REV-17-1605 (2)Miami Shores Village RECEIVED
Building Department Piti P
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 WCLe°
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201'1
BUILDING Master Permit No. / (, - Z 9(0 Z
PERMIT APPLICATION Sub Permit No. Q,e "'1 C=P ^ Icco5
El BUILDING ❑ ELECTRIC ❑ ROOFING NREVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING ❑ MECHANICAL [II PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
0(00 uC 9g" 5T
City: Miami Shores County: Miami Dade Zip: 3.s'/.
Folio/Parcel#: \ k " 32o s `c (6 - D 310 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /"'0.w-t,11 1 K-4 C0 Phone#:
Address: i I.Lod ,�1 f~ 9 - Si �J
City: ) ' —" ' 9r t r('S State: tF Zip: 33 1 3a'
Tenant/Lessee Name: Phone#: 3o y--Coo `j - 00 ?(
Email:
CONTRACTOR: Company Name: Essig Pools, Inc Phone#: 305-949-0000
Address: 1800 NE 151 St
City: North Miami State: FI Zip: 33162
Qualifier Name: Daniel Essig
Phone#:
State Certification or Registration #: CPC052505 /� '(1Certificate of Competency #:
DESIGNER: Architect/Engineer: \ t9PAP-C Gsr Phone#: TrG -035'-2'
Address: `6-7- sal ZU (Q Lh City: A T State:(( Zip: 33ik?
Value of Work for this Permit: $_ / /i 006 - O 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition ` ❑ Alteration [ New ❑ Repair/Replace n Demolition
Description of Work: A-�V Cc 5,(a-1, 1\-c.fo-cv- A-19 pvn
Specify color of color thru tile: 330
Submittal Fee $ Permit Fee $ �CCF"$ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ o
TOTAL FEE NOW DUE $ 3C0
(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 YOUR1PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORE 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
R or AGENT
The foregoing instrument was acknowledged before me this
2•Lo- day of —�1G , 20 I -] , by
1 fa='p , who is personally known to
me or who has produced)
identification and who did take . • oath.
A
Print:
Seal:
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MISSION # FF 022108
:o EXPIRES: September 27, 2017
- , .• Foe; Bonded Thru Notary Public Underv+riters
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*************
APPROVED BY
***************
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Si
Print:
Seal:
Plans Examiner
The foregoing instrument was acknowledged before me this
2-C=.• day ofJ , 20 1 1 , by
Daniel Essig , who is personally known to
me or who has produced as
identification and who did tak:r]i1•ath.
ii.
I(LIbi/111.�1ii
m*WV►%' Vl&V4
"115°‘;••
� .. MY COMMISSION # FF 022108
V.klUH
:,- �P, EXPIRES: September 27,2017
••,*o„;4••' Bonded Thru Notary Public Underwnters
Structural Review
Zoning
Clerk
(Revised02/24/2014)