REV-17-2665M
Miami 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
OBUILDING ❑ ELECTRIC ❑ ROOFING
4�c-r,�
Nov 8 2017
FBC 201 s
Master Permit No. 6 P P i-I 5 io
Sub Permit No. gty
dREVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 19 k o kE 10 ( Sr
City: Miami Shores County: Miami Dade Zip:
Foiio/i-arcei#: 11 -32o �_ --o3S - ego 3 o is the Buiiding Historicaiiy Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Imo—f-, S k., ^r-S Gt-C Phone#:
Address: 312, t v- \ .
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ESSIG POOLS, INC Phone#: 305-949-0000
Address: 1800 NE 151 ST
City: NORTH MIAMI State: FL
Qualifier Name: DANIEL ESSIG
State Certification or Registration #: CPC052505
DESIGNER: Architect/Engineer:
_Zip: 331625
ne#: 305-949-0000
Certificate of Competency #:
ne#:
Address: City: State: Zip:
Value of Work for this Permit: $ —4� )2:) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: I_ko/c lnc�i-�1��
}y • _"' . - -
{ ' r
Specify col r of color thru tile:
.. ._v
Submittal Fee $ Permit Fee $ 0� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ l 4 '
(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 wort: 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.
Signa Signature
OWNER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 120 by day of 20 by
, who is personally known to DANIEL ESSIG who is personally known to
me or who has produced as me or who has produced as
identification and who did take an identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
COMMISSION # FF 133916
Print: Print:
Bonded ThruNotary Public Undo. r:ftcrn 1 =a?' SZNAJDERMAN
y `*; +� MY COMMISSION # FF 133916
Seal: — Seal: ,.
EXPIRES: August 30, 2018
Jrj�b Bonded Thrill Notary Public Underwrite.
v ` Zoning
APPROVED BY Plans Examiner g
Structural Review Clerk
(Revised02/24/2014)