EL-16-2484 (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 0 ELECTRIC ❑ ROOFING
C 1t av'ED
EP 07 2016
BY MuLaL
BC20►�-i
Master Permit No P I. h 2 l8 \
Sub Permit No. tL 6- 2(4 9y
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
/� CONTRACTOR
JOB ADDRESS: 4 �L 1 `c " �' IJ i v=—
City:
Miami Shores County:
Folio/Parcel#: 1 1 3 i.O 0 1 aim 3..
Occupancy Type: Load: Construction Type:
i\1
OWNER: Name (Fee Simple Titleholder): ! ^�t—tc=ait r"1,71 11/
"( l iT .1=:s kV C--
Miami Dade
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip:33�So
Is the Building tiistoricaiiy Designated: Yes NO •
Address:�
j
City: 1" �I 4l ► v.1 Q t e."—. State: L'
Flood Zone:
BFE: FFE:
Phone#Tl ( - '4=) Z- O a
Tenant/Lessee Name:
Email:
Zip: 33 (
Phone#:
CONTRACTOR: Company Name: SHINE ELECTRICAL ENGINEERING
Address: 3876 NW 125 ST
City: OPA-LOCKA State: FL
Qualifier Name: FRANCISCO SANTOS
State Certification or Registrat' f #: E-00001514
DESIGNER: Architect/Engine 1c1'
Address:
8 'l SI ..514 Zoe (-4+'-)
Value of Work for this Permit: $ i J 5
a1)
Type of Work: ❑ Addition ❑ Alteration
Description of Work:. ---
Phone#: 305-688-2000
zip: 33025
Phone#: 305-688-2000
Certificate of Competency #:
Phone#: "MG 2_ 5z_ T 3-5
City:..
ft . " State:f -- Zip:331V'1
Square/Linear Footage of Work:
New ❑ Repair/Replace
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 5.° Permit Fee $ 30med0
Scanning Fee $ 3 ' Radon Fee $ `-f-' S v
Training/Education Fee $ 0, 40
Technology Fee $ f ' 6 o
Structural Reviews $
2
CCF $ ' 2_0
(, CO/CC $
DBPR $ �' G v Notary $
Double Fee $
Bond $
53(
0
TOTAL FEE NOW DUE $ c S n.0
(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 OFCOMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with.an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure•will be delivered to the person;
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved • d a reinspection fee will be charged.
1
Signature
0 m'' or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of
FRANCISCO SANTOS who is ersonally known to
0011104
day of p�I , 20 Q . , by
-IVI..1_I IC/Who is personOlifwmwn to
me or who.Has produced
at ry7
identification and who did take an
NO
Sign:
Print:
Seal:
PUBLIC:
******************
APPROVED BY
oat
777 �, ERNgN i/
, •* c 27 i9 ode
.
•o .
.mu) •� :o1$O
aF� 072\O o
6014,1
••'�1°�t ��\�� Sig
7UBLIC� e<< Print:
Seal:
,20 ,by
}z'A ; O ii, me orwho-hasproduced..
cation an • who did take an oa
7 Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk