EL-17-446BUILDING
PERMIT APPLICATION
❑BUILDING
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
REC
r -l=' 1 701
FBC 201(4' t
Master Permit No. p.pM
-- � _C S
Sub Permit No. ( A _UUCP
ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
4/2
City: Miami Shores County: Miami Dade Zip
Folio/Parcel#: // 32O " O1. _—a
Occupancy Type:
Is the Building Historically Designated: Yes NO
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: 23 S 1✓�'cyli�
City: /7%,,
Tenant/Lessee Name:
Email:
Zak: ) G/s'1 -
State: ;-?-.
Phone#:
Phone#:
Zip: 33
CONTRACTOR: Company Name:
vtc__-_f
Address: ,�� ' -O l/C Ui✓
Phone#: ; Of fz
City:,/,`—;
Qualifier Name: ?'1
State:
State Certification or Registration #:,�-e 0 0 `�
Zip: 'T~ ;)
Phone �j
#: - �� -
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: / 3X)�� City: State: Zip:
Value of Work for this Permit: $ / L Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Descriptidn of Work:
❑ New El Repair/Replace ❑ Demolition
et): y
71
Specify color of colo(rrtthru tile: C. �y
Submittal Fee $ `C? r1' ')Permit Fee $ l?�'�� CCF $ W, r �/ CO/CC $
Scanning Fee $ ( Radon Fee $ C-( , SC) DBPR $ ( sC-' Notary $ r
-meq
Technology Fee $ , [.�) Training/Education Fee $ ^ 21(S Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 6,Cj • —(.;C
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State 1 Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City Sta - 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 brochui'e 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 permi . . - . In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
3 day of ,7/ eZ 20 / 7 , by day op�
f V/r "1 , 20 , by
•,1',1 ,--.,7,1-4---'‘ , who is personally known to 0r , V7? vi' �, who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
,%t ALFRED MCKNIGHT
:.: :.g Commission # FF 065936
.���. •
Expires January 23, 2018
,•
Boded Thru Troy Fain Insurance 800385.7019
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*****i*********i###**********rtrR*****************##iii**** ******** ******** *************#####r *************
APPROVED BY
AI
-.2/ Plans Examiner Zoning
Structural Review
Clerk