BPP-19-1378 (2)BUILDING
ENTEREDMiami Shores Village DE"', 13 2019
Building Department
BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 �}- Ll
ABC 2 1-7
Master Permit No.
PERMIT APPLICATION Sub Permit No.13f'f? CG --I1-13-1r
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION D216TENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLICWORKS []CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 114 l D IJ E 0\
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: \\ - ROS K 003 d Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): ��^� '� `� �c.`,GS �LC- Phone#:
Address: T Z� Q0 L✓A S I'e.�
City: State: Zip:: 3`14 �'(o
Tenant/Lessee Name: n Phone#: b 6 3^ �S � h
Email: 1 / A a\\t4,r -� VA,,- C.y�
CONTRACTOR: Company Name: CSS "
Address: ( 6\�A 3" 5 \--m S r .
City: ) k. r-�•� V
Qualifier Name: N�bL'Z�\ tE- SSi
State Certification or Registration #:
State:
ne#:
730 L �-
hone#: 3oS�-9N4 -D-nO
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address
Value of Work for this Permit: $
Type of Work: ❑ Addition
City:
Square/Linear Footage of Work:
State: Zip:
❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: gigTdw�si.1
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $,
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
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
n
13 day of tA�LW V-V 20 11 , by
Signature liel
G�
CONTVtTOR
The foregoing instrument was acknowledged before me this
13 day of 20 / ' by
A!L M\LCrL who is Oersonally known to e, \ C5'5,�who is personally Known to
me or who has produced ►� 'I1 77�p,s me or who has produced ,.•` a M1CHgFj
identification and who did take an oath Q.Z. N��PR:I''••,9,p/ identification and who did take an oath���pQ: '• NPug IL C ' :%
NOTARY PUBLIC: ti�:� Pug�IC \ssp0';� 'NOTARY PUBLIC: `? : GG 157200
;REG # GG 15710N N ' s :REG OMMISSiON �" =
COIMeS : �Z ; v • MY EXPIRES Q
. J EyPI 1,: cs' •' ,1110112021: NO
Sign: � 1202 � ; Sign: � • Q-
Print: C�� 5 �-�n 11e/ �'�K tVt;"" CiF•F .�`� Print:
Seal: Seal:
APPROVED BY ( Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
12/13/19
To whom it may concern:
I am requesting an extension of permit # BPP-6-17-1540. The reason for this extension request is due
to the house being under construction so the pool is on hold. Please extend it for 6 months. Thank you
and best regards.
Qualifier
STATE OF FLORIDA
COUNTY OF MIAMI DADE
The foregoing instrument was acknowledged before me 111 o f f t"O"
This I'S day of Tkzs 'A1 , 2019 by �CHgFz
c� Q 'NOTARY •''•, p�, s
` �� ' • PUBLIC
-----------
: Z
who is personally own to me. ' Ej REG # MISS ON
v '. MY coM ES
EXP1R : Q
' c9�; •. 1110112021.•��
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(Not ryWblic--S-tate of Florida)
�.OF.F�'
!,Gj Pw�L
10111 Business Drive • Miramar, FL 33025
Main: (305) 949-0000 South Dade: (305) 253-4673
Broward: (954) 438-6251 Fax: (305) 949-9171
www.EssigPools.com I sales@essigpools.com