REV-19-207RECEuVED
Miami Shores Village
JN 2 9 2019
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972 11
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. V4
PERMIT APPLICATION Sub Permit No. V Lu (I - ZU�
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0q0
City: Miami Shores County: Miami Dade Zip: 1
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: O� FFE: G�
OWNER: Name (Fee Simple
/Titleholder): �` Phone#: � l�i� 1
Address: A [ �/"! to ij l c)
City: A-kI \ o"tc State: Zip: X
Tenant/Lessee Name: Phone#:
Email
CONTF
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
1-0,0ue of Work is Permit: $
�v' —Typ of Work: ❑ Addition ❑ Alteration
�` ' tion of Work: �CGf
C
. -
Phone#:
Certificate of Competency #: _
Phone#:
City: State:/�� r�Zip:
re/Linear Footage of Work:
New 5-Repair/Replace Fyn ❑ QDemolition
1y�.J� --
. (' -/1 V f '5 1kd C71 v
Specify c-7or of color thru tile: T9 VtCV-,5
Submittal Fee $ Permit Fee $ CCF $_
Scanning Fee $ Radon Fee $ DBPR'$
Technology Fee $
Structural Reviews $
Training/Education Fee $
4. 1�e�sS, 41-• c-e
CO/CC $
Notary $
Double Fee $
Bond $
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
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CONTRACTOR
The foregoing instrument was acknowledged before me this
�—� day of 20 I by day of 20 , by
P-V—lii `'!2 who is personally known to who is personally known to
me or who has produced as me or who has produced as
fication and who did take an oath.
BLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 1(yD��� Print:
Seal: Seal:
APPROVED BY
SINDIA ALVAREZ
MY COMMISSION # GG 238273
*eyjlN s*SePlen6Z ss
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
RECE:
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PDtdPANO BEACHH
FLORIDA 33060 L.B. #3635 FAX. (954) 782-1442
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PAL 31. M 41' MA`RJAN 2 9 2019 '`j
GRAPHIC SCALE
BY:
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This survey was made for mortgage and title purposes only and is not valid for design or construction purposes,
I. tares agherwise Haled eaa raeaxaerl�rb are h agreenaelnt MPo1lecerd
Mn
(�tiTIFlCATI_�_:
Tics Is b certify dud I have recendly surveyed the property described
2. Beeringsshowni eaa ara based on a bearing d NIP,
In the kffegokV We caption and Hove set or bud nxmww s as
3. The Lads showntreraon were not a!>sftaoted jar aawlerahip.llgdls dvrdy, easemevis
or other mattes ofracecds by Amaale tad Suveyars kc
Indicated on this skeldh and that said above grand survey and
alretGt are emetic and wreci to the OeSt dngr Imowiedge and
. Ownership of fences and wets B any are not delnmlirrea
bend I kwdw ae[tl6y otat this survey meets bornbarm Technical
5. This is the d Amaate land
11roP�f Surveyors. trlc and sinali not be used cr
Stmutards udder Rule SJ-1T.052 adapted by one Florida Bwrd ofY
Land surveyors, January 11, 2070.
reproduced in whole or In part uv101otr vudCen evUlorizaoorn.
6. This survey Is made br the ixdushe use tithe ONSW henu n, to be valid one year
from the dale of scary as shown herean
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7. This survey on a map and tmd report ane is not votld without the other.
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a. Thla survey wm made for nortgege nd line pupases onhy w4 B not va®d for deatgrt
NOT VAUD 1111NOUT
or cmmbtxsm puq m m
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J N 2 9 2019
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