DEMO-18-2340Miami Shores Village
REcE. J VED
Building Department AUG 302018
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 lAt, ELECTRIC ❑ ROOFING
FBC 20V 1
Master Permit No.IDEM O Cl - 2 e3
Sub Permit No. m O 1 23't
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City:
Folio/Parcel#:
°i1o4 N /10' Ave
Miami Shores County: U4/4 Miami Dade I/741ME' Zip: �%16D
lt-32-cb -0IDo
Occupancy Type:
Is the Building Historically Designated: Yes NO
Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee,Simple Titleholder): ram(€ • --SW C�(U![� V Phone#:
Address: I1o4 NE 10 t
City: Ii fMM J
Zip: 3, State: 1 r7D
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ' ii1 wig VFW Svc_. Phone#:7S&'• ?-7733
Address: 33C a • E sUk
City:
I- l 14114L17
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
State: F(.
Zip: 3301 3
►el)(P Phone#:
t 3v 1 Certificate of Competency #: I E'' E Cho (P2Z 4
Value of Work for this Permit: $ 5QO•
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of,Work: _;rDer�nc:��us
❑ Repair/Replace LXJ Demolition
Specify color of color thru tile:
Permit Fee $ l6m CJ O CCF $ -+ CO/CC $
Radon Fee $ 2 - DBPR $ 2 ' C Notary $
Submittal Fee $
Scanning Fee $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ ( Ue• , C�
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Comp'any's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City, t State Zip
• 11
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. .1 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. 4 r ' r, 1
"WARNING PTO 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:".
! d, .. .t ,. '
Notice to Applicant: As a con ion to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that aiopp of the notice of commencement and construction lien law brochure will be delivered "to the, person
whose property is subject to atta. ' ent. Also, a certified copy of the recorded notice of commence
rneAj
t'be posted at the job site
for the it nsp: on which occu seven.(7) days after the building permit is issued. In the obs such posted notice, the
insp ction wi no.. approve. and • -'nspection fee will be charged.
Signature Sign.,Ii- 'lJlII
a `r /t.P".— {..
Al
OWNER or AGENT
The foregoing instrument was acknowledged before me this
20. , day of
7' , 20 /6— , by
is personally known to
The foregoing instrument was acknowledged before me this
me or who has produced as me or who Ifas produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: r/�20‘
Print: 8qPI A7k1 J LifLG'
Seal:
` VY3:1;,,s Barbara Moreno
1% Commission I GG170164
R• Expires: January 11, 2022 - '
•
**********itM�� **iii **#S isqii***hr4I4ireR400(11r*
****s.************s*ss***********s***************s************.sr***
, 20 II by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
YACELIS ROQUE
• !SCION # CG 132472
as
APPROVED BY
Sign:
Print:
Seal:
Plans Examiner
I ....... `: �1I�t. 7 :121
underwnwrs
Zoning
Structural Review Clerk
(Revised02/24/2014)
•
ICK SCOT1; OVERNOR z. - ' *� ,�` 1t7NATHAN��ZACHEM, SECRETARY �'r . �: ';
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` . �� .) Do :not, alter this document in'any form �rx,
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This rs yourrlicense !t is unlawful -forany'orie other than the licensee 'to use this document.
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ualifying Board
INES CER" t tCATE OF COMPETENCY
CITYWIDE ELECTRICAL SERVICE LLC