WS-18-2290V
BUILDING
PERMIT APPLICATION
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
RECEIVED
AUG 2 g 2018el�7
FBC 201
Master Permit No.w Sl O-- 22411 0
Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �le25 N4,--- K .ST
City: Miami Shores County: Miami Dade Zip: 3.313'6
Folio/Parcel#: -I, - 32,05 -0/9-0030 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): W W -G Wo l Q uaggo Phoned:
Address/: &(5�E S 7 `
City: -nlmi urns Stater Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
Address:
City: Dora State: �� Zip: �3212Z
Qualifier Name:�jn �. �(/Zrd '' ll Phone#: �5103225
State Certification or Registration Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ I1 '1 .) Square/Linear Footage of Work: !�atp , 0.3
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition
Description of Work: W,
Specify color of color thru We:
Submittal Fee $ 4 -Permit Fee $ ;�-Dc .03 CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $,
(Revised02/24/2014)
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ a19 -W
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 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
—(J J
OWNER or AGENT C/ONTIR&WOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of
14*" 1 20 Li by
day of �
20 CC , by
, who is personally known to
Sa.. 18`J,
who is personally known to
me or who has produced
-'% la=rt3 as
me or who has produced
as
identification and
rd d take an oath.
identification and d t ke an oath.
NO: PUBLIC:
NOTARY PUBLIC:
OSCAR CAR SERGIO CUEVA
..... ' --
<
OSCAR SERGIO CUEVA
►; �:
MY COMMISSION # GG 046361
*� MY COMMISSION # GG 046361
='r
,? ;4°'
EXPIRES: March 9, 2021
Bonded Thru Notary
Sign:
.
Sign: tNw
Public Undenar tars
on ed Thru Notary Public Unde rwrtters
11
Print:
Print:
Seal:
Seal: vt
iw L7*
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)