REV-16-912 Miami Shores Village -1 --I r c
Building Department APIR ® 52 16
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B `
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.RC 6-15-1499
PERMIT APPLICATION sub Permit No. RE-(] l(0` q G"J?
❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1399 NE 104TH STREET, MIAMI SHORES , FL 33138-2661
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-032-0040 Is the Building Historically Designated:Yes NO X
Occupancy Type: RES. Load: Construction Type: RES. Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):ANGELA KELSEY F/K/A/ANGELA WICHMANN Phone#:(954)444-2156
Address: 1399 NE 104TH STREET
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: FAIRBAIRN ELECTRIC LLC Phone#: (305) 753-2550
Address: 1227 SW 3RD AVE. STE 406 (P.O. BOX 330856, MIAMI , FL 33233)
City: MIAMI State: FL Zip: 33130
Qualifier Name: BRUCE FAIRBAIRN Phone#: (305) 753-2550
State Certification or Registration#: fG oo d a 9/Z Certificate of Competency#:
DESIGNER:Architect/Engineer: JAO ARCHITECTS & PLANNERS Phone#: (561) 391-4115
Address:300 NW BOCA RATON BLVD. SUITE 115 city: BOCA RATON State: FL Zip: 33432
Value of Work for this Permit:$ 8• a0
Square/Linear Footage of Work:
Type of Work: M Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: KITCHEN AND BATH REMODEL&ADDITION OF 1/2 BATH
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ �S �� CCF$ CO/CC$
Scanning Fee$ 3 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_i
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of n,,bA A 20 16 .by 6TFi day of ��'L .20 I by
who is personally known to U�)C- "FA i i2911i R d who is personally known to
me or who has produced as me or who has produced I-Lo V4 DA DF1 U EA--U'(-s JJ. £ 'as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
i
Sign: Sign: `1
Print: Print v f1 A-T IA v 4 6�2N/'r Nobn Public
Seal: �, REATHA .BORN Seal:
,,p•�ua, to of Florida
�.•� �� �9 .�`
o• Notary Public-State of Florida My My Commission Expires 09/18/2018
• Commission#FF 934043
My Comm.Expires Feb 4.2020 Commission No. FF 161336
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)