REV-16-3217Ral16-3214
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City: Miami Shores
Folio/Parcel#:
Occupancy Type:
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
RECEIVED
)N/OV 2 j016
FBC ioi�
Master Permit No. RC-- 2-1 "I 3
Sub Permit Not ( (0-
0
-❑ ROOFING AREVISION ❑ EXTENSION El RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
N 112 rid SI—
County: Miami Dade
Zip:
33150
Is the Building Historically Designated: Yes NO
Load: Construction Type:
OWNER: Name (Fee Simple Titleholder):JeXo
:ol ri / (auf
City: / iif' fj
Address:
State:
Flood Zone:
BFE: FFE:
e S L.LC Phone#: 3v5 g4z. —(I O
$a,; /5C)
F (_ Zip: '3/3/
Tenant/Lessee Name:Phone#:
Email: lilc-�``o i� � �d n s411P_S //C . CO/17
CONTRACTOR: Company Name: PC‘ OA ( di¢L 0e..v5/
Address: I S 2 1 rr l3,. fid, FY --
City: 4/...
.fCity:.4L. ts1 ,, e4 -(i State: ri
Qualifier Name: jO,ypy/ k .$'h. -.44
ification or Re
Phone#;.,3a,s;$ 176'67 p1
zip: 33/3 q
Phone#: /S'Y_ c f 3 -
�f'7l
State Cert
gistration #: C`y C /3- 7 / 7 C f Certificate of Competency if:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition / Alterationte`n New Repair/Replace ❑ Demolition
Description of Work: ,9c'c9eO /�J r( ve ,%\ - L �c%' is C
M -Frit (13 loci -(4 p ,460) r a ll ex*ri -; op7 /hJs d
ctr�
ben/ 8.;?,1 c/05
•,1rL "'SCS ..f . �!
Specify color o cillo ,thru tilerdV i
Submittal Fee $ C.J Permit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ (r ^w
TOTAL FEE NOW DUE $ t(.o 9
CO/CC $
Notary $ L O
(Revised02/24/2014)
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 issubnce of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reins�, ion ee will be charged.
Signature *m00% C Signa
OWNER or AGENT
The foregoing instrumentmewas acknowledged before me this
re
Z. p day of //D •, 20 1 6 , by
who is pe sonally known to
me or who has produced �L-- CC2-N►"2—
identification and who did take an oath.
NOTARY PUBLIC: `1N111111111/0/
0\rp.9(1d Ayyl /i�/i
=0• 0• fin:
:_.72_ 4'.': a_
Sign:
Print:
Seal:
as
*******************************
APPROVED BY
(Revised02/24/2014)
*. •.°91dX3 .......co
1
«�liIEIOIf111N1
CONTRACTOR
The foregoing instrument was acknowledged before me this
).+$ day of ,l/b d , 20 AA , by
I w�I k 1/44' , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
40-4
man*p sumNE
MfOOr
Ott
o E&113328,Saki In* ist Sou Immo
Zp,e
as
********************************************************************
Plans Examiner
Structural Review
Zoning
Clerk