EL-17-2634r
BUILDING
PERMIT APPLICATION
❑BUILDING yELECTRIC
PLUMBING 0 MECHANICAL
JOB ADDRESS: 1250 NE 101 st.
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
RECEIVED
NqV 08.2
BY•1 Y�
FBC 20i-
Master Permit No,PC-N _p — 2G32
Sub Permit No. 1 L R 2)3`4
❑ ROOFING ❑ REVISION ❑ EXTENSION
El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
❑ RENEWAL
SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: CANCEL
11-3205-008-0020
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Maria & Neil McGuinness
Address: 1250 NE 101 st.
Phone#: (3) 3 LI "Z--III 2-
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 1-04k I 6OL4/Ct Clt-C—kc L- 36.4—_ Phone#: q5 / " 3 Yo - 3-J 3
Address:sl / ?-a-3 % Nt'l% 3 ' 51
City: Cd (A-! S f rSt1 State: FL Zip: r3 -SO C r
Qualifier Name: tbOM V)i c—r, IPO(ft O 'V Phone#: { ip5 V (SO ,-,n (3
State Certification or Registration #: t- C. / ;CDC) )-��! % Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 2000
Type of Work: ❑ Addition ❑ Alteration n New ❑ Repair/Replace ❑ Demolition
Description of Work: LminirOde eletAriCA1 <>LAMAS 's sP; 4-'cor4Q
Zip:
Square/Linear Footage of Work:
Specify color
� of color thru tile:
Submittal Fee $ Sv ' Permit Fee $ J V" /de9 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ ' C� DBPR $ 2. 2S Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ I (0 • ‘--/S
(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 reinspection fee will be charged.
Signature
ignature/
2
mnigerm
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
%l dayofOCt' ,20 t% ,by 4.jfr day of AI' ,20l' ,by
l0. l i t' U 0 1eS5v sonally kno to
as
me or who has produced
ho is personally known to Dpntn.c. 94 ((aft)
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARYPUBLIC:
Sign: / Sign:
Print: Print:
.,�
Seal:
•.Nancy Seal:
• /j1 )Nan1Cajuste
1155
EXPIRES: �/F4, 2018
'WV WWW.AA
APPROVED BY
�/V�� Plans Examiner
"rig
JENNIFER R. A'HERN
PU •y.
•� : = MY COMMISSION # GG 100114
• •���- o • EXPIRES: May 23, 2021
Zoning
Structural Review Clerk
(Revised02/24/2014)