REV-19-538I
Aami 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
F-IBUILDING ELECTRIC ROOFING
1AR 1 2 9
BY:
FBC 20
Master Permit No. P -e-' 18- ) Z-1
Sub Permit No. w\j., S
REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
r nK1TRAr'Tr1R r)RA\A/INr;C
JOB ADDRESS:
Folio/Parcel#: AN— ZZ3Z-632`Q(A-,L°
Occupancy Type: Load: Construction Type
Is the Building Historically Designated: Yes NO
Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder):
l
Q- N Phone#:
Addresss: "2` V /45
City: , Ny' S °-S State: - Zip:_'? 33
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name:
r,
6' sm tov Phone#:
Address: 3t0 0 (/1/- _ flU/"t,s
City: P kAAA 11//
St
Qualifier Name: l [ [X Ga
State Certification or Registration #: ` t
Zip: 331DI C/
ne#: 7?6 Z'A7 —76'7
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ -570 Square/LinearrFFootage of Work:
Type of Work: Addition Alteration New E2-Repair/ReplaceRepair/Replace Demolition
of Work: T•,s-) vM dlx -CL4WQ C APaI "n S
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ j CO Q CCF $ 0, 0 CO/CC $
Scanning Fee $ Radon Fee DBPR $ -,--2 '03 Notary $
Technology Fee $ 2' 2i Training/Education Fee $ O ' Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ (0 . GS
Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Application is hereby made to obtain a permit to do the work and instal
commenced prior to the issuance of a permit and that all work will
construction in this jurisdiction. I understand that a separate permit
Zip
M
lations as indicated. I certify that no work or installation has
be performed to meet the standards of all laws regulating
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 L_---,-7 / V
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of rCh 20 )
c)
by
00(,UWr who is personally known toT
me or who has produced as
identification and
whRpO.NNOTARY&PBLIC: of
Florida21117123
21
Sign: //
Print: 40bllbq zac>o1
Seal:
The foregoing instrumen" a5knowledged before me this
da of (
rwf Al 20 by
who is personally known to
me or who has produced qb U7i(.C `'[ Os
identification and who did take an oath.
NOTARY PUBLIC:
Sign: C. !1Z
Print: JussinN # FFS97102 1
EXPIRES July Ut)
Seal: SCS.:..; „ t
APPROVED BY f'
r ~ 31,1 Plans Examiner Zoning
Structural Review Clerk
lIevised02/24/2014)