REV-18-2228BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
5 795-2204 Fax: (305) 756-8972
MBER: (305) 762-4949
❑ ROOFING
❑PUBLIC WORKS
JOB ADDRESS: / Z-Z A) / 0 s-rn 2 f7
City:
Folio/Parcel#:
Miami Shores County:
I 3z b5'0 zSo t i
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Address: <
RECEIVED
AUG 21 1p1B
FBC 20r) �1
Master Permit No. 1.C.( �
Sub Permit No! F \J I a G
-222-3
❑ REVISION ❑ EXTENSION 0 RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Zip:
Is the Building Historically Designated: Yes
Construction Type: Flood Zone: BFE:
L-(2-01 oh-e c a kt Z_
1.4-14
NO
FFE:
Phone#r T l LI —'._1 - q 6
City: State: Zip:
Tenant/Lessee Name: e
Email: / L
CONTRACTOR: Company Name:
Address:
Phone#:
City:
Qualifier Name:
State Certification or Registration #: Ce
DESIGNER: Architect/Engineer:
Address:
State:
Zip:
Value of Work for this Permit: $ ,1S/dam •
Type of Work: ❑ Addition Alteration
Description of Work: C-OV C >CaS7-/A5
Y01"tT Uzi b 7 c@Yc.7ttV
Phone#:
e of Competency #:
Phone#:
City: State:
Zip:
Square/Linear Footage of Work:
❑ New ❑ •Repair/Replace ❑ Demolition
/ 4 vrt-t?r ' R6 rr0A.A 4 ' !-i-oorg
S P to C3'T)p+( S III by -•
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
APPROVED BY
+! :
Bonding Company's Name (if applicable)
Bonding Company's Address
City State ..Zip---..u,,.4---'-•"--K- .. ....mot 1
Mortgage Lender's Name (if applicable) �°'"''" „ =,A rr4•+ _ ! l . .�-Kr«"t t
"'
Mortgage Lender's Address 0 1;:1 if'' \ e at' �'f \ , :i II .P'
7 *.t: '
City 1 I - • '' a. A i State T. �f .—.-•-- '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. 'fF 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 appro . and a rei spectio ee will be charged. i -Ni ,; y f q , 'w
.. i • •Jy4 '.'ti ♦ `.r '+".,% ..,.F,,,,J� ...1. •i �...J•-� `.1i
•
Signature
, OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
Z( day off �n(, S1 20� by day of 20 by.
\ (. • 9Ave4'fl-2 , whois
Personally known to , who is personally known to
me or who.has produced' I 2 vM-- as me or who has produced as
identification and who did take an oath. identification and who did.take an oath.
NOTARY PUBLIC: •,•* .°, �� 4t.tf�1,,,/�jNOTARY PUBLIC:
'a\.,h2rchs �0i
Sign: :: ,r -0,,,.5, % Sign:
Print: w•': g. _ Print:
Seal: `r,V,`•.2r0rhn, :� Seal:
?`f'f A4 T 11O111111 O \`\\
************************************** ***************************
14241
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
G. 25)
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69.08'54"(M)
PERMIT #:
Miami Shor
APPROVED
ZONING DEPT
BLDG DEPT
SUBJECT TO COMPLIANCE V''
STATE AND COUNTY RULES ;
•
19' PAVEMENT 75' R/W
UNE-5 I UKY
RESIDENCE # 1223
19.65'
PARKWAY
stekit.Q,
16.7_0' ..,_
Planter
9.94'
F.I.P.
No I.[
0.20'
112 7re,Zf'4
-2.f It
fbotreg--
ems- Cc-47- • (L)
RECEIVED
AUG 21 2018