REV-16-1804 � Miami Shores Villagec��
V" B ildin De artment CJ2 u g p10050 N.E.2nd Avenue,Miami Shores,Florida 33138B�
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762.4949
FBC 20)4t
BUILDING Master Permit No.DS 15-2732
PERMIT APPLICATION Sub Permit No.,Ke /— (- so
❑BUILDING ❑ELECTRIC ❑ ROOFING M REVISION ❑ EXTENSION ❑RENEWAL
[:]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
!OB ADDRESS: 147 NW 109 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcei#:11-2136-003-0200 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Shirley Murillo Phone#:
Address: 147 NW 109 St
City: Miami Shores State: FL Zip: 33168
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Tinez Construction Inc/Pro Handyman Phone#: 786-301-1057
Address: 4725 SW 74 Ave
City: Miami State: FI Zip: 33155
qualifier Name: Ruben Martinez Phone#: 786-301-1057
State Certification or Registration#: C13C1258561 Certificate of Competency#:
DESIGNER:Architect/Engineer: N/A Phone#:
Address:N/A City: State: Zip:
Value of Work for this Permit:$0 Square/Linear Footage of Work: 0
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: revise drawing to show on plan correct driveway approach and walkway dimentions as per inspector
Specify color of color thrn We:
Submittal Fee$ Permit Fee$ • CITZ-) CCF$ COAC$
Scanning Fee$5. W Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ '
(Revisea02/24/2M)
Bonding Company's Name(if applicable) N/A
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 a of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
27 day of June 20 16 by 27 day of June 20 16 .by
Shirley Murillo who is personally known to Ruben Martinez who is personally known 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: NOTARY PUBLIC:
Sign: Sign:
CIN'11A COPLIN 1NTHYA C®,s
Print: Print:
(d07)35:3 9153 MY CO MISSION#FF245W? �' MAISSION#FF245967
Seal ,� • EXPIRES July 20.2019 Seal: fs„
. A EXPEXPIRES July 20
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APPROVED BY �// ' Plans Examiner Zoning
Structural Review Clerk
(ReAsed02/24/2014)
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