PL-17-211 (4)Miami Shores Village77iJAN
,- -
Building Department2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel: (305) 795-2204 Fax: (305) 756-8972 — ---.?
INSPECTION LINE PHONE NUMBER: (305) 762-4949 l L
FBC 20 (q
BUILDING Master Permit No. P-,
PERMIT APPLICATION Sub Permit No. P
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
MPLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
1 CONTRACTOR DRAWINGS
JOB ADDRESS: S S ��^� Y) O V e 0y V •C �^
rity• Miami Chnrac rniinty Miami Maria Tin- Z31 Its
Folio/Parcel#: Is the Building Historically Designated: Yes NO_
Occupancy Type:!SF Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): YG( v`.�P Phone#:
Address:
City:
L, e- J
0-) (n e- o c/ V S P
State: r ( Zip:
Tenant/Lessee Name: Phone#:
Email: �c`
CONTRACTOR: Company Name: PJ V 11414M Phone#:
Address: 3.3 7 ,& uo I a C� n
City: UP A -LP< j2 State_ f =--/co ,t el AL Zip: '-t
Qualifier Name:
ne#:
State Certification or Registration #: (2- P�—' I q;j Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: Ogg City: State: Zip:
Value of Work for this Permit: $ `7 Square/Linear Footage of Work: �7 ci
Type of Work: & Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: -P. � ��� C4 -g V in G\/\ !'-P
Specify color of color.dirt tile:
Submittal Fee $ 'SOpli: f"Vi 1L)Rermit Fee $ / p v CCF CO/CC
Scanning Fee $ ( Radon Fee $ �( 3 S DBPR $ - 3 S Notary $
Technology Fee $ �(� Uy Training/Education Fee $ f! • d Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ O S�
(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..... "St
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 BFORE RECORDING
YOUR NOTICE'OF COMMENCEMENT." , . .
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding 52500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will tie 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.
.�.
J Signature � Signature I
OWNER or AGENT e r- CO ACTOR
The foregoing instrum nt was acknowledged before me this
41_�da of %Z11- 20�� , by
who s personally known to
me or who has produced as
identification and who did to an oath.
NOTARY PU IC:
Sign:
Print: _ LGl_(-1J r./--
The foregoing instrument was ack
G day of Cc.
o v �
me or who has produc _
before me this
20 t7 by
who islpersonally known to
identification and who did take an oath.
NOTARY PU
Sign: // Cl
Print: /tx Cam)
� prtM Py
Seal: Seal: +�`o•'•,°`� LAURAFARLEY
�r w LAURA FEY *AAA* MY COMMISSION i FF 1 27
MY COMMISSION t FF 181047 EXPIRES: March %2019
*A EXPIRES: March 16, 2019 %� foe Bvft Thru Budgd Notary Se}rlm
wn
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
as
Zoning
Clerk