ELC-17-1553 Miami Shores Village
Building Department artment �c�i
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10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 J
INSPECTION LINE PHONE NUMBER:(305)762-4949 S
FBC 20
BUILDING Master Permit No. S6Ni 1—
PERMIT APPLICATION Sub Permit No.F LC'
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❑BUILDING ■❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9545 NE 2 Avenue
City: Miami Shores County: Miami Dade Zip: 33138-2704
Folio/Parcel#: 11-3206-013-3910 Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name(Fee Simple Titleholder): DVS LLC Phone#:
Address:201 NE 95 St
City. Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Dunkin Donuts Phone#:
Email:
CONTRACTOR:Company Name: Sign Effex Phone#: 863-294-4498
Address: 512 Sixth Street NW
City: Winter Haven St Zip: 33811
Qualifier Name: James P. Richards, Jr. It Phone#: 813-404-9207
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State Certification or Registration#: EC0000562 Certificate of Competency#:
DESIGNER:Architect/Engineer: David Norris Engineering Phone#: 863-299-1048
Address: 112 Coleman Road City. Winter Haven State: FL Zip: 33880
Value of Work for this Permit:$ 100.00 Square/Linear Footage of Work: 36.435 SF
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
Description of Work: East elevation - installation of reverse lit channel letters measuring 36.435 SF
hooking to existing electric.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 1,5�te0 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)
i
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 Signatur
0 NERorAGENT CONTRACTOR
The foregoing instru nt was acknowledged before me this The foregoing instrument was acknowledged before me this
5k day of Z%me 20 Ir cJ by 5� day of Qn-e- 20 19 by
[ve11 411116 CLL who is personally known to OGfY1P_S P RiC (Jrd--rI who is personally known to
me or who has produced as Dle or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: ML1?-Q L±L- M. (T.1 Q m_!Xat
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Print:*398-'0
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Seal: EXPIRES June 21,2020 Seal: "e MY COMMISSION N GG004387
FbrldeNote ervia.com A EXPIRES June 21,2020
407 398-0153rys—
APPROVED BY �1 -Zt �!"Ci�l/f�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)