REV-19-1429Miami Shores Village RECTEI?VZD
own
01103)2019
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BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Building Department J �. 2 1 2019
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY'
INSPECTION LINE PHONE NUMBER: (305) 762-4949 t
❑ ROOFING
F�
]BC 20(
Master Permit No. 1 Lds ` ` l iG
—9 bl �0
o. K�-C
Sub Permit Nv-
REVISION
❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ 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 Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:30S:4SS -� LzV
City: I • Vt o..M ', 1� State: �A
Tenant/Lessee Name: 1 ) A Phone#:
Email:
CONTRACTOR: Company Name: `� h 4(� 1 tC� G ! OJO Phone#:( O )
Address: t (., U rz,W S�
City: t GM �k State:
Qualifier Name: -0hj'A o N Phone#:
State Certification or Registration #:
Certificate of Competency #:
33 \ c s-
DESIGNER: Architect/Engineer: Phone#:
Address: Cityt�,��seisa�ds State: Zip:
Value of Work for this Permit: $ Squa' a/tii dar;Fpbtpge of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ Nevi Repaiv/R►lace
❑ Demolition
4 `j r V1 I
Description of Work: ��I S h Qli Ct�t rt 1 S s- l� h S
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Com,pany'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
day of 20 by
,who is'personall kn n to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC: �. `•••/%s' Ismael A. Pabon
Commission # GG082163
Expires: March 13, 2021
Sign: ' , + Bonded thru Aaron Notari
Print
as
Signa
NTRACT
The foregoing instrumgqent was acknowledged before me this
2� day of J - 20 by
.L11`) who is rsonally know
:)6
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Si
Print:
Seal: — Seal: .,b ��� Ismael A_ Pabon
_* Commission # 6G082163
Expires: March 13, 2021
oFF�cR� Bonded thru Aaron Nota.7
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)