WS-16-3015Miami Shores Village
BUILDING
PERMIT APPLICATION
1Ir g D rtiettent
. # & ,vu .t. 1 [ sh i is ,.
1.0050:# :2nd Avenue Miami- hores, lor-ida 33138-------�-
Tel: (305) 795 2204 Fax x(305) 756-8972 •
INSPECTION UNE PHONE NUMBER: (305) 762-4949
•
FBC 20e4
Master Permit No. Ge.) - ( .6-ajtS
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /6/ 'i/6 /04 5T
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: //2 /36e0 603 $ o Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): cht-4-J
Address: 3 8 2( ' P.,,a_0? 66,
Phone#: 305 °l8 9 3 5 5 /
City: /t -P<.1 -0.- r, State:
Zip: 3 3 / 3 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: /7-8 S w 3 3 P%
406e/5846 3 8
Phone#: e) .5 36 52- 140
City: /4'4 Ai / , /J . -h State: F(6' !
Qualifier Name: {7o2% !A /J e)
State Certification or Registration #:_._.,...—.a-Gertifrcate't5f'Compe en #: 4R A 5 bb 2-2-3
DESIGNER: Architect/Engineer: r, • ' ,/-- 7 r A, ,.
�'• , Phone#: •
Address: 1 t•• r `J City: _ ../ State: Zip:
Value of Work for this Permit: $ i2, - ..__,..,.-Square/Linear'Footageo or :
Type of Work: ❑ Addition
❑erato)n ❑ New �)❑Repa
ir/Reeplace ❑emolition
Description of Work: WI N�W L 2j0Eai+H�JL/rCVD
Zip: 3 3 4 (R.
Phone#: SDS 36</7 752
Specify color of color thru tile:
Submittal Fee $ • 03 Permit Fee $ 290 • W CCF $ O_• CO/CC $
'
Radon Fee $ �-P.31- DBPR $ .3 Notary $
Technology Fee $ 0 U Training/Education Fee $ 2 - Gc Double Fee $
Structural Reviews $ Bond $
Scanning Fee $ 2. 03
(Revised02/24/2014)
TOTAL FEE NOW DUE $ 29\ g(:)
Bondivig 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 < L• r'r
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 alblaws 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.
The foregoing instrument was acknowledged before me this
c;)6 day of 0 6)s3G42
sE2,4T Si413/-
me or who has produced as
identification and who did take an oath.
,20 1'6 .by
, who is personally known to
NOTARY PUBLIC:
Sign:
Print:
Seal:
MARY D. CAMARGO
a?•+ (fl ..`°" SS M #FF242221
y2,.t'.,,M
J„I '1,2019
_. ate Insurance
a ,
6..16, °r
.40
-� ���
Signature `mil'
CO RACTOR
The foregoing instrument was acknowledged before me this
dZ //day of / ( , 20 16 , by
, who is personally known to
me or who has produced /7 5,0 f% k i as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
##################******######## #### ### #####################
I6 o'
APPROVED BY
IRcvicmrin, /7A /Wn7 AI
Plans Examiner
Structural Review
.•: REINALDO P
MY COMMISSION # FF980486
EXPIRES April 10, 2020
(407) 398-0153 F oridaNdery9erv� Com
###################################
Zoning
Clerk