WS-16-1304 Miami Shores Village aBX: 1
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Building Department
10050N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 '(
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2/0114
BUILDING Master Permit No. .VV
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
i
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ^ IJcj �� 51
City' Miami Shores County: Miami Dade Zip: 3a Q>s
Folio/Parcel#: �� 3�( ,-UIQ-S��C� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):-,h N rPA Phone#:
Address: �q U ED q 45
City: to Ckrrn, `�hprP�S State: (4 0 Zip:
Tenant/Lessee Name: Phone#:?,o5�
Email:
CONTRACTOR:Company Name: 'niip, i j ( Phone#: ,
Address: ZkcX��
City: tx� State: Fl. Zip:
4
Qualifier Name: (�c..�,o p "� Phone#: 15 1?,-
State Certification or Registration#: '')oy- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ In, OC77 Square/Linear Z
ootage of Work:
Type of Work: F-1Addition [:1 Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: g zic e c:nenA cx= wy 6,p�_;r,r r'[ �s� �,�
Specify color of color thru tile:
Submittal Fee$1) Permit Fee$ b ' 0 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)
B vending 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 installation a
pP Y p s s 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: Asa co a th issu a of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith ti
t a co y of th notice of ommencement and construction lien law brochure will be delivered to the person
whose property is subj ct to at achm t. Also, a c tified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ich c s seven (7) ys after the building permit is-issued. In the absence of such posted notice, the
inspection will not be approv a reinspe on fee will,be,charged.'`:;
Signaturex ure
O ENT CONT TOR
The foregoing inst ment was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 by day of_ 20 ,�, by
who is personally known to — a ��t'� who is personally known to
me or who has produced l�V�. as me or who has produced as
ijdentification nd o did take an oath. identification a w o did take an oath.
NOTARY PU I NOTARY P C:
Sign: Sign:
Print: ! Print:
V Pr .,
SCAR SEKI
Seal- := MY COMMISSION#EE 851033 Sea I: MOCOMMISSI)N#EE 851033
,W_ EXPIRES:March 9,2017 EXPIRES:March 9,2017
Bonded Thru Notary Public Underwriters aL�' Bonded Thru Notary Public Underwriters
F h•
APPROVED BY ( Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)