REV-18-2253BUILDING
PERMIT APPLICATION
BUILDING
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) 76Z-4949
LI ELECTRIC ROOFING
Master Permit No.
Sub Permit No.
[1] REVISION
LUMBING E MECHANICAL DPUBLICWORKS Lal CHANGE OF
CONTRACTOR
JOB ADDRESS:
City: Miami Shores County: Miami Dade
Folio/Parcelft: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
RECEIVED
AUG 2 2 2018
Ci2.6
FBC 2011-
Pi 18'1)1H
C2fAl'3-2Z-3
EXTENSION ni RENEWAL
CANCELLATION D SHOP
DRAWINGS
OWNER: Name (Fee Simple Titleholder): .) \
Address: 07 \
City: Aerv- \r\O ft
State:
Zip: ?) 3e)
BFE: FFE:
Phone#:
Tenant/Lessee Name: Phone#:
"331 31-3
Email:
CONTRACTOR: Company Name: t
Address:
Phone#:
City: )L...k (N.,\ State: Zip: 3
Qualifier Name:
State Certification or Registration #: C Z
DESIGNER: Architect/Engineer:
Address:
Phone:
Certificate of Competency #:
Phone#:
Value of Work for this Permit: $
1
Type of Work: ED Addition El Alteration
City:
State: Zip:
Square/Linear Footage of Work:
E] New
Description of Work: C \ 0 C-e_ \.J\-)a-kQ
Lil Repair/Replace El Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ (40, 00 CCF $ CO/CC $
Scanning Fee $ -- - CD: Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
c_i
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lenders 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.
t
I R
Signature / Signature
OWNER or AGENT
The foregoing instrum nt was acknowledged before me this
-7-- day of l , 20 , by
\`' a , wh erso Ilan y known to
CONTRACTOR
The foregoing instru ent was acknowledged before me this
( day of 1J... 20 18 by
O.S\-1 '(p � t. C t , who ersonally known to
me oho has produced as me who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
:FENS
lie of Florida
Co"itt7Ftg ;on= Gf i 0in;
My Comm. 5T6resJun 29,202J
9crvr3r .`'k5, r?notep sk
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
as
Print:
Seal:
C T?STNEs-rEvE.N>
°yPublic _ Stee5f ioridd
r iSSip� r GG 120341
rmm,tzvir�tsj n29
... .40a=
APPROVED BY Plans Examiner
Zoning