FW-19-1084BUILDING
PERMIT APPLICATION
Miami Shores Village
o es age
Building Department Mr 14 2019
10050 N,E.2nd Avenue, Miami Shores, Florida 33138 BY;
Tel: (305) 795-2204 Fax: (305) 756-8972 041
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 17)/\C�
Master Permit Noll A - n'-1 ! to
Sub Permit No
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
t1 fir,-/ CONTRACTOR DRAWINGS
JOB ADDRESS: '51
City: Miami Shores County: Miami Dade Zip: 3 3/S(f:>
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: � 0 /VW S
ne#: 305 f >8 4d; 0
City: Z1.4 l N -o e y State: L Zip: .33/S'0
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
City: State:
Qualifier Name:
hone#: ,30ry>6 4�4 0
hone#: '
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ / O Square/Linear Footage of Work: ( 1
Type of Work: ❑ Addition ❑ Alteration_ ,❑ New ElRepair/Replace ❑ Demolition
Description of Work: 540004 wd AtJ6' irf gCd
Specify color of color thru tile:,
Submittal Fee $ GJ6 Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
J.,
. , . • is:, - r - :. .•..:.;
CO/CC4$
_ DBPR $ Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ i C '3
Bonding Company's Name (if applicable)
Bonding Company's Address
City j 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. 1•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. fi.; +U` , ' V ,\J^+ s
"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."
y.,+., t"'•..rte
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 9posted 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.
C;,...,*...
OWNER or
The foregoing instrument .was acknowledged before me this
P daof + �� 20 14p; by
�jWb ��5�?Pt � � , who is personally known to
me or who has produced *FL—D4 M9?—, LkGFAs
identification and who did take an oath.
NOTARY PUlDLIC:
1�a ZaWLpllllllI�i ` h, Q
Seal:
APPROVED BY
(Revised02/24/2014)
SINDIA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
r17,
Signature
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' • .
Print:
Seal:
as
s**s•*s*s*******r*r*s•r�*rr******ss�**ss******r*s****msss
Plans Examiner Zoning
Structural Review
Clerk