MC-18-1250BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
❑PLUMBING IdMECHANICAL
JOB ADDRESS:
Miami Shores Village i,r r -; ; EU,
Building Department MAY 102018
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 201
Master Permit N�KI (
Sub Permit No. l 5 C)
❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: 1 l 3 7-0 �o 1 21- `V1 r) Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: _
A A i , i r
OWr
Addr
City:
Tena
NO
FFE:
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Addr
Add
Company Name: Phone#:
State: Zip:
�Xa
lifier Name: Phone#:
e Certification or Registration #: Certificate of Competency #:
IGNER: Architect/Engineer: Phone#: _
Value of
City: State:
Permit: $ — Square/Linear Footage of bw.
Type of Work: ❑ Addition
Description of Work:
Specify color of color thru tile:
Zip:
❑ Demolition
Submittal Fee $ Permit Fee $ y CCF $ CO/CC $
Scanning Fee $ Radon Fee $ 4t 50 DBPR $ j::; Notary $ t. Q
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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
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 low 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
OWNER or AGENT
Theregoing instrument was acknowledged before m this
�— day of CLAct 20 by
VGA�_�_ who is perspnally known to
me or who has produced < < `C� las
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal
MANARA1K.GONZALEZ
MY COMMlssinki "__
exriKES: November2, 2020
Bonded Thru Notary Public Undem,
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
as
APPROVED BY _ ans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)