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Miami Shores Village
RECEIVED
Building Department SE2016 .
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201 .
BUILDING Master Permit No.CC-12-15-3013
PERMIT APPLICATION Sub Permit No. (;�E� 1C0 " E�'
❑BUILDING ❑ ELECTRIC ❑ ROOFING K REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2nd Avenue- Fine Arts Quad, Miami Shores, FL, 33161
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Barry University Phone#:
Address: 11300 NE 2nd Avenue, Miami Shores, FL, 33161
City: Miami Shores State: FL Zip: 33161
Tenant/Lessee Name: Jeffrey Yao Phone#:305-899-3995
Email: lyao@barry.edu
CONTRACTOR:Company Name: Sk-A62 S(CA USA b%-4'tj-W 17 Phone#: S` , 20 2'7-
Address:: + (91 S < l)M'[ 1 hl R-O" Iso 17-E -2-04
City: UA*JIA &ACW State: FL Zip: 3300V
Qualifier Name: F4,5z7Pg n'm ck" U/4fKtz:& p� Phone#:
State Certification or Registration#:CGI✓ j s) ��3 I Certificate of Competency#: _
DESIGNER:Architect/Engineer: Harvard Jolly Phone#: 5614784457
Address:2047 Vista Parkway, Suite 100, City: West Palm Beach State: FL Zip: 33411
Value of Work for this Permit:$ O. no Square/Linear Footage of Work:
Type of Work: ❑ Addition N Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:�-LG ', SOWN APO SW TN WE-ST W�a 6S rr-jW 65a D to Liv Yt k- 10,zNoVAI-I'CV�
(,loRtN AI-0 WtNfoS C;L;min9KfiiorJ br So&Av- Oc11( WAijk-S A00
C.SILINbS —A - 1, �LltaiND��600� CSC IRS �'fLA In�A-�S
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
F
� - J
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 commenc nt must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In sence of such'posted notice, the
inspection will not be approved and a reinspection fee will be charged.
IA
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acl owledged before me this The foregoing instrument was acknowledged before me this
da of p n 6th 20 16! , by day of_ 20 by
Dom., ,who is personally known toMWV,�—� who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
`, �•s1.�� /moi
Sign: z �Z9.2o��q $ Sign:
Print: Print:
14 220337 :Q
Seal: �.�� �d�N ;oQ` Seal: o�,n.,,� Notary Public State of Florida
�i��i9�A;j P+bGcUn � ` : Diana Adams
My Commission FF 042570
OF4d'flI Expires 0911612017
APPROVED BY Plans Examiner ning
f�
l Structural Review Clerk
(Revised02/24/2014)