DS-16-2323 Miami Shores Village
D
Building Department AUG�I8 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax: (305)756-8972 !PY:
INSPECTION LINE PHONE NUMBER:(305)762-4949 I 5
FBC 2014
BUILDING Master Permit No.T)E�1 `O--a3a3
PERMIT APPLICATION Sub Permit No.
02�dl ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING F--] MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION Q SHOP
C g� CONTRACTOR DRAWINGS,
JOB ADDRESS:
City: Miami Shores Countv: Miami Dade Zip: r
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Phone#:
Address: )•
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: A_VA_ AX@_ 0OV6 CA9_ &aj'o
/ Phone#: ��(a ll
Address: a
City: State: t Zip:33 1 66
Qualifier Name: l Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
0
Value of Work for this Permit:$ SODS- Square/Linear Footage of Work
y
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Re ce ❑ Demolition
I
I
Description of Work: C�
y ° i
' 1
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$ 2
TOTAL FEE NOW DUE$
(Revised02/24/2014)
r
Bonding Company's Name(if applicable)
Bonding Company's Address
City, State Zip
r
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 OKAN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
fi }
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' Signature
OWNER or AGENT CONTRAC OR
The for ing instrument was acknowledged before me this f oing instrument was acknowledged before me this
1 !2 day of 20 , by y o ►`F �� 20 by
Who is personally known to , 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: F
t
Sign: _ _ "'" + Sign:
+ �cAi A IA'DE BRVW41 t d x «�.. •--3
Print: If �M� Print: "" L,
`� L.'Si'i a �gusd w, r � �����n"� 'h�1�'0(b1�VII�,Sit�J�ff�+;R9et+:=•
Seal: � oicw�z`� L Seal: 1 � f�1Rfeus+ nj
i.A���"�.""'m"'u'+ticw.iK'...va!, IMid �i! � , �1TTI.q�'kdtn➢Y`fJ-Yy1A�N+li¢saa
APPROVED BY �o/f ` Plans Examiner Zoning
+
Structural Review Clerk
(Revised02/24/2014)