WS-16-1566BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
JUN 0 6 2016
ILBY:
201q s
ACELLED Master Permit No.
PE MIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: 1066 NE 94th Street
Sub Permit No.
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores Countv: Miami Dade Zip: 33k 3 6
Folio/Parcel#: /— 3?-oS — e)/2 ! / Zv Is the Building Historically Designated: Yes NO
Occupancy Type: Af Load: . Construction Type: Flood Zone: BFE: _ FFE:
OWNER: Name (Fee Simple Titleholder): Stephen A. Marino, Jr
Address: 1066 NE 94th Street
City: Miami Shores State: FL
Tenant/Lessee Name: N/A
Email: smarino@vpl-law.com
CONTRACTOR:
Company Name:
[
Address: 1 0
ot:7%
hone#: 3058120629
zip: 33138
hone#:
hone;
City: IA-M1 State: L";4— Zip: ✓ -3 13c)
Qualifier Name: ��'�/� (/AU1,41JQ Phone#: z11 7-
State Certification or Registration #: C C_ 2 Certificate of Competency #: tp
DESIGNER: Architect/Engineer: iat j�qU Phone#:(7� r� 7 —`3r,
<l 3�- M� y-vfr �� 3313C7
Address: �� r51 City: State: Zip:
o;D
Value of Work for this Permit: $_21 Square/Linea�r-Footage of Work:
Type of Work: El Addition ❑ Alteration El New L Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
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
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 Signature z
O NER or AGENT —� CONTRACTOR
The foregoing instrument was acknowledged before this The foregoin instrument as acknowledged befarg this
ay of 20 by day of ��— 20 — by
ST �.
who is personally known to rr ,who is personally known to
me or who has produced Pk_ as 1 r who has produced as
identification and who did take an
NOTARY PUBLIC:
Sign }
PrinGO
.r a ary u a oFlorida
Seal. =s� + 4 My Comm. Ex res J 15, 2017
Commission # F 195
APPROVED BY
identification and who did lake an oath.
NOTARY PUBLIC: 11
Sign. ~""
Print y�uhlie - State of Florida
y tApires u
Seal: '' a�.� -mission # FF 195
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)