MC-16-2483Tenant/Lessee Name:
Email:
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
FBC20t`
BUILDING Master Permit No�l� P 245'1
PERMIT APPLICATION Sub Permit NYC I o— 2493
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0 RENEWAL
El PLUMBING El MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
1 t 7o Ilw t iic
City: Miami Shores County: Miami Dade Zip`-, 1 Ste
Folio/Parcel#L
: / 1 3c=1, 0 (1 La, �03\,
.C) is the Building Historicaiiy Designated: Yes NO 7�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): A"c=I cort M,c,c.1 � (
Address: e=t 1 9 .o J lry l AVE-
City: 41 l T4w t Pc•rL State: Zip: 3 514�
Phone#:
Phone#: loo 4 c 2. 03 3 .o
CONTRACTOR: Company Name: ESSIG POOLS, INC
Address: 1800 NE 151 ST
Phone#: 305-949-0000
City: NORTH MIAMI State: FL
Qualifier Name: DANIEL ESSIG
Zip: 331625
Phone#: 305-949-0000
State Certification or Registration
#: CPC052505 Certificate of Competency #:
DESIGNER: Architect/EngineerGrpfir yam` . f:. pne#:�7P (v 235 Z�f, S
Address.? 4J 2- -f C4) City: . 1-, /••State.`- Zip: 53Io
r.�. , 4,.
Value of Work for this Permit: -
•
Type of Work: ❑ Addition ❑ AlterationPew • F❑ Repair/Replace ❑ Demolition
Description`of Work: POOL HEATER . ~
Specify color of color thru tile: (� �}% ��
Submittal Fee $ no Permit Fee $ 4D D(/`7 V ¢ CCF $ I ' O�
Scanning Fee $ 2) Radon Fee $
Technology Fee $ Z • 00 Training/Education Fee $
Structural Reviews $ �—
(Revised02/24/2014)
co/ccs
DBPR $ 7 Notary $
• (0 O Double Fee $ __JO"
Bond $
TOTAL FEE NOW DUE $ (tO l .
0,e
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zi p
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
R or AGENT
The foregoing instrumen was acknowledged before me this
1dayof ,20 t,C�t , by
1.L-i IC'(, who is personally known to
me or who has produced
�,z.P-wpFzbi�us* • " me or who has produced as
�����'� EXPIR ��\ iidentif)
identification and who did take an oath ._;p21 207js •• bi
N• 'Y PUBLIC: � 1 � G '�L�
o 4 2. rl
t.
Signature
The foregoing instrument was acknowledged before me this
day of��r—p
DANIEL ESSIG
,20 l C ,by
, who is personally known to
Sig
Print:
Seal:
`N" Print:
r,r.a,.,,,.�ri
Seal:
cation and o did take an oath
Y PUBUC:
of
�Ii MOAw.-- -New
**************s*ss**r***ss***ss*s***sss*s*s****************************************a*s********x************
C1n `0 `-1i Plan xaminer
APPROVED BY
Zoning
(Revised02/24/2014)
Structural Review
Clerk