EL-16-2684BUILDING
PERMIT APPLICATION
El 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
0 ROOFING
RECEIVED
SEP 3 0 �2016p •
FBC 20 ISI
Master Permit No. -1-C 11,-1 G•301
Sub Permit No. € I I(o - Z(,&
El REVISION ❑ EXTENSION RENEWAL
El PUBLIC WORKS 10 CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 445 NE 94 ST, Miami Shores, FL 33138-2845
City: Miami Shores County:
Folio/Parcel#: 11-3206-014-0520 Is the Building Historically Designated: Yes
Miami Dade Zip:
Occupancy Type: Load:
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): DARREN OCKERT
Address:445 NE 94 ST
BFE:
NO
FFE:
Phone#: 917.573.9022
City: Miami Shores
State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
0/14
1 -
Address: ' 3 D 3 N ! «
Phone#:?5'L( 9 7 ^ `i ? yo
City: C. Go I t 1 S t' F 5 State: )^ I
T 0Aci Q A 4 -`o
State Certification or Registration #: D 3 9"
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $ 3Q L? 7-0
Qualifier Name:
Zip: 3 3 d 7 (
Phone#: 75-1 sG - 417 Yd
Certificate of Competency #:
Phone#:
State:
Type of Work:
Description of Work:
�!f
Addition Alteration'
Zip:
Square/Linear Footage of Work:
New
Repair/Replace
Specify color of Color thru tile: C'
Submittal Fee $ 6-0 ' vv Permit Fee $ ,j,3 I9' y,3 CCF $ Z3• k) CO/CC $
Scanning Fee $ 3 • Uv Radon Fee $ 20 •a9 DBPR(($ v' I Notary $ •
Technology Fee $ t ' !- O Training/Education Fee $ �V Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $ 2
TOTAL FEE NOW DUE $ I,400 • 01-3
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
OWNER or AGENT
The foregoing instrument was acknowledged before npe this
day of 3v`-1 , 20 I
1C-Eg , who is personally known to
me or who has produced 7 0)21\.2- u cce.I'as
identification and who did take an oath.
Signature
CONTRACTOR
The foregoing instrument as acknowledged before me this
by !.// /da of 20 l(
, by
O./fr/ • , who is personally known to
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
*****************
APPROVED BY
(Revised02/24/2014)
00\ (.2-
- -
04 ,5.0 Pue,� Notary Public State of Florida
;. % f' Sindia Alvarez
,s c_ o My Commission FF 156750
'40, ft, Expires 09/0 312 01 8
*
*
me or who has produced ------ as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*************
P/'02.--. GPlans Examiner
Structural Review
�?/'r!asi
Notary Public - State of Florida
• f My Comm. Expires Nov 14, 2018
Commission # FF 161435
" Bonded through National Notary Assn
************
***********
Zoning
Clerk