EL-16-2964JOB ADDRESS:
BUILDING
PERMIT APPLICATION
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
RECEIVED
0CJ-3I 2016
BY:
FBC 201+
Master PermitNo.bipi) -16 -2962
Sub Permit No. V L'O'lb-2f164
BUILDING 0 ELECTRIC ❑ ROOFING El REVISION EXTENSION
❑ RENEWAL
PLUMBING D MECHANICAL El PUBLIC WORKS D CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Srt .
IL
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QD
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
I I 3 Z r�S J l.8 �J (.C2 Is the Building Historically Designated: Yes
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder): �I
Construction Type:
atvv' l�l I 2
Address: I 1 Le £9 "
Sv tD 2S State: P(._-- Zip: 35 (
35 3s3
Flood Zone: A BFE: N I
NU •
FFE:
Phone#: c'(�I =c9
City: 1\../1.i r,,-,
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: SHINE ELECTRICAL ENGINEERING
Address: 3876 NW 125 ST
City: OPA-LOCKA State: FL
Qualifier Name: FRANCISCO SANTOS
State Certification or Registration #: EC0001514
DESIGNER: Architect/Engineer: PCi
Address: `9% -
Value of Work for this Permit: $
•.1❑ Alteration
Type of Work`: ❑ : Addition 1
$; Description of Work:' (•���'�
•
Square/Linear Footage of Work:
Phone#: 305-688-2000
zip: 33025
Phone#: 305-688-2000
Certificate of Competency #:
Phone#: -7 gc,
City: Cam`--�( State: •Zip:
I ,, Z 74— -P
New ❑ Repair/Replace ❑ Demolition
t•
Specify color of color thru tile:
Submittal Fee $ V,t 11 Permit Fee $gmd 'bd
Scanning Fee $ 3- CZ Radon Fee $ (to. `'
Technology Fee $ ' CDC) Training/Education Fee $ 0 • 't
Structural Reviews $ 52)
CCF $ . Zv CO/CC $
DBPR $ 4. G O Notary $
Double Fee $
Bond $ TOTAL FEE NOW DUE $ a/ '6 • 20
(Revlsed02/24/2014)
1.
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 - -
•� rr
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 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 b reinspection fee will be charged.
"Signature Signature
ER or AGENT
The foregoing instrument was acknowledged before me this
t day of �� Lc r, 20 L Cr., by
m or who has produ
1 , who is personally known to FRANCISCO SANTOS
be_ as me or who has produced
identi c-tion and who did take an oath. iden
NOT.' " PUBLIC:
Sig
Print:
Se
-"_
4 '.
..
MY COMMISSION # FF022108
EXPIRES: September
'4„Eklgte BerdeC Thru Notary FuCOv Uaderwr^ers
Si
Print:
Seal:
fication and who did take an
RY PUB C:
CONTRACTOR
The foregoing instrument was acknowledged before me this
2 day o -�. if , � by
to
as
YORLENYM �'•�;��: HERNANOEZ
.;+1 MY COMMISSION it FF022108
EXPIRES: September27, 2017
• Bonded Thru Notary Public Underwriters
• -4
##############################################################################******##################******
•
APPROVED BY f;2, �, -" fr/, Plans Exaininer, .Zoning
Structural Review
(Revised02/24/2014)
Clerk