DS-12-603Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
B G Permit No. IltreWlelf
PERMIT APPLICATION , Master Permit No.
FBC 20
Permit Type: BUILDING r, ROOFING
OWNER: Name (Fee Simple Titleholder): UIY g, `9U ir Phone#: (3b5)'75S " 69er"
Address: 114-47 tJ C q14 sr
City: 1-11 (41-1 I S 5
State:
Zip: 33138
138
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 746 )1 ' gilt.
City: Miami Shores �` _ County: F -- Miami Dade siva Zip:
Folio/Parcel #: 11 —32 04 . .N-- I('bv,
Is the Building Historically Designated: Yes NO Flood Zone:
2e�r 6- �.3Q— V7S
7
CONTRACTOR: Company Name: P&trt C�'�� � Phone#: (30 s) Q- / A//9 /
Address: 1010 tae-1 8.'57---
City: ` t-i. la-M i State: rt.-
Qualifier Name: 0,1 e i I D 6V Z f)'14ii
State Certification or Registration #: E ?-t6, (% 0 Certificate of Competency #:
Contact Phone#:(93J Qi & " 154 j Email Address:
DESIGNER: Architect/Engineer: r ( b
Value of Work for this Permit: $ 1 Ci 8C15"--
> J Square/Linear Foo ork:
33(38
Zip: 3 3 /to
Phone#:
Phone#: kJ A.
Type of Work: OAddition OAlteration ONew
PLa4n CO CI G Dr2( 01,0
Description of Work:
it
.st 5 ►-- A-r @fort
.epair/Replace ODemolition,
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ C: Permit Fee $ �� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ -_�� DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
**** * * * * * * * * * * * * * * * * * * * * * * * * *** * * **
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Zip
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 RT RCIRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 COMMENCEMENTS"
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 (('-, `V\ ('VAS (" Signature
Owner or Agent Contra
The fore: ingr r trument was acknoowledged before me this 14- The fore : : instrument was acknowledged before me this Y"
day of ;gR 13_y, UWI ANC Gai , day of
who D tonally known to me o ho has produced who is
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: A
20 IL, by O_112.1(t) 61)Zniah,
or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Print: pryv i r' �:a 1/
gr. i
My Commis �.:. STATE OF FLORIDA My co„ „' ,- K ! ,rr BB � �
amaris Negrin -. ' on :,) ,
_,F
.1 Commission #DD89546� `r•,,.�� pires: ,llr
$�1VDIDTI[RUATI.AIVTl6lii;?l 'Br
- •. ;3 ;.- 'Expires: JULY 07, 2013
xa� *�x�a**** iP � ' '�f� a��x* x�****> g�nx� ** **** ** *�r�x** **** ** * **** * * ** xx�** **e�x� **** * **** *ii ** ** **** *a**
APPROVED BY Plans Examiner 4 . C f 1 Zoning
Sign:
Print:
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Rainbow Concrete SA
1010NE138ST
North Miami 33161
3C)S— ?8Co
Miami Shores Village
This letter is to cancel the permit for the job address 746 NE 94 St Miami
Shores Florida. Due to other permits needed. DS j `Z - (d3
Sincerely;
Cirilo Guzman
President /Qualifier
CTQB
Construction Trades-Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
E26180
RAINBOW CONCRETE S.A. INC
GUZMAN CIRILO
Is certified under the provisions of Chapter 10 of Miami -Dade ColntY