PL-16-2963 (2)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 APPLICATION
El BUILDING ELECTRIC ❑ ROOFING
❑0 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
I RECEIVED
j. OCT 12016
13Y: I_ .
FBC 20 14 s
Master Permit No. eP 216 Z.
Sub Permit No. PI, l t- l b- 2a 6 3
❑ REVISION ❑ EXTENSION RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JO13ADDRESS: I 1 CP'C) l\-1." • 9 , "1--
City: Miami Shores County: Miami Dade Zip: S 5.1 3
1- 1 32 '�'� 1 s 0 3 9 h_ i lly n. .gnat :
rUli�l/ Yaf(.Ciit: h `auc 6'Gii�iiii� itiiSturi%ay ucmgnawC�a. Yes
Occupancy Type: Load: Construction Type: Flood Zone: X BFE: MI A FFE:
OWNER: Name (Fee Simple Titleholder): 1\./) ®t v 1 1 IL c
Address: 1 (C-e d N 9 8 �T
city: 1\ t ��, jl- 1 �S
iv 0
Phone#: Q'S (po 49
State: I\-(� ci 5-cc r r5 Zip: 3 31 3 8
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ESSIG POOLS, INC
Address: 1800 NE 151 ST
Phone#: 305-949-0000
City: NORTH MIAMI
Qualifier Name: DANIEL ESSIG
State: FL
State Certification or Registration#: CPC052505
DESIGNER: Architect/Engineer:CPC-c--;ttGi
Address: Z(PS
Value of Work for this Permit: $ I
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
zip: 331625
Phone#: 305-949-0000
Certificate of Competency #:
o3 • Phone#::(-4 235 Z4-3",
City: k-fCJ ` ate: .H_ Zip: 33i �-�•
Square/Linear Footage of Work: I 1 4- SQ r 1
New
❑ Repair/Replace ❑ Demolition
.p / n . VV p r 1
Specify color of colorthru the
V 0 • 1 Permit Fee $ iY CCF $
Submittal Fee $ t • 2�� CO/CG$
Scanning Fee $ ` -�� Radon Fee $ ' • Se DBPR $ ' c Notary $
Technology Fee $ t - Training/Education Fee $ 0 'fO Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Co'mpi'any's Name (if applicable)
Bonding Company's Address 1
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 lawAK 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 f r
OWor AGENT
The foregoing instrument ' acknowledged before me this
%_ day of , 20 I, 4 , by
1r.40 , Who is personally known to
me or who has produced - D'i l-- as
identification and who did take an o
NO/TA'Y PUBLIC:
Si: . .���.. I 1
VA'
Signature
The foregoing instrument was acknowledged before me this
�� day of ����L�c f, 20 L Ct , by
DANIEL ESSIG
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOT ° Y PUBLIC:
Seal: / fr!:Ib.
,LENYM,HERNANDE2 ..aa... A
MY COMMISSION N ff 02210f :,� ig"'''', YORLENY M. HERNANDEZ
EXPIRES: ?�tepmbe_r� �. , MY COMMISSION 0 FF p
li
t.• EXPIRES: Se tem u221o8
%;�•.... p o6r27, 2ut7
f d t• Bowed Thru Now P'eFc u°* * *
APPROVED BY
Sig
Print:
Seal:
Plans Examiner
'Zoning
(Revised02/24/2014)
Structural Review Clerk