FENCE PERMITMiami Shores Village
IC_1— �r , 7- 1Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel: (305) 795.2204 Fax: (305) 756.8972
FRE
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20 to
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
� C -1z' 5( N
Permit Type: BUILDING
JOB ADDRESS: 7,
i
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): "Ar -4 AEE Phone#: 7 • ��
e
Address: h -1 % �` �i—
City: A a .S Hr4W State: Zip: �✓f�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: � ,e_fhwr t4,aj5 &yP,,;) '10C_ Phone#:�3 '3%2"
Address: /%I r-. Ak–"= , , :5u i R -N?-
City: M I 4AM State: rz Zip: 33-131
Qualifier Name: �_ Phone#:
State Certification or Registration #:ICertificate of Competency #:
Contact Phone#: � Email Address: i7mar e- r 4' 4' A
DESIGNER: Architect/Engineer: Phone#:
Value of Work for its Pexn is � d ., , .:� Square/Linear Footage of Work: 3 4
Type of W k: ❑Addition° ❑Alteration ONew e 1 act_ T C�Demolition
DescriptioofWork
,,
J. A
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 t be osted a job site
for the first inspection which occurs seven (7) days after the building permit is, issued. In the ab , ce of s h p t notice, the
inspection will not be pproved and a reinspection fee will be charged.
Signature Signature
Owner o�ent Contractor
The foregoing instrument was ac/,,,w �eforree me this � The foregoing instrument was acknowledged before me this
day of y, 20 L 3, by IJ�S __y L c: , day of r , 20 J3 , by GK ,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
APPROVED BY
Notary Public - State of Florida
My Comm. Expires May 16, 2017
Commission i FF 012325
Plans Examiner
Structural Review
NOTARY PUBLIC:
My
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Expires; May 16, 2017
s10n #► FF 012925
Zoning
Clerk
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BLOCK - 215
LOT - 15
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RES. # 62
LOT -3
BLOCK - 215
24.85'
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7
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MIAMI SMOKES VILLAo E
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LOT - 13
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SCT TO COM?LIAN„ E ,4i fti ALL FEU RAL,
T) AND COUNTY RULES AND REGULA ION=
75.00' — --
15'ALLEY (N.A.P.) 11' ASPHALT NO CAP
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LOT - 14
BLOCK - 215
LOT -15
BLOCK - 215