REV-18-3086 (2)Miami Shores Village
� BuildingDepartment � Tb42018
N sY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 _T1+ +
INSPECTION LINE PHONE NUMBER: (305) 762-4949 CJ�
FBC 2014-(
BUILDING Master Permit No �l :;l�1
- 12 `�
PERMIT APPLICATION Sub Permit NO.�V I C`�` a Cct�G
j BUILDING ❑ ELECTRIC ❑ ROOFING �!f REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
_g�jt,(-) 11) 1--
OWNER: Nam Fee Simple T'tleholderrj):� In Phone#: ✓ d 9Va u
n 77
Address: Z I V 3 S
City: U
Tenant/Lessee
Email: 10d
CONTRACTOR: Company Name:
Address: 2:� 7,2
City:
State: "'N Zip,33/ 34Y
Phone#:
hone#: ::�
�!4/ Zip: 3_S4.271
Qualifier Name: eZ-i !,(,je/1y4J✓ Phone#:
State Certification or Registration #: Certificate of Competency M
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 Work: X X;"_ /-:200
A
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $. Notary $
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 Ad
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 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 th'e 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 appro nd a reinspection fee will be charged.
Signatu Signature
OWNER or AGENT CONTRACTOR
The f regoing instrument was acknowledged before me this The f regoing instrument was acknowledged before me this
day of rxas.20 d' by // day of // 20 � by
who is personally known to who is personally known to
_me or who has produced
identification and who did take an oath.
LILL I It LLUht I
State of Florida -Notal ; F
(Revised02/24/2014)
as me or who has produced
identification and who did take an oath.
NOTARY P LIC:
Sign•
Print.
peal:
LIZETTE LLORET
1<<;state of Florida -Notary Publi
l.� Commission # GG 118087
MV Commission Expires
Plans Examiner
Structural Review
as
***************
U I -I Zoning
Clerk