REV-17-1174BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City:
Folio/Parcel#:
Miami Shores
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
❑ ROOFING
Master Permit No.
Sub Permit No.
RECEIVED
'CAW9u
F C 20 gq
-176- aa�
❑ REVISION ❑ EXTENSION ❑ RENEWAL
0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
3 s age, s�
i1--011, a,)o
Occupancy Type: Load:
County:
Construction Type:
Miami Dade
Zip:
❑ SHOP
DRAWINGS
Is the Building Historically Designated:, Yes NO .
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Ti l holder): OnSgrry¢t, 0.,vecf4,19A
Address: 7a to J .
City:
Tolcv
Tenant/Lessee Name:
State:
Phone#:
Phone#:
Zip: ' 3'41
4wg•-aa3
Email:
CONTRACTOR: Company Name: Aka
Address: Ltg Syi/ l (4-9 0)14
City: (� ,, State:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
CFC.) 5151
llij)e'i1x. Eli O
Value of Work for;this;Permit:•$'
0,o% •v j
Type of Work! '`Addit n•.}s.
S;11,r. 1'r'rc�i{tEq!.71.,. al/.y
4:r!
Descript +, oWork:
1,t0'
Specify�colort• " • o AWL
,.
of colorthrutle
Submittal Fee $
Scanning Fee $
d" nit LLC Phone#:
Zip: 3W6
Phone#: k,/
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
New ❑ Repair/Replace
❑ Dem+lition
Permit Fee $ �co
CCF $ €pO CO/CC $
Radon Fee $ DBPR $
Technology Fee $ I r6t) Training/Education Fee $ o • 40
Notary $ CIJ
Double Fee $ 0
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ 12-' 0
11111111%
Sign:
Bonding Company's;Name (if applicable)
Bonding Company's Address *,
City • + 1,. State t! Zip
Mortgage Lender's`Name (if applicable)
Mortgage Lender's Address "K
City State
i t
Zip
Application is hereby made to obtain a permit to dope work and installations as indicated. I certify that no work or installation has
r
commenced prior to the issuance of a permit' and that all'vvork will be performed to meet the standards of all Iavvs regulating
construction in this jurisdiction. I understand that -a separates permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, -ET_'? ` ;)
wt +
OWNER'S AFFIDAVIT: I certify that all the foregoing inforrhaticn is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning: ,,"q ",�, ' , l'
"WARNING TO OWNER: YOUR FAILURE TORECORD 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." } i
1
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 rei p:ction fee will be charged. + �'
Fa
4
Signature
R or AGENT
The foregoing instrument was acknowledged before me this
day of 'Wiz t L __ , 20 (7 , by
Vi u 2_U �1x1'� C `-' ,'Ao iC p rsonally known to
PL.
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
***************************
APPROVED BY
as
CONTRACTOR
The foregoing instrument was
me or who has produced
identification and
Si:
Print:
Seal:
cknowledged before me this
20 ,, + , , by
,who is personally known to
1
as
..y
ath. John Joseph
Commission 4 GG023014
Expires: An u . et. 2020
thru Aaron Notary
•******************s***************************************#********** *******
! Plans Examiner
'7 Zoning
(Revised02/24/2014)
Structural Review
Clerk