REV-18-1399BUILDING
77,11IT APPLICATION
Miami Shores Village
Building Department
LDING ELEQRIC10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 ;`t�'—
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC2011Master Permit No /2 2f7- 2
Sub Permit No. 1' e.v `e— ��' 9
LDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0 RENEWAL
AY
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Age /VW
City: Miami Shores
94
County:
Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type:
Load: Construction Type:
OWNER: Name (Fee Simple Titleholder): , LZ.'//( .hi e , O Phone#:. �i 9�z9
'
Address: /8// -Titi /rD/S 4 eweto/2. &-/6D
City: edj State: Zip: /6v
Tenant/Lessee Name: Phone#:
Email:
Flood Zone: BFE: FFE:
CONTRACTOR: Company Name: & r ,tri7b170/1a/ Mel ,S;il&hone#:'S' 26
Address: /6 t'S/ /Lli 8/ CT Ffs%D /S
City: Ali t%�ag4 State: Zip. .3 de,
Qualifier Name: '-'6 / 1l3 "—
State Certification or Registration #: C± C.. / ,®4'. Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ . q Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:, C— /1 e/ S u/ 1--,1T76-,'J. t0 J_ orins
al-- Beciroo/)7 ,
Phone#:
Specify color of color thru tile: � 0
Submittal Fee $ Permit Fee $ v( •. CI° CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
•f
Technology Fee $ Training/Education Fee $ Double Fee $
c
Structural Reviews $ ..( -• CA) Bond $
TOTALFEENOWDUE$ (.fly. • /3
(Revised02/24/2014)
11 Bonding Company's Name (if applicable)
, 0'4'5 rr
Bonding'Company's Address
City State Zip
•
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 4`.
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 iand 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.
�rt
"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."
r
Notice to Applicant: As a condition to the issuance ofa 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 i reinspection fee will be charged.
Signature
0
or AGENT
The foreg ing instrume was acknowledged before me this
2,1 day of ,20 _8 by
3010r , ' SV fhb r``Q� , who is personally known
me or who has produced Y k 1 (4,
identification
NOTARY PUB
Sign:
Print:
Seal
ndw •didt
IC:
YANADYPR
MY COMMISSION # FF 214031
EXPIRES: March 25, 2019•
Bonded Thru Notary Public Underwriters
APPROVED BY
(Revised02/24/2014)
Signature
ONTACTOR ,
The foregoing instrument was acknowledged before me this
Zd Ztday of , 20 Et , by
to 0 (e . V\-,.S,,w,br1/41 , who is personally known to
as a or �ITo has produced r1V�QY 11 �1�Q�I�g`l as
identificati. an. • ho did oath.
Sign:
Print:
Seal:
*************************
Plans Examiner
Structural Review
..,. ,F.'Py . YAN% i PRIETO
'; MY COMMISSION # FF 214031
EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
Zoning
Clerk