RF-16-3027 (2) Miami Shores Village
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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
AC 20
BUILDING Master Permit No.}� - 1) ` 1 D
PERMIT APPLICATION 'ANCR F
Sub Permit No.
❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 296 NE 99 St
Com: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-4300 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Jeff Kamp Phone#:786-536-2004
Address: 296 NE 99 St
City. Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Brower Electric, LLC Phone#: 954-748-6236
Address: 8716 SW 55 St
City. Cooper City State: FL Zip: 33328
Qualifier Name: James Brower Phone#: 954-748-6236
State Certification or Registration#: EC13004068 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 4930.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Solar Attic Fans
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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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 on estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low 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.
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Signature �i, Signatur
OWNS or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�—day of 2 by day 20 by
s ersonally kn to ��(li�_f"Y\'�S (l�(7. i sonally kno 0
me r w o has produced as me or who has produced '— as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
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Sign: ign:
Print: Print:
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Seal: _,, .e Seal: �;o<Pa�Ae, •.,
rg MY COMMISSION#FF121822 r, ,�.'�c`':LINDA SUE �lIIDYETTE
" a` MY COMMISSION#FF121822
„Forw�?• EXPIRES July 8, 2018
(407)39e0153 Florldallota i EXPIRES July 8,2018
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FloridallotaryService.com
APPROVED BY Plans Examiner _____ ___-______ _____________Zoning
Structural Review Clerk
(Revised02/24/2014)