MC-16-2960 Miami Shores Village
Building Department OCT 3 Y016
2 �
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JY; ►
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
I=BC 2014-
BUILDING
0f4BUILDING Master Permit No. b9p kb-295q
PERMIT APPLICATION Sub Permit No. �MC 10-16 —Z-q X00
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 14 1 1 5-T-
City: Miami Shores County: Miami Dade Zip: 33 1 ,3 !a
Foiio/Parcei#: 1 1 3 2-®.S O2—"+ is the Buiiding Historicaiiy Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):J Phone#:t-4 C-- 2—SS o cv 3—7
Address: 1 4-
City:
City: 1 I S L i fl r S. State: -- Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: ESSIG POOLS, INC Phone#: 305-949-0000
Address: 1800 NE 151 ST
City: NORTH MIAMI State: FL Zip: 331625
Qualifier Name: DANIEL ESSIG Phone#: 305-949-0000
State Certification or Registration#: CPC052505 Certificate of Competency#:
DESIGNER:Architect/Engineer: ��G �' �` r �G "' c r �q Phone#: —12-5 t, 2-3 2.435
Address 75-,I-- Str`12, o Le C, � city: State:State• f-LZip: 6-31 %01
Value of Work for this Permit:$ 3► 5�� Square/Linear Footage of Work: �4 S�
Type of Work: ❑ Addition ❑ Alteration ] New ❑ Repair/Replace ❑ Demolition
Description of Work: POOL HEATER
Specify color of color thru tile:
Submittal Fee$ Z)1 CL Permit Fee$ �'� CCF$ Z ' �4® CO/CC$ —107'
Scanning Fee$ Radon Fee$ 2 DBPR$ 2— Notary$ '01"
Technology Fee$ 3 • z Training/Education Fee$ g Double Fee$ -49—
Structural Reviews$ Bond$ 42= _
TOTAL FEE NOW DUE$
(Rev1sed02/24/2014)
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.
Signature Signature1�3 l/
OWNER or AGENT CON
OK
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
�-3 day ofry A20 t ,by Z day of Com r ,20 by
['tee— who is personally known to DANIEL ESSIG ,who is personally known to
me or who has produced i~L_ I>41 v'?-- vC-!-c---,-5m- me or who has produced as
identification and who did take an o identification and who did take an o
NO A Y PUBLIC NO X PUBLIC:
Sign: Sign:
Print: - Print:
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APPROVED BY Pq� 'aminer Zoning
Structural Review Clerk
(Revised02/24/2014)