S 1 7.] 4 W O Phone#: 726 7/9S3 43
State Certification or Registration #: Certificate of Competency #: I S zs on / I T
DESIGNER: Architect/Engineer: Phone#: {,
Address: � !' 10 SW I / % A VI City; i Ok State: Zip: 1 S
Value of Work for this Permit: $ Z) 006. 00 ,_,,/ Square/Linear Footage of Work: Z I S / f
Type of Work: 1-1Addition❑ L,.� Alteration New I ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
N
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $ CO/CC $
DBPR$ Notary:
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Scanned with CamScanner
Bonding Company's Name (if applicable)
Bonding Company's Address
City
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 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 issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sign:egoing
e -
OWNER or AGENT
The instrument was acknowledged before me this
.. day of 20 i z . by
Wly.( Mika VIa0I4,J4 who is personally known to
me or who has produced
Identification and who did take an oath.
NOTARY PUBLIC:
Seal:
LISA KOGER
Notary Public - State of Florida
Commission # GG 910580
CONTRACTOR
The foregoing instrument was acknowledged before me this
ZO dayof 5^"Qlkvr( .20 211- .by
'3osus 74 U l a , who is personally known to
me or who has produced t_ as
identification and who did take an oath.
NOTARYPUBUC: (�-'y Ada. r�PSVs �cs �a�-Its.
Sign:
Print: M 9J.o 4. 1d1:i-sZ 1Z&*Ac+t
Seal:
•.:di:"'•••. MARIO LUIS MENDEZ RAXACH
Commission # HH 046206
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Scanned with CamScanner
eagleview-
ROOF DIAGRAM
Total Eave Length: 215 ft
Stories by Direction
North
South
West
East
1
1
1
1
GIV
QePa�megt
e g0% , ate
ON
m` S„ores��\\a9 Gate E <
�Zo��n9 � kept. �` ce Wdh a`e9n�at�ons'
euomP fees t�dm9 to �and
, �,e a d GoUnr1
pef fo#
Miter Count
Inside (900)
Outside (900)
Non-900
N
A
Y
5
GutterReport
July 12, 2021
pai�CEIVEL
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9,329,749. CAW PaWts Pen01n9.
PAGE 2