REV-19-670Miami 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
BUILDING
PERMIT APPLICATION
BUILDING M ELECTRIC [-] ROOFING
RECEIVED
MAR 2 8 2019
0- 4--
Cf -In
FBC 201
Master Permit No. RC 17-1482
Sub Permit W. 19 "
Q REVISION [:] EXTENSION RENEWAL
r-JPLUMBING MECHANICAL PUBLIC WORKS n CHANGE OF CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10007 NE 4th Avenue
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): John & Cristina Butler Phone#:305.970.9419
Address: 10007 NE 4th Avenue
City:
Miami Shores
Tenant/Lessee Name: N/A
Email: cibutier102@gmaii.com
State: FL Zip: 33138
n.......u. N/A
CONTRACTOR: Company Name: 0144" ('23to 1 koL 01 Act1w 1 Phone#: % ffo '_D ? -L/ t f'
Address: 55- /1 14 to 7 Ll Pr
city: —W (0-PYL 1I State: Zip: 33CE
Qualifier Name: °O Z 2 -e -K -S Phone#:
State Certification or Registration #: C YYiL I2 QSLS Certificate of Competency M
DESIGNER: Architect/Engineer: Dan Owens Phone#: 305.610.9490
Address: 2700 N. Miami Avenue # 408 city. Miami State: FL
Zip; 33127
Value of Work for this Permit: $100.00 Square/Linear Footage of Work:
Type of Work: Addition Q Alteration New Repair/Replace Demolition
Description of Work: Minor Adjustments due to field conditions
M'e6AaVVVi 0
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Revised02/24/2014)
CO/CC $
Notary
Double Fee $ .
Bond $
TOTAL FEE NOW DUE $ 0 - C,A 0
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City State _
Mortgage Lender's Name (if applicable) N/A
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: 1 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 firs 'nspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection vit o be app"areifee will be charged.
Si natur Si na rC , g .tut
OWNER or AGENT CO v / nRACTOR
The fore oing instrument was acknowledged before me this The foregoing instrumen w acknowledge ore me this
day of /` 20 _
tC( ,
by zuby
C\ as is personally known toN1'r 0 TIMI all known to
x. 2 ,
me or who has produced 11_Ws as me or who a c as
identification and who did take an oath. identification w o id ake an oath.
NOTARY PUB NOTARY PUBL
Sig Sign:
ra9C d MAHARAI K.
Print: OMMISSION # GG 044602 Print:
EXPIRES: November 2. ZUkU
Seal: ffif s ?j k? Bonded Thru Notary Pub!Ic underwriters eal:
sssssssssssssssssssssss s sssss sssssssslsssssssssssssssssssssssssssssssssss:sssssssssssssss*sssss
V
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)