REV-16-1736BUILDING
PERMIT APPLICATION
Miami Shores Village
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
RECEIVED
JUN 22 20a6
BY:
FBC 20145a44
Master Permit No. RC -15-3040
Sub Permit No. c2 ) «' (7%
❑BUILDING ❑ ELECTRIC ❑ ROOFING 0 REVISION 1 1 EXTENSION (RENEWAL
❑ PLUMBING J MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 518 NE 94 Street
City:
Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:11-3206-014-0960 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:
OWNER: Name (Fee Simple Titleholder):JUarl J Guerra
Address:518 NE 94 Street
Phone#:
FFE:
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Air Systerr AJC LLC Phone#: 305-681-1040
Address: 4698 NW 133 Street
City: Opa-Locka State: FL Zip: 33054
Qualifier Name: Roy Vazquez
State Certification or Registration #: CAC033544
Phone#:
Certificate of Competency #: _
DESIGNER: Architect/Engineer: V Phone#:
Address: City: State: Zip: `�,
Value of Work for this Permit: $ ��_: i&_4111— . , are/Linear Footage of Work: C � _ `� r&
Type of Work: n Addition ❑ Alteration �/%J ❑ New ❑ Repair/Replace n Demolition
e i.f r �.l (2t /1 , (cvi(..,
Description of Work:
1 i. i clo.tf.:.
Specify color* color thru tile:
1 u.
Submittal Fee $ ,l t r. U: Permit Fee.•$ i 5 . W CCF $ CO/CC $', ,
Scanning Fee $ 3 - `)" Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ c
(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 reins•ection fee will be charged.
% iSignature �/
,ow
ENT
Signature
i
KONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged beforeme this
2.1 day of Jun/Ii , 20 Ile , by day of "� , 20 b , by
Jun . % [7u.erra , who is personally known to
me or who has produced DL. '4 On 4I (-c
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
✓
Print: Su. vq p.S
Seal: 01.1 11Z,b,,,
1
APPROVED BY
(Revised02/24/2014)
6 2
Suyapa T. Vasquez
Commission # FF942611
Expires: December 9, 2019
Bonded thru Aaron Notary
?c74 v r't& _
as me or who has produced
identification and who did take an oath.
, who is personally known to
dN f ' Kt as
NOTARY PUBLIC:
Sign:
Print:
Seal:
*******************14q9�
aminer Zoning
Suyapa . Vasquez
Commission # FF942611
Expires: December 9, 2019
****** ********N*************
Structural Review
Clerk