MC-18-1111Miami Shores Village
R •v'E0
Building Department APR 26 709
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305)'762-4949
FBC 201-A
BUILDING Master Permit No. i�9
l l 6g
PERMIT APPLICATION sub Permit No. VlC 6' 1 1 1 U
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑ PLUMBING LCHANICAL ❑ PUBLIC WORKS ❑ CHANGE .OF; , ❑ CANCELLATION ❑; SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /0,50f A V E 2n T
City: Miami Shores County: Miami Dade Zip: 29
Folio/Parcel#: / / 2031- 013 - 0610 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: , FFE: �
OWNER: Name (Fee Simple Titleholder): 6-enn Y J eu' b17 Phone#:30S-33 o6) .
Address: (0525 W L 2 ed l 1 2
City: 1�ifo m i Sho(' Stater Zip: 3313g
Phone#:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
ESSIG POOLS, INC Phone#: 305-949-0000
Address: 10111 BUSINESS DR
City: MIRAMAR State: FL Zip: 33025
Qualifier Name: DANIEL ESSIG
Phone#:
State Certification or Registration #: CPC052505 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of Work: \ ree.. 'f "I vT Po°
❑ Repair/Replace ❑ Demolition
r -
Specify color of color thru the:'
r ,.
Submittal Fee $ Permit Fee $ r �� CCF $
5
Scanning Fee $ Radon Fee $ a DBPR $ a
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
• Et) 4
TOTAL FEE NOW DUE $ (40G
(Revised02/24/2014)
CO/CC $
Notary $
NOTARY
Seal:
me or who has produced
identification and who did take an oath•
yT
BLIC:
Bonding Company's Name (if applicable)
Bonding Company's Address
City . t State
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address =_
City State , Zip
Application is hereb''y made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior tb 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•do\ in compliance with all
applicable laws regulating construction and zoning.
it
"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-BEFORERECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: jAs 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 bf 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.
ISggnature`
Signature
OWNER or AGENT
CONTRACT
The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this
— day of . Y1( , 20 , byh , 20 !b , by
n I '1 ij , who is personally known to , who is personally known to
PERSONALLY KNOWN as
Notary Public State of Fioritla
FF Estrella Gomez
My Commission GG 162104
Fol Expires 11/21/2021
APPROVED BY
as
day of
DANIEL ESSIG
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Pri
al:•
******************
Plans Examiner
Structural Review
**
Notary Public State of Florida
Estrella Gomez
My Commission GG 162104
Expires 11/21/2021
*.**********"**
**********
•
Zoning
Clerk
(Revised02/24/2014)