DS-18-2181Miami Shores Village
10050 N.E. 2nd Avenue N
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. DS-8-18-2181
Permit Type: Driveways/Sidewalks/Slabs
en m Work Classification: Addition/Alteration
Permit Status: APPROVED
Parcel Number
Issue Date: 8/29/2018 1 Expiration: 02/25/2019
Applicant
9400 N BAYSHORE Drive 1132050100110
AMINE DOUKKALI MARIELA B F
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
AMINE DOUKKALI MARIELA B ROVITO 801 N VENETIAN Drive (305)992-6776
--- MIAMI BEACH FL 33139-
801 N VENETIAN Drive
MIAMI BEACH FL 33139-
Contractor(s) Phone Cell Phone
SLUYTER CONSTRUCTION (970)379-9730
Approved: In Review
Comments:
Date Approved:: In Review
Date Denied:
Type of Work: CONCRETE DRIVEWAY, PAD AND SLABS Additional Info:
Bond Return : Classification: Residential
Scanning: 3
Fees Due
Amount
CCF
$4.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.40
P&Z Review Fee
$35.00
Permit Fee
$125.00
Scanning Fee
$9.00
Technology Fee
$5.60
Total:
$184.20
Valuation: $ 6,500.00
Total Sq Feet: 925
Pay Date Pay Type Amt Paid Annt Due
Invoice # DS-8-18-68571
08/29/2018 Credit Card $ 134.20 $ 50.00
08/16/2018 Credit Card $ 50.00 $ 0.00
Avauame I
Inspection Type:
Final
Review Building
Review Building
Review Planning
Review Planning
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 z ni a. FiAeryOre. I aut4rize the above -named contractor to do the work stated.
August 29, 2018
Authoriz4d-Signatufe:Owner N Applicant / Contractor / Agent
Building Department Copy
August 29, 2018
1
40 V
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village RECE,v
BuildingDepartmentD
p AUGAUD
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 1 6 f8 A
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 r
FBC 201 �1 �
Master Permit No. L C )�
Sub Permit No.D c5 �-- 21 �S
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING [:]MECHANICAL []PUBLICWORKS
JOB ADDRESS: t / 6 0 / ' ' 8, Li S %l d A E
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
D2.
City' Miami Shores County: Miami Dade Zip: 3 3 3
Folio/Parcel#: 0 - 3 Z07 - o! b - O t (b Is the Building Historically Designated: Yes NO
Occupancy Type:S F.4tgLoad: Construction Type: ca S Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /�l /L(/ /� {- kJ� L) 1�1-� 4— Phone#:
Addresss:, R Y fl'� %U
City: V f� / (? �J✓Lf'� S State: Zip: le
Tenant/Lessee Name:
Email:
r C�
ne#:
CONTRACTOR: Company Name: U ` wl UC- 7—( ` 1 Phone#: Cr 7 �
Address: Z_ � % Vy F C> 5 1
city: " S
Qualifier Name: f -(t--> r
State Certification or Registration #:
Zip: 33 (3 i7
Phone#:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ t5 Square/Linear Footage of Work: f
Type of Work: ❑ Addition ❑ Alteration ❑ NewRepair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: '
Submittal Fee $ Permit Fee $ "� G� CCF $ CO/CC $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $ Z "
Notary
Double Fee $
Bond $ Y--I ISO 1'-1 6
TOTAL FEE NOW DUE $ )-�a Ll ' Z0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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
—A,sc--� L k .1 ;,
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 120 1.8 by
tLL
o is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:li. ?} My COMMISSION # GG 041376
}^, EXPIRES: iecember 30, 2020
T?-,u N" lary Public Underwriters
**************************
APPROVED BY
as
Signature
_ z4i�4
TRACTOR
The fore ing instrument was acknowledged before me this
day of 20 , by
who is ersonally known to
me or as produce as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Cpp, �-
Print: L(r'
Seal' =r�A.,V
MY COMMISSION # GG 041376
?"` EXPIRES: December 30 2020
1-2 d F._ 17 Bonded Thru Notary Public Underwriters
Plans Examiner < Zoning
Structural Review
Clerk
(Revised02/24/2014)