PL-16-3152Qualifier Name:
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC
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
❑ ROOFING
PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS:
City:
RECETI % T_... ,
N0V 1 7 2016
5-
FBC 201(4
Master Permit No. P p 1 0- �) 5
Sub Permit No. p 1 I ce, - 315 Z. .
REVISION ❑ EXTENSION ❑RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
/z96 //g-
Miami Shores County:
Miami Dade
Zip:
Folio/Parcel#: ��� C09' ewo Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder ):/% 444- e s �?
Address:
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City: ///% I* ,oreJ
State:
e_
Flood Zone:
NO
BFE: FFE:
Phone#:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: i c O ArGy 4
Address:
if/ Etied
City: ((l -( 6/ State:
1�.ff. CJZ �6G�.�. A
Phone#:
Phone#:
Zip: JTg
State Certification or Registration #: aFc_l EZ3 ( Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $ / 5-bQc-12 Square/Linear Footage of Work: 2 ZZ
Type of Work: ❑ Addition ❑ Alteration
Description of Work: eroZ_
❑ New
l7�.sEi 44/
State: Zip:
❑ Repair/Replace ❑ Demolition
•
Specify color of color thru WO:
Submittal Fee $ „�........M _ 1.M+'Permit Fee $ 22T—
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE$ '
CCF $ CO/CC $
DBPR $ `Notary $
(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 IMPROVEMENTS TO YOUR PROPERTY; IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT." CANCELLED
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
OWNER or AGENT
The foregoing instrument as acknowledged before me this
..`Signature
CONTRACTOR
L The foregoing instrumen as acknowledged before me this
/ ' day of de'H L , 20 1 , by / `% day of / lre..14-e e' , 20 %6 by
O„.., i C cl(pa , who i �.ersonall kno __P/iVlCk�� J , w is personally know
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUB
Sign:
Print:
Seal:
Commission # FF 065936
x•% Expires January 23, 2018
' ,R•e At Bonded TWu Troy Fain Munroe a00,1857019
identification and who did take an oath.
NOTARY PU IC:
M
Sign: 924"
Print:
� .� ALFRED MCKNI
Seal: �' ,„ Commission # FF 065936
g
•� Expires January 23, 2018
�enyee ilea 'hey Fin Mreanse eti PPOO
I •
************************************************************************************************************
APPROVED BY
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)