PL-14-1413 . , Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-$972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Mauer Permit No. P�- 1`4 —1`-_2) Ci 3
PERMIT APPLICATION Sub Permit No. P�- �� - LA \ ?�
❑BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION RENEWAL
®PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ® CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS- 1461 NE 102 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Paraegf:11-3205-024-0140 Is the Bei HMorically DeslCmated:Yes NO X
Occupancy Type: toad: Consbuction Type: Flood Zone: BFE: FEE:
OWNER:Name(Fee Simple Titleholder): JACQUELINE BUTLER phone#:786-797-5527
Address:1461 NE 102 ST
City; MIAMI SHORES State: FL Zip; 33138
Tenant/Lessee Name: Phone#;
Email:
CONTRACTOR-Company Name: DREAM DESIGN POOLS, INC. Phone#; 954-816-5337
Address: 13771 N Garden Cove Circle
City: DAVIE State: FL 710: 33325
Qualifier Name: RAFAEL PELLERANO Phone#: 786-402-2253
State Certification or Registration#: CPC `-3 ) G Certificate of competency#:
DESIGNER:Architect/Engineer: Phones
Address- City: State Zip:
Value of Work for this Pennil:$ ��} .tom, Square/Lkww Foote of Work:
Type of Work: ❑ Addition ❑ Arieration ® New ❑ Repair/Replace ❑ Demolition
Description of Work: I jj c: I i�tW�'I—,,r-,C�I — �1 ,J Al of,GL..
Specify color of color thru die.-
Submittal
ie.Submittal Fee$ Permit Fee$ (�dU- ^i' CCF$ co/cc$
Scanning Fee S Rarbn Fee S MR$ Notary$
Technology Fee S Trak&WEdacadon Fee$ Double Fee S
Structural Reviews$ Bond$
N
TOTAL FEE NOW DUE$
(Revise 2/24/2014)
~ Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgagee 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
--om rtenced 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. 1 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 buffing permit with on estimated value exceeding$25M the oppiicant must
Promise in good faith that a copy of the notice of commencement and construction lien Jaw brochure will be delivered to the person
whose property is subject to attachment: AEu,a certified copy of the rerortled natke 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 refrhspedion fee will be charged.
Signature ryi:x y�-
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before methis The ung instrument was acknowledged before me this
day of V � 20 1 by -`% day of :v-t: 20 ,by
who b nersonallYkaown to ✓1 who is trersonalhrknown to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NWARY PtJgLIC-;
Sigt1: --. - - -
Print= U f S �}- y �V Print
Seal; Seal:
V Notary Public State of Florida
V0 Notary Public State Of Florida
��
Luis Ariel DuarteLuis Ariel Duarte
My Commission EE 183181
My Commission EE 183181 Ex i
APPROVED BY - L(Plans Examiner Zoning
Structural Review Clerk
(Revi5ed02/24/2014)