REV-17-1527a
BUILDING
PERMIT APPLICATION
4'UILDING ❑ ELECTRIC
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
El ROOFING
FBC 2014 s}h
Master Permit No. Z.) S 7 Z S
Sub Permit No. f)1-C\i Al— 152.-1
REVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING 0 MECHANICAL PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: /0/ /v t J ( 0 0 t-'€'674:
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County:
Folio/Parcel#: 7/3/0/ 0 Z. 2 05 o 0
Occupancy Type:
Miami Dade Zip: -3 3 /ro
Load: Construction Type:
Is the Building Historically Designated: Yes
Flood Zone: BFE:
NO
FFE:
OWNER: Name (Fee Simple Titleholder): /i/(0/ 1 9o(-Zi/4-%`s/ GL c- Phone#: 7 x� vs �i 77 29
Address: 23 t
0 // ///0 1 P,Z� / /
City: ../1 ( 0)....t4/ S //U2 S State: i C Zip: 3 3 l p i
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 7;2 (j.c,Q Gj %i},,�,0-e G�i<i C/L ezz Phone#: �! 0c c -(9`4767 j
Address: ,g, 2 0 S y9 7— /
City: A/) /01- A-11 _ State: /- C Zip: -27 33 /,r--5.-
Qualifier
SQualifier Name: Pili(( r!/.y. L 7-4.4 A- Oct Phone#:
State Certification or Registration #: 6—.570/0 07e -f? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1-5C-6? t7 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of Work: /Lig ,., 401✓G/ .' /"t'c
6)- 'ire A -a 5 --.1) ' LS lb-sn
Leek
❑ Repair/Replace
❑ Demolition
cX %Q �iQ ( �P4i,,�
fN WteR S Oa -tee Ssl""y ",
Specify color of color thru tile: c
Submittal Fee $ Permit Fee $J CCF $ CO/CC $
Gt
Scanning Fee $ 1 Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 4 L
(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 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.
Signature X
Signature
OW R or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
s day of �v� 42.
, 20 /7 , by D� z-,
day of 3C..,"--,-(2-, 20 / i , by
4/1-(A 4,1, nifs4o Rwho is Ersonally known, 4/7/: le /a -►^'1 7-4.-44--/Z //who is ersonally knowJ)
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
y&61-D-If2,1J_2
;101'-1 t. ARANELIS GONZALEZ
1*.:4 MY COMMISSION It FF 913308
.-w4a€ EXPIRES: September 18, 2019
'r °; ,h.`•• Bonded Thru Notary Public Underwriters
APPROVED BY
(Revised02/24/2014)
8/0
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
tib, ARANEUS GONZALEZ
;;: MY COMMISSION # FF 913306
EXPIRES: September 18, 2019
• Bonded Thru Notary Public Underwriters
Zoning
Structural Review Clerk
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