REV-17-453BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
PLUMBING
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
FBC 20
Master Permit No. RC- 6 I5 - / 601.14
Sub Permit No. -AE N( (-4 "u 5 �J -
ROOFINGEVISION
MECHANICAL PUBLIC WORKS El CHANGE OF
CONTRACTOR
2,0( ,O E 4'f f( , '--Aog,fS
EXTENSION ❑ RENEWAL
El CANCELLATION
-F(- 33 (n$
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: R.6-j ad: Construction Type: Flood Zone:
SHOP
DRAWINGS
NO X
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): itil i g-tD coas rRleAi4 (E Phone#: �P — J iZ - P�?
Address: 'Z 0( pJ ?4 1A- S(
City: t&4 itI 5+{O (ZJ
State:
Zip: 3 (
Tenant/Lessee Name: -- Phone#:
Email: DLL 2. Aibac C . CAit
CONTRACTOR: Company Name: D M CCMJ 1 tt&&C4 (aAi
Address: / q o War ,ciaU
City: 4/16
Qualifier Name:
'R66 u c,a Rea
State: r
State Certification or Registration #: C6 C /5/e9 F.5 5
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ 3-000 Square/Linear Footage of Work:
Type of Work: U Addition IVI?? Alteration New Repair/Replace Demolition
Description of Work: -I/g af)U Db--7414. rgevaivsz/ n e55.46 04 Thi APDina4J,
R R& ec2-4.o LA C 6uaz- A 2,5A hvA i.). -50t6 6I,6-67R-(c4L. 1-1 i147"S.,A»D 4
FLvr-t B 1 N4' D5 T4 / L Fog. WATER- F i rr OP-4
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 0 5 CCF $ CO/CC $
Scanning Fee $ LS Radon Fee $ 2._ DBPR $
Technology Fee $ • 20 Training/Education Fee $
Structural Reviews $ 120 6 0 ,c)0
Phone#: 76K- t1.2‘35o
zip: 33 3 25
Phone#: 11515 ^ .Z6+5.16°
Certificate of Competency #:
Phone#:
City: State: Zip:
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ LI I 5
(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 !N 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 su h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2 ( day of - b , 20 l , by
��► ' 1 ( 0 (or ( ho is personally known to
me or who has produced e._(f220--- 7 r(40 Z - qp
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
020
o?' Bonded Thru Notary Public Underwriters
•LP;,,
******************************** **
APPROVED BY
Signature
RACTOR
The foregoing instru '-nt was acknowledged before me this
21 day of D , 20 l� , by
�Y•j �lv(N ,' ho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
SiiL•.,•
EXPIRES. Nuvember 2, 2020
Bonded Thru Notary Public Underwriters
r i►� ■r♦ .
MAKARAI K. GONZALEZ
MY COMMISSION # GG 044602
*************************************** *********************
Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)