BPP-18-1036BUILDING
PERMIT APPLICATION
Miami Shores Village RECEIgE,
Building Department APR 19 101
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
F B 2019�- 2
Master Permit No. ,L')Q
Sub Permit No
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: 12 c.-C7 i>JIG�- ` t4
+❑RENEWAL
V
I
SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip•-> 3�
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):"it+2-tA ed4j)12ellq NIIE;—L Phone#: _"J�305.
Address: ! 26 d � 94
City: V41 O�-M % Sip re & State: T11 zip:
Tenant/Lessee Name: Phone#: I
Email: ,0i1dr'.AAa, t'Yl Vs bJ Clkl'LQt L C-�yYl
CONTRACTOR: Company Name: a Phone#:91ARLED
I
i
Address: i
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Add
ne#:
Certificate of Competency #:
ne#:
City: State: I Zip:
Value of Work for this Permit: $� s� O O b Square/Linear Footage of Work-O rrl�y x I�T-}�
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition S�,FGG+v
Description of Work: f-eS--tr
Specify color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $,
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ _
(Revised02/24/2014)
9
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.
Signatu
ER or AGENT
The'fgoing instrument was acknowledged before this
Y
Mori an MotoI� who is personal) k own to
me or who has produced --- A0 U as
identification and who did take an oath.
NOTARY PUB L
I K. GONZALEZ
L-.7�
SION # GG 044602
November 2,2020
Sign: tary Public Underwriters
Print:
Seal:
APPROVED BY
4igriatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20, by
me or who has produced
who is personally known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
.Seal:
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)