RC-15-1884 (6) Miami Shores Village JUN ®22016
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
FBC 20
BUILDING Master Permit No. Wx,— 1�5 l O�v
PERMIT APPLICATION Sub Permit No. V/6' 7�
❑BUILDING 06EjCTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
F—IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ' o '
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
"fit
OWNER:Name(Fee Simple Titleholder): , G�� ,� Phone#: s1 05'
Address:
, , 1 �,_a - '� �
+tf� t
City: I reK1 I State: (5c, Zip'E> �53 .
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name �� ='� ZI �� Phone#:
Address: Yv� 0
City: ✓ /1 State:( Zip: �Z
Qualifier Name: A-4- � 'Z-/— Phone#:
State Certification or Registration#: 1�Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New Repair/Rel1ace ❑ Demolition
Description of Work: "'°'""".� ��-� ��`�� 3•
a
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or NT CONTRACTOR
The foregoing' strume as acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 .by to day of 20 ,by
whoersonally kngwxrt�" who Xpersonally known to
me or who has produce lvd S me or who has produce A r MPAk Q Jytas
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
.1MEMO=
11�
Sign: Sign:
Print: Print: no
Seal: Seal:
************************************************************************************************************
APPROVED BY ,R IMU�° Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami-Dade County-Building and neighborhood Compliance Office Page 1 of 1
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Contractor Restriction Codes
Page:1
Contractor Number. 000013851
Contractor Name: AMENGUAL ELECTRIC INC
Trade: ELEC status: RESTRICTED I Res/Sus Code: 11
Description: NO NEW PERMITS UNLESS QUAL AGENT APPLIES IN PERSON
Applied Date: 03/08/2016 By: JL045 JLESCANO,JOSE
Trade: ELEC Status: RESTRICTED I Res/Sus Code: 25
Description: CONTACT STATE OF FL.DIV.OF WORKER'S COMPENSATION
Applied Date: 03/08/2016 By: JL045 LESCANO,JOSE
Trade: ELEC Status: I RESTRICTED I Res/sus Code: 33
Description: PERMIT/FINE UNPAID-SEE BLDG SUPPORT SECTION
Applied Date: 03/08/2016 By: I KJO45 JACKSON,KAREN
INQUIRY SUCC9$S 0k,..N0,A0 lTt0KAL RESTRICTIONS TO DISPLAY
ACCO Contractor Inguiry and Comgiaint Search I BCCO Home Page I State License Search Menu
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®2001 Miami-Dade County.All rights reserved.
http://egvsys.miamidade.gov:1608/W W WSERV/ggvt/BNZAW942.DIA?CNTR=000013 8... 3/15/2016
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