REV-17-2936Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPL ATION
BUILDING ELECTRIC ROOFING
PLUMBING ❑ MECHANICAL
[]PUBLIC WORKS
JOB ADDRESS: 27 4/E -/ tIS?QG-T
Master Permit No.
Sub Permit No.
RECEIVED
jp...10)7
FBC 20 l y
��-'0-17-•2517
REV iq Z93
0 REVISION EXTENSION
[] CHANGE OF ❑ CANCELLATION
CONTRACTOR
E RENEWAL
SHOP
DRAWINGS
Occupancy Type:
City: Miami Shores County:
Folio/Parcel#: Is the Building Historically Designated: Yes
Load: Construction Type:Flood Zone:
BFE:
3/3t
NO
FFE:
D
OWNER:-Nammee (Fee Simple Titleholder): rQS 7; `O °, 1 ►0p �,V v osTry`a�7
/ f Phone#: ��p�- 3 7 (p - q1 �p v
Address: 5.3 SU)
a r Tp�ra.ce,
City:
Tenant/Levee Name:
Email:
State:
CONTRACTOR: Company Name:
Address: �SL(
City:
o ; ` (( S /.
Qualifier Name:
0
Mrl✓n,
zip: 3.7,93
Phorie#:
LVS-31(0- IS5
Phone#: 3sy s7'/ -7GZ5'
State: �' l
l�Sls .r��{) , ,clr'(pi -F•
State Certification or Registration #:
Miami Dade Zip:
Zip: -3-3/ zl�
Phone#: 3c 7 S--7 -
Certificate of Competency #: q 7L-C. cDc c,o 3
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
aVV,alue,of_Work.for thispermit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition E Alteration n New ElRepair/Replace
Description•of Work:-- 1-- 1•1�lZ elr CA_,-4 10 2' e 0eQ e"
3 o-v f le is fel 4hv /.; +cha t
L ilZ C9 c 7
0.00
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ , .: -Permit Fee $
Scanning; '' `�
Fee $ Radon.Fee $
Technology Fee w>���;.�»�
$ Training/Education Fee $
Structural Reviews $
CCF
DBPR$,,~�
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City L , State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
1
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 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 nest• I'
mat
promise in good faith that a copy of the notice of commencement and construction lliened law brochurevaluedinwill be delivered tog $2500, theIicant the permust
son
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. !n the absence of such posted notice, the
inspection will not be appro aand a reinspection fee will be charged:
(L a
gnature-r-..
i
rAGENT
The foregoing instrument was acknowledged before me this
Imo; day of RejZ 20 (
who is ers' p n. ly known to
me or who has produced
identification and who did take an oath.
t.
NOTARY PUl3lIC:
Signature da---drt
CONTRACTOR
The foregoing instrumept was acknowledged before me this
P day of : 00 Q.CO44 c, , 20 (7 , by
OS.Vo.la�o__ oOi.
_ __ ,Ho is personally known to
by
as me or who has produced
identification and who did take an oath:.
NOTARY PUBLI :
Sign: �i1 V41JlW \ l I
Print:
Seal:
***************
APPROVED BY
�► Notary Public State o1 Florida
• WAQAAS MERCHANT
'fir A* My Commission GG 151488
****ours** ` AYWO 1*********
i
Print:
Seal:
*****
17,®2c L>"Plans Examiner
*41
e i0
fQt/
.
. t;a!, o' AIREN SUAREZ
Lei
+°. �.� : Notary Public - State of Florida
N` " : •= Commission # GG 013555
os ry f •*May+C.roise. tyiiesitbieq�i i0
iiRA
""" �f,,,""� Bonded through National Notary
y Assn.
as
*************
Zoning
(Revised02/24/2014)
Structural Review
Clerk