REV-18-15800.2\
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
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
❑ PLUMBING ZfMECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS: IOS J I l O '
City:
Folio/Parcel#:
REVISION
RECEIVED
JUN082018
Ok'A
FBC 20P
Master Permit No. ea - - 14 - I OI •
Sub Permit No. c
❑ EXTENSION ❑RENEWrALeV I�-iSgb
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Occupancy Type:
Miami Shores County:
— 2230.. —02B -oar
Load: Construction Type:
Miami Dade Zip: 331bn_
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): fiD =L. i Phone#: ` ) k•-k98-
Address: 1O ( - 1O $T-
City: L 5 1 E State: Ttoekoo
Tenant/Lessee Name: Phone#:
Email:
Zip: 33I61
CONTRACTOR: Company Name: 2
Address: (S
City: V-&-)1-->L,
Qualifier Name:
f Q— CSr ) t korry M +Ej
t Gt'o Jcvsv D
State:
Undo b=ctm
Phone#: (33433013c)
Phone#:
Zip:IS-14:1
State Certification or Registration #: C) C 04 �/) a Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: i. l'. ' 1 Z re ) ljaV eic-'�2N5' oZ ��
ti WOut-es , OZ -- ieai - , 03 D.1-tilkIN TnNS
T-1)42 P SSW-00-6 I titoo x ctr C .-.-
Specify color of color thru tile: ,,
Submittal Fee $ Permit Fee $ keli CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
(F) 3 ®tom-/.
TOTAL FEE NOW DUE $
(Revised02/24/2014)
A
Bonding Company's Name (if applicable)
Bonding Company's Address
City a . State Zip ,
Mortgage Lender's.Name:(if applicable)
`•t
Mortgage Lender's Address 1 a
City -t 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
cdrnnienced 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 propert is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first i
inspection wil
Signature
tion which occurs seve (7) days after the building permit is issued. In the absence of such posted notice, the
appr. ram.. nd • eins n fee will be charged.
OWNER`orAGENT
The foregoing instrument•.was acknowledged before me this
d 4- day ofJD , 20 17 , by
CONTRACTOR
The foregoing instrument was acknowledged before me this
0-9- day of , 20 /P , by
ea(gIelel ieuSI Cl,AJ , who is personally known to 7A1 who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
:1 LG
�A2D,0-v46
�•— — AA , AA —®Asp
JU
LIAN A CARDONA
i**..G.a.riinpi$441.4.ii,,i44104.**
;`r° �NotaryPublic -.State of Florida
******
r.
%;,,,,,
. My Comm. Expires Jan 21, 2019
�'qF OF il0p ‘`
Bonded through National Notary AsK.31
, APPROVE.
.12
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Exam!
,tructural Review Clerk
-TL-
JULIAN A CARDONA
PRF` ,'- 1 a ry Public - State of Florida
• Commission t')'i- 1t'i iu
My Comm. Expires Jan 21, 2019
r $;,, ,��� Bonded through National Notary As',^
###############
Zoning
(Revised02/24/2014)