EL-18-3437Miami Shores Village RECEIVED
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
PLUMBING ❑ MECHANICAL PUBLICS
JOB ADDRESS: 4 k)f - [ °do ST
City: Miami Shores County:
Folio/Parcel#:
Occupancy Type: Load: Construction Type:
OWNER: Name (Fee Simple Titleholder):
Address: 33 OOf' 1004 jd-
City:
I�(f19M1 f JolZP
OV 13 1018
Co
FBC2019
Master Permit No. 6 \e
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade Zip: 3j31 3 B
Is the Building Historically Designated: Yes
Flood Zone: BFE:
cost- C 9 1,o
State: FL-
Tenant/Lessee Name:
PAP -cat,cPrzto&6K61c.Cold
Email:
CONTRACTOR: Company Name:
Address:
City: State: Zip:
Qualifier Name: Phone#: "t •
4kf \‘‘ ‘-\\
NO
FFE:
Phone#: L14 727 0G- (
Phone#:
Phone#:
Zip: 3g/7?
(J F
State Certification or Registration #: Certificate of Competency #: . .
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑
Description of Work:
Square/Linear Footage of Work:
Alteration ❑ New ❑ Repair/Replace
Pr m at.
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
113 V 1 L -
Bonding Companys Name (if applicable)
t'il'+ )s i i1;4T
Bonding Company's Address
' _.
City
y State Zip
Mortgage Lender's Name (if applicable)
�;•t
.Mortgage Lender' Address
City.r...,^i f c 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."
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Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500,'the 6p*plicant 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 mist 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.. /,(`� Signature
OWNER or AGENT CONTRACTOR
The for Ding instrument was acknowledged before this The foregoing instrument was acknowledged before me this
'day of Nov ,'20 \_, by day of , 20 , by
DS-e. C C is personally known`ito , who is personally known to
or who has producedl 1 tc.1o'�� ��l�as me or who has produced as
identification and who did take an oath.
NOTARY PUBLI
#41.041
Print:
Seal:
APPROVED BY
•s MY COMMISSION # GG 044602
*: EXPIRE : `ov
Public Underwriters
%'rFofF�o?; Bonded Thru
identification and who did take an oath.
NOTARY PUBLIC:
r!
ign:-- •
rint:
eal:
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)