PL-17-2205BUILDING
PERMIT APPLICATION
0BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
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
Master Permit No.
Sub Permit No.
PLUMBING ❑ MECHANICAL 0PUBLIC WORKS CHANGE OF
CONTRACTOR
JOB ADDRESS:
50 ) I o
R:.caveb.
AUG 31 7017
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FBC 20N
iaC I l - 2207_
PI R- - 2205
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores ( County: Miami Dade
Folio/Parcel#: �^ 32_19.5----t7 1 �"' Is the Building Historically Designated: Yes NO
Zip: 33)3 fb
Occupancy Type: Load: Construction Type: Flood Zone:
Fi
OWNER: Name (Fee Simple Titleholder):14T9 14N
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Address: t 9 (vim 1\15 L 6 C54
M \ A M 1 (..e -_A
BFE: FFE:
Phone#:3O5-OLv-z/
State:
Zip: 33 Ve2
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: S'/&1t)c% PIumbiio CorriI aml Phone#: 3�1'"v�ga°(
Address: ';22.';22.CraSdr` g1Vd X017 J
City: 1g
14/ 5. revrte State: F�
Qualifier Na /
Name: Wi (S ger,9001icy(1olrN.
State Certification or Registration #: e FC- 0S7 +8c., Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $ 1/2.,00,44
Type of Work: ❑Addition Alteration ❑ New ❑ Repair/Replace
Description of Work:/MA/w')
zip: 33I (C
Phone#: 3 36%""a`/,21
Phone#:
Square/Linear Footage of Work:
State: Zip:
� lG�a-ckrna
❑ Demolition
a
•a
Specify color,ofcolor thru tile:
Submittal Fee $ --- - - - - - - Permit Fee $ -- - = /5 CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ I ___ °�"/ 7
,rl�r
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.
OWNER or AGENT
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument wasacknowledged before me this
gp day of , 20 11 , by a3 4
�day of 41- , 20 17 , by
1 l
<��� Ilii.. �C�la,1� , who is personally known to �Ui3 QEriou-c)noV‘ , who i ersonally know to
me or who has produced V-51046 Wi Y 1 Qas me or who has produced
identification and who did take an oath. identificatio d who did take an oath.
NOTARY PUBLIC: NOTARY PUB
Sign:
Print:
Seal:
MY CO OMISSION k FF151364
EXPIRES: August 14, 2018
*************************** ********
APPROVED BY
(Revised02/24/2014)
Sign:
Print:
U
Seal: UILLERMO 1GUYEN PORRAS
:�:; ,� �•:
MY COMMISSION #FF077653
ora?: EXPIRES December 18.2017
n.,,
4407 398.0153 Floridallota Service.Com
Plans Examiner
as
************
Zoning
Structural Review Clerk