DGT-16-1858October 11, 2017
Can we use DGT16-2454 to closed out DGT16-1858?
Arlenis
®,
BUILDING
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
-
JUL 0 5 2016
FBC 2O '
Master Permit No. DOT- l 6 «38
Sub Permit No.
ly(3UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION EI RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
-7� G CONTRACTOR
JOB ADDRESS: 11177- �ry "` N✓ Q b 3 rd 5- �� r
❑ CANCELLATION
❑ SHOP
DRAWINGS
City: Miami Shores Q p County:
Folio/Parcel#: I J 2. 0 P) p t'O
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Construction Type:
Miami Dade Zip: 33
Is the Building Historically Designated: Yes NO
Flood Zone:
�t�L1 F3e-or-f-K
Address: 1�2 t k OBJ i/ 4 s-k'{ZE,C-1-
City:
M t prbV1/4 e $ ht9 Ile- State: �L
N /,t
I�✓ P40NI•C.
Tenant/Lessee Name:
Email: Wl).-1 •
BFE: FFE:
Phone#: 102 2. G `-L g
Phone#:
Zip: .Y i 3
CONTRACTOR: Company Name: -1‘11 -e.) Pet 0 \ i 5ts I C Phone#:
Address: 3.05 NW 19 av-e,
33 t 22
City: `(�(v\ a m State: �..
�k...-.�� � Zip:
331
Qualifier Name: 1'110Xia S a fGI t2. tPhone#: 1 /� �to3 1, St 2 3 b7
�g
State Certification or Registration #: C Glb .2 to 2_L Certificate of Competency #:
DESIGNER::Arrccjhitect/Engineer: V !Ck'Or C 3 on � Phone#: � Z52.52.9Z
Address: a D q 3 VO 0 k -C t (? 1✓�' CU City: f a n(vt State L Zip: 33 I �7
Value of Work for this Permit: $ if l,�0 , Square/Linear Footage of Work: —�T� ? ti
�'(5 2303
Type of Work: ❑ Addition ❑ Alteration LJ New
Description of Work: \v 100 CI ?Lf Q O vt '» x 14,
J
❑ Repair/Replace ❑ Demolition
-tach.k d -o i Ko u C
Specify color of color thru tile:
Submittal Fee $ el ` °C-1)Permit Fee $ 449* 41 CCF $ ' (. " CO/CC $
Scanning Fee $ o r1 (---1 Radon Fee $ o , DBPR $ o;,'p
Notary $
Technology Fee $ 1 NFPen Training/Education Fee $ Double Fee $
Structural Reviews $1 °( 1; ''i Bond $
TOTAL FEE NOW DUE $ <�` 3) a !! i)
(Revised02/24/2014)
i
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) ()WO-- '€(4 \N/
Mortgage endder's Address
City A 4 -
Wsa (e tkAofL't�.k.�
p` 0
State Zip In 1 0 1
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 -a d construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of- corded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the biH�tj`/permit is issued. In the absence of such posted notice, the
inspection will n • \, approved and a reinspection fee will be chargec CP
Signature Signature -i,
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of nJU \.y , 201 ("4 , by
j1`.Iam ,Q'-1 , who is personally known to
me or who has produced rt- ID L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: -%C1. a
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of J utile , 20 t , by
�Q,(t Q SCkf e► _e�% Z , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Print: )r-rl ri q
Seal'"
S
.0.0.4:•;;;„..KARLA A GGIMIEZ
M'{ COMMISSION # E'E869904
*******1`' **EXPIRES Ja*
nuary 29.2017
v4 7, 398-0153 FloralaN • :: Service com
APPROVEBY
(Revised02/24/2014)
4,0*, 6A A GOM
MY COMMISSION # IE839,94
EXPIRES January 24. 2017
7/1
PI
***** *
((_: � _ •
ns Examiner
liar******
Structural Review
Clerk