EL-16-25300
Miami Shores Village cFrcTp- ;
I SEP 14, 2016
Building Department 2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 tU
BUILDING Master Permit No. R C 1(9 -25Za
1
PERMIT APPLICATION Sub Perm ` Permit No. 1 (O • Z530
❑BUILDING ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
El PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION El SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
C Qs-6/l,) L(
Miami Shores County~;
Miami Dade Zip:
Folio Parcel#: !' �5 "f;' / o Is the Building Historically Designated: Yes NO
Occupancy Type: Load: ' J ''. Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): G c ij Phone#: F.70((1)
(i LI�
Address: / 9 SO A `A 2
City: / i 0�-•-.� 3 State: � Zip: . / 3 �Y
Tenant/Lessee Name: Phone#:
Email: a •-v` C-Q.O`(`CfY- -- �� r- t 4- .r o ✓-r-k a",
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: C UCity: State: Zip:
Value of Work for this Permit: $ JI ,L o . w Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ElDemolition
Description of Work: ELQ-.2-c ((-i--c-- -----Prx n,--:- �_ /)'• Q� "_ a LI - / t 1 &
S.--
-IC) ELSVC._, ZDv ?fo. IT,
•
Specify color of color thru tile:
Submittal Fee $ S.Permit Fee $ As U/C%� CCF $ B •B. 'G coicc $
Scanning Fee $ Radon Fee $ 2-• 63 DBPR $ 2 • 63 Notary $
Technology Fee $ -, Training/Education Fee $ I • a) Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
20 ICA ,by
Print: ! J 2i N • '�� Print:
'qr
%��0 v '�i Seal: s %-exp A. V Seal:
.. �.• �.
Ni 0
**************************************************s**************************************************s***s**
•
Bonding Company's Name (if applicable)
Bonding Company's Address, •
City State Zip
Mortgage Lender's Name (if applicable)
t i
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 perfdrmed 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 REC •k(S!'l i ;'n .' • COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMEN �y I ;���1' ERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTOR EY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building• '*nit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copyk 'J' � ' 9 f � of the notice of commence�m�nt�and construction Iien_ iow hrnc/zura wi/l.be_deluveKed.ta-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 gpproved and a reinpection fee,v ill be charged.
y
Signature
J
OWNER or AGEN
The foregoing instrument was acknowledged before me this
i( day of
^•
`4'"'rram- MC-(o \fix/ io is personally known to
me or who has produced
Signature
CONTRACTOR'
The foregoing instrument was acknowledged before me this
day of , 20 , , by
, who is personally known to
as me or who has produced as
•
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC: \``",III llb�i� NOTARY PUBLIC:
Sign: Sign: r
APPROVED BY --
is Examiner
Zoning-
(Revised02/24/2014)
Structural Review Clerk