FW-16-502Miami 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 ELECTRIC ROOFING
I FEB 24 2016
BY: 1„ -
FBC 20/l/ .
Master Permit No. IzLs. L Z
Sub Permit No.
REVISION EXTENSION [—]RENEWAL
PLUMBING MECHANICAL [:]PUBLICWORKS [:]CHANGE OF CANCELLATION [—]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I(3" I I N E
City: Miami Shores County: Miami Dade Zip: '7-3/'3V
Folio/Parcel#: Is the Building Historically Designated: Yes NO t/
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): / . A -e_ Phone#:
Address: 106 d 4-1-E /Z 4f 7`=
City: Z!4 )-Alel jr 40/1.QS State: FL Zip: J 3%,-Px
Tenant/Lessee Name: Phone#: 71F(., - 0i ( --7.3 q g
Email: '5+j'- tt ^,.L,- ty —'r G % (VL"-
CONTRACTOR: Company Name:
Address:
City
Qualifier Name:
ne#:
Phone#:
p:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ (d00 _ Square/Linear Footage of Work: 2
Type of Work: Addition Altteration .New Repair/Replace Demolition
Description of Work: (', /h /h r-e, yt X.
Specify color of color thru tile:
Submittal Fee $Permit Fee $ C0 CCF $ 2-0" ` CO/CC $
Scanning Fee $ 6 4 Radon Fee $ DCBIPRR $ Q_ Notary $ l
Technology Fee $ V Training/Education Fee $ V ' T'V Double Fee $
Structural Reviews $ Bond $ 0
TOTAL FEE NOW DUE $
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
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: 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2 v day of //few 20 1Z by
j05712yLZ,who is personally known to
me or who has produced / [/t_ as
identification and who did take an oath.
NOTARY PUBLIC:
Sig
Print:
OoW
k Notary Public State of Florida
Joanna M Feliciano
g 8 My Commission FF 082753
f
Ion
Expires 01/12/2018
APPROVED BY
Revised02/24/2014)
Signature
a
CONTRACTOR
The foregoing instrum2nt was acknowledged before me this
1711/
day of 20, by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
Plans Examiner
Structural Review
a
9-127:11 Zoning
Clerk
BUILDING
PERMIT APPLICATION
Miami Shores Village RECEIVED
Building Department
JUN 12 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: z
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
Fe14BfC,/
j ]
120(
Master Permit No. T- ` -
D
Sub Permit No.
F-1 BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF t4CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction
cConstructionType:
Flood Zone: BFE: FFE::
OWNER: Name (Fee Simple Titleholder):Joyo- t 44y; -t- Phone#:L $V d-71- / q
Address:
4c
11 "I ct
y, City: 1 Y m 5 orG h State: Zip:
Tenant/Lessee Name: / Phone#:
Email: tJ m h / j-4 xV k,. %P in
CONTRACTOR: Company Name: Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
Address:
Value of Work for this Permit: $
Type of Work: Addition
Description of Work:
Alteration
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Revised02/24/2014)
Zip:
Phone#:
Certificate of Competency M
hone#:
City: State:
Square/Linear Footage of Work:
New Repair/Replace
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $_
DBPR $
Zip:
Demolition
CO/CC $ _
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ _
Bonding Company's Name (if applicable)
Bonding Company's Address
City 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. 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.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 , by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: Seal:
as
APPROVED BY v5 Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
roc ( 41 t4-