PL-15-2082 qua. - o -.# •� 9 w 2 i Y� t.
Miami Shores Village
10050 N.E.2nd Avenue NW
Miami Shores,FL 33138-0000"
Phone: (305)795-2204h
: � F
�t*� Upiration: 02/141201
Project Address Parcel Number Applicant
88 NW 111 Street 1121360030400
Miami Shores, FL 33138- Block: Lot: Trifecta Capital LLC
Owner Information Address Phone Cell
Trifecta Capital LLC 1504 BAY Road (954)465-3753
MIAMI BEACH FL 33139-
1504 BAY Road
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone Valuation: $ 6,600.00
STATEWIDE SEPTIC CONNECTIONS (954)963-0082
-.---.--_.-.--- Total Sq Feet: 0
Type of Work:REPLACE SEPTIC TANK AND DRAIN FIELD Available Inspections:
Type of Piping: Inspection Type:
Additional Info: HRS Approval
Bond Retum: Final
Classification:Residential Scanning:3 Review Plumbing
CELLED
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
Bond Type-Contractors Bond $500.00 Invoice# PL-8-15-56745
CCF $4.20 08/17/2015 Check#:4856 $50.00 $779.20
DBPR Fee $4.50
DCA Fee $4.50 08/18/2015 Check#:4862 $779.20 $0.00
Education Surcharge $1.40 Bond#:2810
Permit Fee $300.00
Scanning Fee $9.00
Technology Fee $5.60
Total: $829.20
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore,I authorize the above-named contractor to do th work stated.
August 18,2015
Authorized Signature:Owner / Applicant ontractor / gent Date
Building Department Copy
August 18,2016 1
Miami Shores Village 7BY:
elBuildin De artment —Ig p 7 201510050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20th
SW
BUILDING Master Permit No. .20 921
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DRENEWAL
['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 88 t4yj j,1 S-rwfC j-
City: Miami Shores County: Miami Dade Zip: 3 3 tG9
Folio/Parcel#: (1`z-)36 >®® J'"0 q C1'�- Is the Building Historically Designated:Yes NO V
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): TV'4 41 �p1 G Phone#: -;1"7R S—®H 1 r4
Address: (SCi 4:17-04 asL-1C 657—3 7 S 3
City:_ d� C�'1 State: �Z Zip: �s1 _
Tenant/Lessee Name: XALA Phone#:
Email: WEER I ED
CONTRACTOR:Company Name: RAC-+C1-8N � 1 C Phone#: 36cl"'to °l3s
Address: � 6 4 S
City: Loc'-'' State: _Zip: Mo 5
Qualifier Name: �� "° Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: / City: State: Zip:
Value of Work for this Permit:S (Soo d Square/Linear Footage of Work:
Type of Work: % Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: �T�Ici
Spec►fy color of color thru tile:`
Submittal Fee$ Permit Fee$ FY CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised 32/24/2014) 9-z)
+ ��
Bondirg Company's Name(if applicable)
Bondirg Company's Address
City_ State Zip
Mortgi,ge Lender's Name(if applicable)
Mortg,ge 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
appliciNe 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
YOUq 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 whi urs seven (7) dor i 'It is issued. In the absence of such posted notice, the
inspection will not b proved an rein ection ja ,
Signat a Signatur V
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of L n'k-- ,20 I , by 3y day of U lit/)< 20 ' �, by
who is personally known to IQs e,- who is personally known to
me or who has produced L ---7V-TZ) 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:
Prin~�C�� ��P-_7 .-s Print: .--
Seal Seal: IIIIIIII'
No"Pubtio SM o1 Flame Notary Pu01ie qM d Florida c
Ttwroella Lewis 0 TM"ft Lewis
My CWMrdomm FF 19&907 My` spy Cpnmisslon FF i9WS
w Exam 02AdPl019 Exom 020512019
...........
APPROVED BY ��/S _ Plans Examiner Zoning
Structural Review Clerk
(Revised)2/24/2014)