EL-18-1110BUILDING
PERMIT APPLICATION
❑ BUILDING
ELECTRIC
El PLUMBING ❑ MECHANICAL
JOB ADDRESS: /O'' W V
City: .Miami Shores �f1
Folio/Parcel#: -- 2231- 0 S -06l0
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
❑ ROOFING
Occupancy Type: Load: 2
OWNER: Name (Fee Simple Titleholder): Benny �ew 6�/ Phone#: u05" 33
❑PUBLIC WORKS
2hdC(
County:
Master Permit No.
BY
PR 2 2018
FBC 20 � (���
Wt8 1108
Sub Permit No. (9 1 J ( 0
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE :OF,...❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Miami Dade
Zip: 3313
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: ! FFE:
Construction Type:
Address: /O$ l5 tie 2na C-t- y�
City: IOinii 3hO(5' State: -! f- Zip: 33/39
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: SHINE ELECTRICAL ENGINEERING
Address: 3876 NW 125 ST
City: OPA-LOCKA State: FL
Qualifier Name: FRANCISCO SANTOS
State Certification or Registration•#: EC0001514 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Phone#: 305=688-2000
zip: 33025
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
Z-519u
Phone#:
Square/Linear Footage of Work:
❑ Alteration ❑ New
Repair/Replace n Demolition
+l.
Specify color of color thru tile:
Submittal Fee $'
Scanning Fee $
Technology Fee $
{
Permit Fee $
Radon Fee $ 3, CM
Structural Reviews $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 5. 30
(Revised02/24/2014)
`Bonding,Company's'Name (if applicable)
Bonding Company's Address
'AI . !'� u , # 1
City R 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 O'F COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS .TO YOUR PROPERTY.- IF you INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANATTORNEY.6 EFORE RECORDING
YOUR NOTICEOF 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 biochure 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.
LSignature
OWNER or AGENT`
The foregoing instrument was
acknowledged before me this
6eNny 44'ai Jy , who is personally known to
me or who has produced
day of
, 20 /-o , by
identification and who did take an oath.
NOTARY P
S'
Seal:
Notary Public State of Florida
I Estrella Gomez
o My Commission GG 162104
ti Expires 11/21/2021
***************
APPROVED BY
as
Theforegoing instrument was cknowledged beforeme this
q day of 4PI'1 , 20 ".,( , by
FRANCISCO SANTOS
who is personally known to
me or who has produced PERSONALLY KNOWN as
identification and who did take an oath.
Seal:
************************
lg Plans Examiner
Structural Review .
Notary Public State of Fk,rida ,
Estrella Gomez
'or f M Commission GG 162104
11/21/2021
* ** **********�
Zoning
Clerk
(Revised02/24/2014)