The URL can be used to link to this page

PL-15-790�}1�312ois .M BUILDING PERMIT APPLICATION 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 ❑B LDING ❑ ELECTRIC ❑ ROOFING FBC 20 10 Master Permit Nod�(\— Sub Permit Nop.�= 0 ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 779 r'ity• Miami Shnrec County: Miami Dade Zin: _3310 Folio/Parcel#: //® :? i0 — t9_5 — 00/UIs the Building Historically Designated: Yes NO _ Occupancy Type: Mu/'A i Load: Construction Type: 19J/,Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):. Address: �'`%© �� 5� City: %?/ / Wn.1 State: Tenant/Lessee Name: Email CONTRACTOR: Company Name: L, 4 Address: 7 v w 7 f k A City: b�L a Qualifier Name: e ;rtW 4 one#: Zip: Jl J9 one#: 302/• �;Lg-2' 14113 Phone#: State: jr- Zip: r-S 04 Phone#: 4 Sy- SS{%SPI S"— I State Certification or Registration #: /0 — CA4P- I &S-Y L(— X Certificate of Competency #: DESIGNER: Architect/Engineer: Address Phone#: City: State Value of Work for this Permit: $ 7S0 Of Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New U;-Irepair/Replace Description of Work: Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ '4J ' Permit Fee $ �` CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ DBPR $ Nntary $ Training/Education Fee $ Qle Fee 1 SO Bond _ p� — TOTAL FEE NOW DUE $�� I • 10 ;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" 7dir promise in good faith that a copy of the notice of commen whose property is subject to attachment. Also, a certified copy for the first inspection which o urs seven (7) days after the inspection will not be appr9 a nd a reinspection fee will be cl Signature OWNER or AGENT The foregoing instrument was /acknowledged before 103 day of I1�QrCh 20 �by -Art (`l who is_ ersonally known to me or� as produced as identification and who did take an oath. NOTARY PUBLIC: with an estimated value exceeding $2500, the applicant must construction lien law brochure will be delivered to the person -orded notice of commencement must be posted at the job site V rmit is issued. In the absence of such posted notice, the M Signatu The foregoing instr' mer f was acknowledged before me this day of Q Q 20 l� by who i personally known to < 3m or who has produced as identification and who did take an oath. n NOTARY PUB Sign: ( Z itle 1' ilZ-0 11 Sign Print: /VIlC1 1� 1 l-d Tatwe Print: Seal e Seal: t„ MICHAM AUBREY OAINES -'_''• s MY COMMISSION # EE19113? EXPIRES Aprl 19, 2018 � **«**************** �e**** /**** *******«**sr APPROVED BY ( —' ` -?f S Plans Examiner MICHAEL AUBREY GAINES MY COMMISSION # EE191132 EXPIRES AprO 19, 2016 Zoning (Revised02/24/2014) Structural Review Clerk 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 Signature (or . 61 WZ t/ OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this S day of .20 ILJby A ILgkJ who is personally known to me or who has produced as identification and who did take a NOTARY PUBLIC: Sign: Print: QL I QRRLONDA YO MY COMMISSION #FF129050 EXPIRES J.n. a, 2o1e • «it««««««►►«►►r►r«««►►rAMCM N'rla....ota. ►r FIaIW Notary SerWt..tam APPROVED BY (Revised02/24/2014) The foregoing instrument was acknowledged before me this �� day of _�fr/ .20 1 Y by VA 11� UQWd , who is personally known to me or who has produced identification and who did tak o th. NOTARY PUBLIC: Sign: Print: (/ Seal: IJ Plans Examiner � yv � IN Structural Review as 4;IN QERLONDA YO[JMANS MY COMMISSION #FF129050 EXPIRES Jun. a, 2o1e «�y1y,�� «► r r r ��r� r r r Zoning Clerk