EL-16-3153Tenant/Lessee Name:
Email:
OWNER: Name (Fee Simple Titleholder):
Address:
JOB ADDRESS:
City:
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
BUILDING
PERMIT APPLI TION
BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
(Nov�i 72016
BY:—C
-bn
FBC 201L--(
Master Permit No.'J PP -10-35(
Sub Permit No. f' -153
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
12c‘ /1/" �yS7r
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /1 3205-1-05 / " e1f/e) . _ .Is h uilding Historically Designated: Yes
Occupancy Type: Load: Construction Type:, 04, I! • Flood Zone: BFE:
di %44 yJ'/ Phone#:
/ Z96 ,c/a- q r ‘5.17'
NO V—
FFE:
City: /*ft ./2OCC'SState: Zip: 33/ 38
Al/1 Phone#:
CONTRACTOR: Company Name:,/�f�� ����/ ✓� may. - ��d o e#: �O� ' .� 88 17
Address: /coo ia- ZO .yam
City: �dL4 //<L~ // I State: �li ♦v Zip: 33/6/
Qualifier Name: ad�/- 2 7ee ci 2.- Phone#:
State Certification or Registration #: /I�DaJ .tificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
/ Ca°2
Value of Work for this Permit: $ </ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration _" 1-7NewElRepair/Replace ❑ Demolition
Description of Work: )/ ( �cf. o 6
Specify c`olor.,of co/or,thru tiler
Submittal Fe`e $`"`""`"'" ' Permit'Fee $ 3.0'®e- O p CCF $ CO/CC $
Scanning Fee $
Radon Fee $ LA .50 DBPR $ Li • 5 0 Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2JCo 5. z
(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.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPR�., T „!, R PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YO;;, ��� �1.tgE;' 1TTORNEY 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 a reinspection fee will be charge
& Cs
Signature ` I�i `` Signature
OWNER or AGENT INki
The fore oing instrume was acknowledged before me this The foregoing instrume was a nowledged before me this
day of O(lel� �� 20 �G by l day of We"V 20 %G- by
/fieg1 .Ci4 , o is personally known o Oa442 fteC, J(e a , who 's personally known to
me or who has produced as me or who has produced
identification and who did take an oath.
CONTRACTOR
identification and who did take an oath.
NOTARY PU : IC: NOTARY P
Sign:
Print:
Seal:
ALFRED MCKNIGHT
7 Al = Commission # FF 065936
Expires January 23, 2018
'o P Boded TM+ Troy Fain Mudrwro 800-385-7019
Sig
Print:
Seal:
`+y :7&, ALFRED MCKNIGHT
,s - € Expires January 23, 2018
''• j cr, Banded Thu Trey Fain 6rwge 100.31 -7019
,.,
:4 Commission # FF 065936
as
************************************************************************************************************
APPROVED BY
/ fr,'w h Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)