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Miami Shores Village �, 4 --_ ,�,
L Building Department CT 3 218
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 I
Tel: (305) 795-2204 Fax: (305) 756-8972 B V
INSPECTION LINE PHONE NUMBER: (305) 762-4949
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
/,FBC 20 /�j
Master Permit No. WW �- � ?-14 / b
Sub Permit No. PTtv Ie - 3325
REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 700 A)E 1101 6�
Citv: Miami Shores Countv: Miami Dade ZiD: 3N'
the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 05C0 K I Phone#:
Address: -700 101 Sf-
City: State: '► L Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: 1 7jjW
� W
City: T / (Lf l_k--'G(`7
Qualifier Name: ito
State Certification or Registration #:
hone#: 3"`-' vJ
_Zip: ��`{—gyp J ! _
ne#: S®/.1� Q 00EE
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State
Value of Work for this Permit: ED
Square/Linear Footage of Work: _
Type of Work: ❑ Addition ED/ Alteration ❑ New ❑ Repair/Repl4ce
of
Zip:
❑ Demolition
Specify color of color thru tile: nn mm �[
Submittal Fee $ Permit Fee $ �V - W CCF $ 2 ' L 6 CO/CC $
Scanning Fee $ Radon Fee $ 2= CND DBPR $ Notary $
Technology Fee $ 2 ' wV Tralning/Education Fee $ 0 ,QL
Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revise d02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State 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 e)f1such posted notice, the
inspection will not be approved and a rection fee will be charged, /I 1-7�f�
Signatu
OWNEA'Trr AGENT
The foregoing instrument was acknowledged before me this
day of C)Cf- 20 O by
Q I/(V'Cirll!�who is personally known to
me or who has produced 0U as
identification and who did take an oath.
NOTARY PUB
Sign:_
Print:
Seal:
>_%`^' Notary Public - State of Florida
,�.- •_
9 Commission 2 GG 196656
My Comm. Expires Mar 30. 2022
Bonded through National Notary Assn.
*****************************
APPROVED BY
(Revisedo2/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20, by
luorc. Ph who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal: ;.para'; CHRISIYABAY
Notary Public State of Florida
Commission k GG 196656
oF;�?p` My Comm. Expires Mar 30, 2022
Plans Examiner
Structural Review
********
Zoning
Clerk
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REVISION
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PERMIT #: I 33ZS
_ Miami
Shires Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
SUBJECT 10 CCNIPt1ANCE WI fN ALL FEUERAL
STATE ANL) C UN i'f HL,L S AND REGULATIONS
2
53X39
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