REV-16-1719Miami Shores Village R CET —
Building Department JUN 21.2016
ULI 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972 �—
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
FBC 20
Master Permit No. RC 15. ?0140
Sub Permit No.' )Ey 16,1-119
031.JILDING ❑ ELECTRIC ❑ ROOFING fEVISION ❑ EXTENSION ❑ RENEWAL
111 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS n CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 5M. NE 9' I s-freci-
City: Miami Shores
County:
Miami Dade Zip: 33137
'
Folio/Parcel#: 11— *2(0'014- 09(00 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:LL FFE: �
OWNER: Name (Fee Simple Titleholder): . loan J �--2ue.rrc Phone#:7 `-, t4 9O p(/ r
Address: 5153 NE ° -i S•h-ic,-t
City: Mtetrr t a ores State: EL- • Zip: aB 13F
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Oro \ Z'-rnC. Phone#: S35•(0'$5.O'-12,
Address: 111040 (D Court
City: N. INA'‘ o Irv; r State: Pt.-• Zip: 53162
Qualifier Name: Orlar o Phone#: 5 -b$S•0(41Z
State Certification or Registration #: CZL 125) /05 LI Certificate of Competency #:
DESIGNER: Architect/Engineer: V"l GlikV>3F Phone#: 3 d S 75(4' 7-7)
}
Address: I rL. 31'SIVB" c7Z ST24&T5 City: H/du'1/S1ao2FS Stater Zip: )3g
f
eoD
Value of Work for this Permit: $ 1 000 Square/Linear Footage of Work:
Type of Work: ❑ Addition n Alteration ❑ New ❑ Repair/Replace n Demolition
Description of Work: R s F4 ` )a"—
I<- LTz4-nz,,a r
Specify color of color thru tile:
Submittal Fee $ ((C3 Permit Fee $ 5 • W CCF $ CO/CC $
Scanning Fee $ ! CJ Ct Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ r•
(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.
Signatur
OW or AGENT
The foregoing instrument was acknowledged before me this
20 day of June
Juan Clue,rra
me or who has produred
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
, 20 Ilt , by `.C) day of 3 .M1e , 20 (` , by
, who is personally known to
DL on -P le
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Or t4r ci T3W1 AS , who i iersonally know
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
uez
il, = Comm ,‘, n It FF942611
Expires: December 9, 2019
Bonded thru Aaron Notary
Sign:
Print:
Seal:
.114x Suyapa T. Vasquez
Commission # FF942611
•"= Expires: December 9, 2019
**P2 ed *U ***O* Nota************
************************* *************************************
11•ei
APPROVED BY
(Revised02/24/2014)
Plans Examiner
as
Zoning
Structural Review Clerk