REV-17-2511Id
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
❑ PLUMBING ❑ MECHANICAL
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
❑ ROOFING
RECEIVED
OCT 202017
0_11-1
Sfi
FBC 201q
Master Permit No. � ' -
Sub Permit No. iZG\il - ZS
REVISION ❑ EXTENSION ED RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: q6-145 S /4 e. 410 Ave.
City:
Miami Shores County:
Miami Dade Zip:
Folio/Parcel#:
1132660/3c110
Occupancy Type: Load: Construction Type:
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1) \1 Phone#: 3 75(p-3-7 J
Address:W00 /sJ a fkVG
City: wokAm 1 sd, State:
Tenant/Lessee Name:
Email: n,1 I4e61 p/0Q
CONTRACTOR: Company Name:
Address: 1 1 (C70
Phone#:
.tu, . Cart
Zip:
Phone#: g513/362--
City: v t t' State: Zip: -R5
Qualifier Name: Mt V4
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: 7470
Value of Work for this Permit: $
�,
�^� Phone#: qGq L /2.�d
�cto4 Certificate of Competency #:
Phone#:
City:fAve 5
Square/Linear Footage of Work:
oD. db
Zip:'��
Type of Work: ❑ Addition )0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: AD Y nAl--. ti4i't I'4 (3) , 13041
,v (rz. , WALL
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 2 S5 CCF $ -5' C4O CO/CC $
Scanning Fee $ 1 �-- ' Radon Fee $
2_ —SS
DBPR $
3. 3 3 Notary $
Technology Fee $ q • 20 Training/Education Fee $ 1 ' o C5 Double Fee $
Structural Reviews $ 730 Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
B ndingtbmpany'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. 1 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 p• -d at the job site
for the first inspection which occurs seven (7) days after the building permit is issu=d. In the abse = e • ch posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT /
The foregoing instrument was acknowledged •efore me this
SZ(, day of (9 L21," , 20 i % , by
-e &tem 11, Vwho ispersonally known to
i� or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
y,+i'' ELIZABETH ELORRIAGA
MY COMMISSION # FF953538
orr• EXPIRES January 25.2020
************##11#1151021114t*** * *s** *******************
Signature
The foregoing instru
dayiof`
me or who has produce • as
identification and who did take an oath.
CONTRACTOR
nt was acknowledged before me this
,20 / ,by
, who is personally known to
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
"/311
Plans Examiner
LINDA R. WALTON
Commission 0 GO 11911
My Commission Expires
October 12. 2020
******************************************
Zoning
Structural Review Clerk