REV-18-1068 (2)BUILDING
PERMIT APPLICATION
(BUILDING ❑ ELECTRIC
RECEIVED
Miami Shores Village APR 24 2018
Building Department QLj
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
�6- 32-G G 3F�B�C ia�A
Master Permit No.y V S CA - 2.8G9
Sub Permit No. � e V I F3- I CD j
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I I<< /V S 9 I j EiL
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 1 (- 1' 0 S - Or- ( - O 1 2.0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): V 41/E 6<Ca(14 Q' Phone#:
Address: It U 'V' C- 71 I C01
City: ✓ A (_e a State: Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: Jlz•'s ", ��i�� s Lo'tu Phone#: �" S,S C/ - -> / I
Address: i C t 5 "`' t( 2. 5 1-
City: l/t/`- lamState: Zip:
Qualifier Name: /y C i CGii 1-1 Phone#: Vsy `t
State Certification or Registration #: G4 l S 1 Go Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: �i City: State: Zip:
Value of Work for this Permit: $ AGE J~G� Square/linear Footage of Work:
Type of Work: ❑ Addition 91 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: v, -)�!j ( J✓ki
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
CCF $ CO/CC $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ _
TOTAL FEE NOW DUE $
(Revisedo2/24/2014)
NO
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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 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 com encement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, a certif d copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days fter the building permit is issued. In the absence of such posted notice, the
inspection will not be app+oved and a reinspection fe will be charged.
Z\ Signature ZM J
OWNER or AGENT CON RACTOR
The foregoing instrument was acknowledged before me this
day of 20 / `j� by
Ifwc- who is personally known to
me or who has produced
NOTARY PU
L4r�
Sign:
Print: VV n
Seal:
MY COMMISSION # G
EXPIRES July 02.
The foregoing instrument was acknowledged before me this
day of 20 l by
4. who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC.,
Sign: ��
Print: -� /� G "'
Seal:
MARTA HER
MY COMMISSION
EXPIRES July
as
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)