RC-17-2131 (3)BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS:
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
RECEIVED
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FBC 20lq
Master Permit No. V �1 S 18 - 32 8
12C 1-4-21,;1
❑ ROOFING ❑ REVISION
❑PUBLIC WORKS
Sub Permit No.
❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
•75/ Ov-Ik" 7 57
City: Miami Shores
County: Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): r-VA17oti /2b' E�ZO cJ, Phone#: 30 S" 796 S / O
Address: -7 L/ ram/ /19 T1 j- 77
City: 4) SC4 `f/L6 M972 State:
Tenant/Lessee Name:
Email:s/,e/r2�i�7k-fOrJ0� sdA-496-67cre--I, C iM
Zip:3 3 6' I
Phone#:3 oS--796 5 C/e c
CONTRACTOR: Company Name: 67 V L%2 Q� i Phone#: 7$6.
- Z"S 6' G Yr3-V
Address: �uJ 5- 7"4-41.
- -2 A% -7e '
City:,7—fr127-be State: Ft Zip: 33 b z3
3/ Qualifier Name: J7Z/fC Phone#: 7G6`Z5 6 6 Yi?‹/
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: 6)
Type of Work: ❑ Addition ❑ Alteration
❑ New
Descript n of Work/�lJ�d l.J.�1� ,0�
❑ Repair/Replace ❑ Demolition
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Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
•
Sig
Bonding Company's Name (if applicable)
BondingCompany's Address
City State Zip
•
Mortgage Lender's Name'(if applicable)
Mortgage Lender's Address
City ; ` State Zip
i
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 rt
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 comrriencement must posted at the job site
for thefirst• 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. y
Signature
r. OWN R or AGENT
The fore oing instrument was acknowledged before me this
....e
I ,day off bhp , 20
1'MIQVr( U[i �;Arhdy�spcer onlaown to
me or who has produced i� ,�(e( 1 ( as
identification and who did take an oath.
NOTA BLIC:,
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Print:
i 'i
by
Signatur
CONTRACTOR
ti
The foregoing instrument was acknowledged before me this
day of p� �� 1 , by
Yh1 oh ' ,L ersonally known to
•
me or who has produced ' t I CQ)n as
identification and who did take an oath.
NOTARY PUBLIC:
•
Si
Print: •
Seal:
MY COMMISSION # GG 044602
EXPIRES: November 2, 2020
• � -:fo,, $•° Bonded Thru Notary Public Underwriters
Seal:
APPROVED BY Plans Examiner
MAHARAI K. GONZALEZ
�. MY WMMISSIUN # GG 044602
•o EXPIRES: November 2, 2020
�o..•;.• Bonded Thru Notary Public Underwriters
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Inspection requirements for:
Windows, Doors, Skylights or Fixed Glass (cladding) Permits
Upon issuance of permits for the scope of work involving the removal, changing and/or
replacement of any type of windows, doors, sidelites, skylights or fixed glass (cladding)
the permit holder or qualifier bearing his signature on the permit application shall abide
by the requirements of this department and comply with the following statement:
Upon obtaining window and/or door permits for the installation of same, it is the
responsibility of the permit holder to request window/door framing in -progress
inspection, prior to concealment of any horizontal or vertical clip mullion, bucks, shims,
etc. Inspector will also verify anchor type, edge distance, embedment and spacing. The
purpose for this inspection, is for the verification of conformance with Product
Approval (NOA).
Acknowledgement:
Qualifier/Owner Signature Date Print Name