DS-15-2296BUILDING
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
SEP 1P 2015
Ad
BY:
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FBC 20,q
CANCELLED Master Permit No.'-Ds--iS-2.Z IQ
6
Sub Permit No.
ZKUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING F-1 MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 00 NV 0 5t
City: Miami Shores
County: Miami Dade
Zip:
33 ( 3r
Folio/Parcel#:
Is the Building Historically Designated: Yes
NO v
Occupancy Type: Load:
Construction Type: 5 Flood Zone:
BFE:
FFE:
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OWNER: Name (Fee Simple Titleholder):
Phone#:
, –,466
Address:
City: M,RpM,
State: L
Zip:
3313�
Tenant/Lessee Name:
Email:
e#:
CONTRACTOR: Company Name: O/� G(.v/VL'Y'v Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Zip:
?h ne
:ertifica Competency #:
Phone#:
City: State: Zip:
Value of Work for this Permit: $ 61 Wavy, — Square/Linear Footage of Work: 2 . 24AO
Type of Work: ❑ Addition ❑ Alteration O'New [A;-R�Pair/Replace ❑ Demolition
Description of Work: i ZE II'ZA C I NC- (; )e 15 Ti Av & 115P/(ALI �'i v wA Wj A Ori do P C%Z5 n v
lac 5.lk NI> 1$4 5e . C T)jziUC VAV-) ,AND ,NCW �P111—I WAV
Specify color of color thru tile:
e� E
Submittal Fee $ Permit Fee $ CCF $ -.M- : -CO/CC $
Scanning Fee $, Radon Fee $
Technology Fee $ ' ' Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
Notary
Double Fee $
Bond $ �500
TOTAL FEE NOW DUE $ 1 � 6''Z 0
6�r.,.20
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if app
Mortgage Lender's Address
City
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
LOV4ER or AGENT
The foregoing instrument was acknowledged before me this
10 day of 20 IS by
`SIBS who is personally known to
me or who has produced L. o y'i Ili Y s (—a -.--as
identification and who did take an oath.
NOTARY PUBLIC:
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:
Sign: Sign:
i_ ,A 1
Print:
Seal:
"OK111,ti BARBARA A ESTEP
MY COMMISSION i FF 073975
'
EXPIRES: March 29, 2018
Bonded Thru Notary Public underwriters
################
APPROVED BY
(Revised02/24/2014)
Print:
Seal:
as
Plans Examiner / /r &-oning
Structural Review
Clerk