PL-17-447Miami 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
{.SFR 9 1 ` fl
FBC20
BUILDING Master Permit No. 3PP 19-' LLC i5
PERMIT APPLICATION Sub Permit No. P I r4 -U U
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
412 /t/e. 9'6 5Z t -
City: Miami Shores County: Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Z._74/./1// j///9 £.. 1-- Phone#:
Address:
�2 3 �% G✓.t, �n 1it.:'
City: /%//d -7j State: Zip: 3-3/S‘i
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: , Da -c 0 lit 42-\4n G Phone#: '7g G .3 f3 9 d
Address: 23k -i t'4 CZ-cQ€-1 ✓ei rte- 7-
Kat— City: C p Gt Lr r
a—�, (-4a State: r L. Zip: 23r L-,
Qualifier Name: DA v 1 L J o h rI Phone#: 716 t 93 c1s9 it
State Certification or Registration #:Cf C l 11 J !' L ,:_i / Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ElNew
i': -e1
Description of Work: %"G''� ",iD
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 50 {' E Permit Fee $ ./2.1) CCF $ 0 CO/CC $
Scanning Fee $ Radon Fee $ `7 F DBPR $ 3 -::2? �'Notary $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
.?10
Training/Education Fee $
Double Fee $
Bond $ nn
TOTAL FEE NOW DUE $ 6 `"1 2.
Bonding Company's Name (if applicable)
Bonding Company's Address
City State ( J 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 commenme t must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. 1 e absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature `---------___ Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 day of .-)hbc.L , 20 1 , by ‘7 day of J A Vt c! a-Jy , 20i , by
%,ice S 1/e, , who is personally known to ri A- >J rJ - 14 , who is personally known to
me or who has produced as me or who has produced ;7 as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBIC: I i NOTARY PUBLIC:
Sign
Print:
ALFRED MCKNIGHT
Seal: '::: Commission # FF 065936
q Expires January 23, 2018
°.�� Bonded Thru Troy fain Imam800.398.7019
Sign:
Print:
Seal:
*********************************iii********************I.********************** r***************************
APPROVED BY
I Dn..inn.d/17 /7 A /')fl1 A%
Plans Examiner Zoning
Structural Review
Clerk