MC-17-1606OWNER: Name (Fee Simple Titleholder):
Address: \ \ la 0
City:
I'`fc-e-S
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
PLUMBING MECHANICAL
JOB ADDRESS: t fie° NE -
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
Master Permit No.
Sub Permit No.
❑ ROOFING ❑ REVISION
❑ PUBLIC WORKS CHANGE OF
CONTRACTOR
9 8 5-r
S
FBC 2017
PRPlb--Z'62
MC 17--1€06
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION
❑ SHOP
DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: ((- 0 3/.0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
(1S \ \ \e nd
Sr
State:
BFE: FFE:
Phone#:
Zip: 3,71 Y
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Essig Pools, Inc
Address: 1800 NE 151 St
Phone#: 305-949-0000
City: North Miami State: FI
Qualifier Name: Daniel Essig
State Certification or Registration #: CPC052505 �.
DESIGNER: Architect/Engineer: L.%cnv•-e.-i..-�`C-k✓
Phone#:
Zip: 33162
Certificate of Competency #:
Phone#:
-75t -2s s - 2q3
Address: 2 6 7e City: 04Tc .. State: V I Zip: 33/ if /
Value of Work for this Permit: $ 3 - v 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ew ❑ Repair/Replace
Description of Work:
96-0
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ T4' CI Permit Fee $ \li
O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
Co (0 • .(17,1
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
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 a reinspection fee will be charged.
Signature
0
R or AGENT
The foregoing instrument was acknowledged befo'r 'me this
i 9 day of J--4-1 , 20 11 by
gvv�1"r�� L� o , who is personally known to
me or who has produced
identification and who did take an oath.
NO PUBLIC:
11'Ft
11FAWfalie...141111.111M1r4111111111_ PP'
Print:
Seal:
as
• ' ; = MY COMMISSI i F 022108
'• '�.4:cti EXPIRES: September 27, 2017
.4 o 04. Bonded Thru Notary Public Underwriters
****************************
APPROVED BY
$ii
. .... . .................. . ................................
Sig
Prin
Seal:
Signature
•
CONTRACTOR
The foregoing instrument was acknowledged before me this
Ic day of , 20 11 , by
Daniel Essig , who is_personally known to
me or who has produced _ as
identifi ation and who did take an oat,
NO PUBLIC:
I
N # FF 022
'pem'•r
Thru No Public Underwriters
PI s Ex miner Zoning
Structural Review Clerk
(Revised02/24/2014)