REV-18-1161(o X
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
❑PLUMBING ❑MECHANICAL
JOB ADDRESS:
City: Miami Shores
Miami 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
❑ ROOFING
❑PUBLIC WORKS
County:
MAY v2;;118
FBC 20 IL-1
Master Permit No. 1w —l119
Sub Permit No. 7`
I' REVISION ❑ EXTENSION
❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone:
BFE:
❑ RENEWAL
V el l I1Q
❑ SHOP
DRAWINGS
NO
FFE:
ke
OWNER: Name (Fee Simple Titleholder): ffnti a►VW ��Pri/ .�.i'v , tXi ` Phone#:
Address: 2/b s O 27 Tezz1Z4c e
City: LC7(7, 4'7 6;f2eVe State: Fe. Zip: 33 /3
Tenant/Lessee Name:
Email:
Phone#:
CONTRACTOR: Company Name: 3 ( PLY"M 5 STA,A..)/CF---&-
Address:3/ Z ' v�i V i (Lc 1 6,z,z
City: Hai/ w u C State: Ft.
Qualifier Name: �C�Gin 1/1
o.) &Lo n
State Certification or Registration #:
DESIGNER: Architect/Engineer:
c-Fe. -ono
Address: City:
Value of Work for this Permit: $
Phone#: :3G) .. y 70 -< 1 : 4
Zip: 35O /
Phone#: 78 rt. -- ?S'7 ' 6 2 7
Certificate of Competency #:
Phone#:
State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration i l New
Description of Work: L (i l4ec 4V pc -Ai
❑ Repair/Replace n Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ ' e-�
(Revised02/24/2014)
whose property is suja
for the first inspec ro
inspection will not / e
Signature
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 pernut 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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS. POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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
ect
attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
rt' z occurs seven (7) days after the building permit is issued. In the bsence such posted notice, the
and a reinspection fee will be charged.
The foregoing instru
to A
gent
nt 1 acknowledged before me this Zy
day of X.r/ , 20 L, by idraigiVDd ( ,
who is personally known to me or who has produced
f _ As identification and who did take an oath.
NOTARY PUBLIC: ,
Sign:
Print: IMAMI S M E2c_il# J T
My Commission Expi
******************
APPROVED BY
4V0
Notary Public State of Florida
WAQAAS MERCHANT
My Commission GG 151486
�nr Expires 10/15/2021
** **.*
*
Signature
ontractor
The foregoing instrument was acknowledged before me this 24
day of 4»u. , 20 if , by `Aiemcaror fto4.1 ,
who is personally kilawato me or who has produced_
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Conuniss
MARIA VELAZQUEZ
WY COMMISSION #GG080751
EXPIRES: MAR 14, 2021
Bonded through 1st State Insurance
***************************************************
Plans Examiner
Zoning
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09)