REV-17-736BUILDIN
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
ONE NUMBER: (305) 762-4949
❑PLUMBING (kC'MECHANICAL
JOB ADDRESS:
❑ ROOFING
MAR 1 7 2017
BY:
FBC 20 IL4
Master Permit No. Qe -31C✓
REVISION -
Sub Permit No.
PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
5 ,)C to ' Sa
❑ EXTENSION
❑ CANCELLATION
❑ RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: L-11500
Construction Type: COS Flood Zone: BFE:
6ro'.p (0 CeA?, J Phone#:
lav
City: Miv)`Y1, State: �L-
FFE:
Zip: ?3023
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 3 (Z k Fe -e-r<( S� vi ces
Address: 2(.9 7 HO SW i 3o A Anz-
Phone#: 305- `i 15- 2 334
City: A O e S ka d
State: CL Zip: 33032
Qualifier Name:
State Certification or Registration #: CJ C ( 11 S '74
DESIGNER: Architect/Engineer: Phone#:
Address:
Phone#: 1 $% - Z10- vgo-i
Certificate of Competency #:
Value of Work for this Permit: $
q
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
City: State: Zip:
Square/Linear Footage of Work:
New ❑ Repair/Replace
MA) ._ A.. C: Po�S,� r X011
(5S ET
r
❑ Demolition
,, • ,
Specify or of 'color'tliru'"tile i
Submittal Fee $ Permit Fee.:
2,A011AV 0 RHT ;t"•''`~ii. 1
1S?Afcc?a ieu1e2,npmo:.)Yah , iw
arfc t -C •tpcm a3$V X.
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $-48
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) ^"- _- '
:` O f a7
Mortgage Lender's Address 1 r'& f-1 /`- •: \ + _, .., IA ?,' ` u ", . 11.:.',.. --,,P
r i 4
City State I. ` 1"=,"' �� 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
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
`{ day of Mac--- , 20 (1 , by 41 day of r,. o..c - , 20 (`7 , by
So r : i, -u , who is personally known to frA. 61, ,.. Pere2 , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY UBLIC: NOTARY PUBLIC:
identification and who did take an oath.
Sign:
Print:
Seal:
�.O F";: T A D VARGAS
'= MY COMMISSION # FF 221452
EXPIRES March 24, 2019
Sign:
Print:
Seal:
*****************************
APPROVED BY
(Revised02/24/2014)
I
ans xaminer
krcws
J
j'. HEA D VARGAS
•'.' MY COMMISSION # FF 221452
EXPIRES March 24, 2019
****************************************** ********
Structural Review
Zoning
Clerk