DGT-18-1908 (4)BUILDING
PERMIT APPLICATION
��CEIVZD
Miami Shores Village
JA 14 20
Building Department
BY.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 1
Master Permit No. V�y�G%�
Sub Permit No. 'bG7-f
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑MECHANICAL ❑PUBLICWORKS
JOB ADDRESS:
gJ�T q4 45T
REVISION ❑ EXTENSION [—]RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: �XiV�r Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type:=1 Ly�tl`�t-
OWNER: Name (Fee Simple Titleholder)
Address: 1 2 8 rJ_ 1�'4 <:;F
Construction Type
`aos� A - sZ�4o
Flood Zone: BFE
ne#:
FFE:
'S A --rB SI I- I
City: M 1 State: Zip: 3 13�3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Jv ppee_ e.4DAP Phone#:
Address: 1 0 J
' �3 13
City: 1�1 ►��t State: � Zip: �f
Qualifier Name: �fl � r Phone#: —7>05 9 �12 Mb�
State Certification or Registration #: Cr"C 1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Description of Wojj00_DPgC V R- \AS1 C rQ
Specify color �of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
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 on 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 arld a reinspection fee will be charged.
Signatu
OWNERI AGENT
The foregoing instrument was acknowledged before me this
day of �G) piy�`f' 20 by
C L�CIZT�p �vfio is personally known to
me or who has produced WCEN�k--
identification and who did take an oath.
NOTlwt--J-p-
Sign:
Print
Seal:
*********************
APPROVED BY
SINDIA ALVAREZ
MY COMMISSION # GG 230273
EXPIRES: September 3, 2022
Signature
CONTRAC OR
The foregoing instrument was acknowledged before me this
day of U `� 20 (GI by
— u who is personally known to
me or who has produced as&A
identification and who did take an oath.
NOT
Sign:
Print: pj;}Z Q
deal: d SINDIA ALVAFGG
MY COMN4SS10N #238273
EXPIRES: Septem, 2022
PublicUtwAlefs
( )h I Plans Examiner Zoning
%/ly/% / Structural Review Clerk
(Revised02/24/2014)