EL-17-1903, REV-18-2314Miami 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
❑ BUILDING ELECTRIC ❑ ROOFING
FBC 2011 Master Permit No. 2 Gl7� 19
01
Sub Permit No. ELI I 405
❑ REVISION ❑ EXTENSI N RENEWAL
PLUMBING ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: IOSO 109
City: Miami Shores County:
Folio/Parcel#: I I -Z.23a. - Oa8 •- os-oo.
Occupancy Type: Load: Construction Type:
Miami Dade Zip: 3314,1
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): pe)1 V-VSV...)IJ3✓ Phone#:
Address: IO O p)c lO`)
City: {-l.tx>L 551t`tt.Cc-
Tenant/Lessee Name:
Email:
State: T oci
op3 .
Phone#:
Zip: 33161
CONTRACTOR: Company Name: LEX CCT k.13
Address: t 1 3 1 UJ [40T = S3
City:
Md`Dlt�
Osoiar
State: Tt-b(Cr on
Qualifier Name: (11en
Phone#: 3I 35 .
State Certification or Registration #: 1 3 E c000 c- ) •
DESIGNER: Architect/Engineer:
Address: City:
Zip: 'J -3
Phone#:& — 3i S 3
Certificate of Competency #:
Phone#:
State: Zip:
Value of Work for this Permit: $ 0 Square/Linear Footage of Work:
Type of Work: ❑ Addition n Alteration
Description of Work:
❑ New ❑ Repair/Replace
❑ Demolition
Woe° P U Q 3iciw oP � s AD) kPo c o-rua l mrAt%T *-c-
Specify color of color thru tile: (�
Submittal Fee $ Permit Fee $ 7 a 6'6 CCF $ CO/CC $
Scanning Fee $ ( Z— • 00 Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 0 2 • co
(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."
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 \ V
g � Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instru t was acknowledged before e his
/6 day ofO-4P7.----- 20 i, by1.6_ day of $ 20 I , by
covegzKU5 16 , who is personally known to _E6I• -- - who is personally known to
me or who has produced as me or who has produced a_C„((4, ,9S (43l as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Prin
Seal:
CONA
o ary •ulc - a e o orl'a
Commission # FF 191910
P My Comm. Expires Jan 21, 2019
, Bonded through National Notary Assn.
************************
APPROVED BY
Sign:
Print:
Seal:
CO TRACTOR
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744.4/67--49 Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review Clerk