DEMO-17-1893 (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
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 42 50 NE. 9 i t - 0ce
Master Permit No.
Sub Permit No.
RECE4VEt
MAR 16 7i)`
FBC 20lq
DeArY)Ok&q-CO
1a93
❑ REVISION ❑ EXTENSION RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores
ran County: Miami Dade Zip: 3313 &
Folio/Parcel#: ` " 51165 5 — 001- 0550 Is the Building Historically Designated: Yes NO
Occupancy Type:
Load: Construction ^Type: Flood Zone: BFE: FFE:
y
OWNER: Name (Fee Simple Titleholder): �Ji1c(y �Iepto 1 1 I�umfr&) Phone#: 33, 461. t6 55
Address: I t O N. ��% blTVllt ti4)i 1Q P(i1 Ti
4 loos
City: 1•) / State:
Tenant/Lessee Name:
Email: 1,
CONTRACTOR: Company Name: NQUXY\O\ WTASNA5 C \NA9s, fP
Address: 201-01 N� 15 ^ •
City: Qokin I ow:I Qgg \Ch State:
1rAt
Zip: 331 Ja
Phone#: 3O5_ y6&, �655
GE( Rti (AWL .cm
Qualifier Name:
hone#:
Phone#:
3)sa33as%:-
Zip: Sb1 b �.
State Certification or Registration #: CE C,16 03 JD Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ C000 Square/Linear Footage of Work: 2 SOt
Type of Work: ❑ Addition{iti❑ Alteration�IXJ El /�.. • New Repair/Replace Demolition
Description of Work: Ye(m,k (242 W0 I C .
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $ Double Fee $
00
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
CO/CC $
Notary $
a(Revised02/24/2014)
,
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)�
Mortg�ggoo '`o ibsocA(t Pocu' d
City 1 ttiO 0 liblV State Zip nbg
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 reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before m
n
1Yl, �(r,_ d of / , 20
U� tPOM& , who ispersonall k
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
NOTARY PUBLIC:
Signature
�
v is2 o
(2 121 N H
aN
d VS W
CC IT 3
aU
i
;S:
c•• . 4 A Sign:
Print:
Seal:
CON CTOR ,a
e foregoing instrument was acknowledged before me he b Pv
4 6 day of {ham
Z t9 n
=z >.:
who is personally kno i4ko0
m.uai0z
e or who has produced
re ci s
identification and who did take an oath. 14 ;j
7
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APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk