REV-17-543 Miami Shores Village ;
IN-S^1- ^ Building Department MY
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 `
C7 Tei:(305)795-2204 Fax:(305)756-8972 —*-'
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBS i01c4
BUILDING Master Permit No.162142
PERMIT APPLICATION Sub Permit No.P�E � -
❑BUILDING ❑ ELECTRIC ❑ ROOFING Q REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
3 I CONTRACTOR DRAWINGS
JOB ADDRESS: 9025 BISCAYNE BLVD
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): SHORE SQUARE PROPERTIES LLC phone#:305 893-9955
Address:696 NE 125TH ST
City: NORTH MIAMI State: FLORIDA Zip: 33161
Tenant/Lessee Name: MODERN MARTIAL ART & FITNESS Phone#:305 542-5549
Email: MODERNMARTIAL@GMAIL.COM
CONTRACTOR:Company Name: BARI NATIONAL BUILDERS, LLC Phone#: 678 696-5676
Address: 12040 NE 16TH AVE UNIT#210
City: MIAMI State: FLORIDA Zip: 33161
Qualifier Name: ANTONIO DELIGIO Phone#: �r m� (.56-'5L%
State Certification or Registration#: CGC 1522573 Certificate of Competency#: N/A
DESIGNER:Architect/Engineer: PAERlCI MALPARTIDA Phone#:30"K— I9L _ qtq%7'
Address: _City:• State: FL Zip:3
Value of Work for this Permit:$2,324.00 Square/Linear Footage of,:.Work: 32SQ FT
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: BUILD LOCKER ROOM AS PER PLAN AT THE REAR OF THE SPACE.
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1 cvl
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ 4 CO/CCS$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(RevisedO2/24/2014)
Bonding Company's Name(if applicable) N/A
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name(if applicable) N/A
Mortgage Lender's Address N/A
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 ven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approve a reinspection fee will be charged.
Signature Signature
—A
NER or AGENT CONTRACTOR
The foregoing instr ment was acknowledged before me this The foregoing instrument was acknowledged before me this
2day of �J&A 20 ,by ZQ�—day of 20 JZ by
E6 (o, who i ersonally known o Rn>1 ,•0 a,1q,-4 who is personally known to
me or who has produced as me or who has produced ,��e as
identification and who did take an oath. identification and who did take an oath.
NOTA LIC NOTARY PUBLIC:
ign: Sign: G�
nt: Print: pu
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,. �4 OSCAR FIALLOS '
a Seal: �r MY COMMISSION#G
Seal: Bio .¢•,� �(pIRES November
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Notary Public.State of Florida 2020
Commission*#FF 946424 '•., „
My Comm.Expires Apr 18,2020
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)