DOCK-17-2785BUILDING
PERMIT APPLICATION
Miami Shores Village RF F
NOV 22 2017
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY._ — _
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINEONE NUMBER: (305) 762-4949
��FBC 201
CALIS_
t�er Permit No. ��
Sub Permit No.
®BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
_,
JOB ADDRESS: 5'00 Alm 10 3 S7--
City: Miami Shores County: Miami Dade Zip: 33t 30
Folio/Parcel#: I± ( - 3.2a — o ( 0 Is the Building Historically Designated: Yes NO
Occupancy Type:
Load:
Construction Type:
Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
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4 1'/ . GEC /`l QSe r
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Phone#: v� ?Z 3
Address: e 5W
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City: {iylco�(r' �(�LC%%�
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State:/
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Zip:
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR:
Address:
;ompany Name: 5,J4tf4O5f-- 1*///11, l d11J f�✓CT • Phone#: A4 -9C)
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City:y Qie(r/2 C/ State: �I
Qualifier Name: ("e4 6 z:&,;,t Phone#:
State Certification or Registration #: Q C-4 , SZ G �J� Certificate of Competency #: _
DESIGNER: Architect/Engineer:
e#:
p: 3333
Address: City: State: Zip:
Value of Work for this Permit: $ / -)" -� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alte�ratio�n ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ (�I id —Permit Fee $ p CCF $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $,
Double Fee $ _
Bond $ TOTAL FEE NOW DUE $ ,f I d S3
a
(Revised02/24/2014)
Bonding Company's Name (if applicable) N/A
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 ppro d e Inspection fee will be charged.
gnature q,4 a//
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
20 day of SEPTEMBER 20 18 by 20 day of SEPTEMBER Zo 18 by
PATRICK FRASER who' ersonally kno o JOSEPH G THOMAS , who i ersonally know o
me or who has produced
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARYNOTARY
Pri
Seal: .......BELLA Seal:
LARRAZABAL �'�' �iy�,.: BELLA LARRAZABAL
MY COMMISSION 0 GG091015 MY COMMISSION * GG091015
EXPIRES'4r1� '�sil,ISit
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
as
Zoning
Clerk