REV-17-2794Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
M�ER: (305) 762-4949
BUILDING
PERMIT APPLICATION
ILDING ❑ ELECTRIC ❑ ROOFING
11 PLUMBING ❑ MECHANICAL E PUBLIC WORKS
JOB ADDRESS: % JV N E { J \ -
FBC2q'i
ster Permit No. i 10 _229ii
Sub Permit No. g,-VI1 —Z11 1
REVISION ❑ EXTENSION E RENEWAL
RECEIVED
NOV 2 7.2017
s
s \
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade
Folio/Parcel#: (I .31,a' 0 J3 -' 23 to Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):1Ft • j'(SI, et CovjMijh i� A"
Address: -7Z 10 N • hi thV /4- (1/ ,4VE )?'(V
State: JL. Zip: 3369
City: T}Yln
BFE:
Phone#:
Zip: tSo
NO
FFE:
Tenant/Lessee N me: Phone#: q91 &68 92V
Email: V 0r 4" A Cr C • Or
CONTRACTOR: Company Name: N A 1,
�- 1 y /
s
Address: E { &/
uzif(0,
City: M A m/ 1 State:
Qualifier Name: V�t�1��i� 1 �^ a Fta,oe
State Certification or Registration #: C_G G 1 S \ /4 2 Certificate of Competency #:
DESIGNER: Architect/Engineer: "'nit 1 Ci&/ A.2 _ rr// Phone#:,�yy��has '77 739j
Address: 23 /�I /r>" /b City: Lv l /1DN /iilr""�tate: Zip: `3 319S`
Value of Work for this Permit: $ / ��D Square/Linear Footage of Work:
Phone#: ` U 6 O J 49 6 S
Zip: 3 ( (D 2
Phone#:
Type of Work: ❑ Addition ❑ Alteration n New :1'‘pair/Replace n Demolition
Description of Work:
Tevq
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ —4S - OA CCF $ CO/CC $
Scanning Fee $ CI . Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ 80 • Bond $
TOTAL FEE NOW DUE$ ((-0((' GO
(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 reins` ' n fee will be charged.
Signature
NER or AGENT
21 dayofAlb V b , 20 i 7 , by
ay- ds4 kn y' , who is personally know bo 5.6( P Y
,who is ersonall known to
as me or who has produced F 3 &a SBS 6'7 2-91-0
The foregoing instrument nips acknowledged before me this The foregoing instrument was acknowledged before me this
71 day of O`r ,20 ,by
me or who has produced D GY32 86
/
identification and who did take an oath.
hn Joseph
Sig
Print:
Seal:
APPROVED BY 1 /
I ei Plans Examiner Zoning
identification and_ ,p#id take aq _Qanh.
��YY��' J011 J
NOTARY PURL ' ,�, t G6023014
Sign:
Print:
Seal:
(Revised02/24/2014)
/#149
Structural Review
Clerk