REV-18-788�-I (-1tg
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BUILDING
PERMIT APPLICATION
❑BUILDING
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
❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: NE to(
Master Permit No.
❑ REVISION
Sub Permit No.
CC'V LL,
MAR 2 71018
BC201u
18=958
0-EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
Folio/Parcel#: 1(32
�a 1311 3 O
County:
Miami Dade Zip:
Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): 46'{ 1 vt7w
Address: L` i()6. (a i
33! 39
NO X
BFE: FFE:
Phone#: CO23 - 330 —9159
City: ltit d awA'
State: Zip: 3 .51 30
Tenant/Lessee Name: Phone#: Co.23 -356 --5407
C,Q-,nOW 14 iarvAeA V1144 1. c v wl
Email:
CONTRACTOR: Company Name: O V� "\/� vPhone#:
Address: \'\O\.k...1
City:
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
State: Zip:
Certificate of Competency #:
Phone#:
City: State:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑
Description of Work: 1 L evt4
Alteration
wL%ram
Square/Linear Footage of Work:
❑ New
❑ Repair/Replace
Zip:
n Demolition
Ae w4co( by z.;- loe 1/21/1g
Pf
Specify color of color thru tile: /� - - F,
Submittal Fee $ Permit Fee $ "v
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $(—Lc . o0
CCF $ CO/CC $
DBPR $ Notary $ 5
Double Fee $
Bond $
TOTAL FEE NOW DUE $ lR f
(Revised02/24/2014)
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. ;'.',
"WARNIN6'TOtOWNER: 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'fir`st inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be aped and a reinspection fee will be charged.
may,
•
i..6..., e � (f l".a � %.i i j Wm.;
SignaturSignature
OWNER or AGENT CONTRACTOR
The foregoing instrument wasc�knnoowledged before me this The foregoing instrument was acknowledged before me this
" -- day off` Ov� , 20 e. , by day of , 20 , by
3kv, D \a1v , who is personally known to , who is personally known to
me or who has produced 4.-A C 2.. ►
gas me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: - , NOTARY PUBLIC:
Sign:
Print:
Seal:
*******************************#*** **F�*******************************s*****s*****************************
APPROVED BY ✓ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)