PL-16-2482BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS: t 1
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
B •
FBC 20 �1
Master Permit No P(G 2 i 9
Sub Permit NoTU �, y 2q 9/7_,
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
City: Miami Shores County:
1 3) 1� t CD3-.0 :c_,iy Xj
Folio/farce;#: is tuc 6'iiiwu�g Y7uwi��ay vcmgnawd: YES NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder)
Address: cr 1 !==. Nt PNJ 1 PI -NC --
City: "L liczenrv" i Jl'74:;=.f.5 State:
BFE: FFE:
Phone#: 4 z c 3
Tenant/Lessee Name:
Phone#:
Zip: 3 aJ I �U
Email:
CONTRACTOR: Company Name: ESSIG POOLS, INC
Address: 1800 NE 151 ST
Phone#: 305-949-0000
City: NORTH MIAMI State: FL
Qualifier Name: DANIEL ESSIG
DRAWINGS
Miami Dade Zip: 36 t!!37
Zip: 331625
Phone#: 305-949-0000
Certificate of Competency #:
Phone# 2—�
Address! S� ��� �--� City: te:'PC—Zip: 33 12.4")
Value of Work for this Permit: $ ;tSquare/Linear Footage of Work:
State 'Certification or Registration #: CPC052505
DESIGNER: Architect/Engineer: C-j
Type of Work: ❑ Addition ❑ Alteration
Description of Work: lrr
❑ Repair/Replace ' ❑ Demolition
1
Specify color'of color thru tile:
Submittal Fee $ `,\1 W Permit Fee $ 2 CCF $ (• .0 co/CC $
Scanning Fee $ 3' Radon Fee $ 3" 3� DBPR $ 3' 3
' e Training/Education Fee $ 1 Fee $ O. 0 Double Fee $
Structural Reviews $ �Q Bond $
0
Notary $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City - — State
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 andthat all work will be done in compliance with all
applicable laws regulating construction and zoning. r 3
"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 pnd a reinspection fee will be charged.
Signature
W or AGENT
The foregoing instrument was acknowledged before me this
1�".—('✓lday
^ofn J�� , 20 L , by
who is personally known to
me or who has produced - as
identification and wh • did t., e an oath.
\111%111If1lli
NOTA BLIC:
Sign:
Print:
Seal.
APPROVED BY
���'� ,��j(1d7R1y
•sue\ .. •....
\* EX.. .
tb 1 .7. / s
•
y
•
The foregoing�instrument was acknowledged before me this
l 're1day of 2 • , 20 L 5 , by
DANIEL ESSIG —
who is personally known to
me or who has,produced as
identification and who did take an"oath
NOT ' UBLIC:
1
Sign:
Print:
Seal:
/'✓j 2•-& • Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk