REV-18-3760BUILDING
PERMIT APPLICATION
Miami Shores Village
".
Building Department ° 26 18
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: A t
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 ���1�
FBC 20
Master Permit No. ff
Sub Permit NoL_ 60
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ DRAWINGS
CONTRACTOR
l' I
JOB ADDRESS'' G 4) �' 10 7 S�
City:
Miami Shores Countv: Miami Dade Zip: -� 3�j' I
Folio/Parcel#: )' Z231 7- - o t 00 Is the Building Historically Designated: Yes _ NO
i
Occupancy Type: Load: Construction Type: Flood Zone: BFE: _ FFE:
OWNER: Name (Fee Simple Titleholder): Cu ��Gj �n �t�k /1- - Phone#:
Address�s: Z S �) 3
^5 State: Zip'
Ill
City:
Phone#:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: ESSIG POOLS, INC Phone#:
Address: 10111 BUSINESS DR
305-949-0000
City: MIRAMAR State: FL ?'p`
Qualifier Name:
DANIEL ESSIG Phone#: _
State Certification or Registration #:
CPC052505 Certificate of competency #: ____
hone#:
DESIGNER: Architect/Engineer'.
City: _ State:
Address:
Value of Work for this Permit: $ 320 C9 Square/Linear Footage of Work:
❑ Alteration El New ❑ Repair/Replace
Type of Work: [I Addition
Description of Work: '61-v` -- `' r ' - -
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
33025
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $
Notary $_
Double Fee $
Bond $
Structural Reviews $ ------ Gi
TOTAL FEE NOW DUE $ lS`I
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) Zip —
Mortgage Lender's Address
City
------- State
Zi
commenced prior to the issuance of a permit and that all work will be performed to
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
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 personally known to
me or who has produced
as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign: AL -
Signature_ll�/L;�
CON TRAICTM- —
The foregoing instrument was acknowledged before me this
day of20 by
DANIEL ESSIG
who is personally known to
me or who has produced PERSONALLY KNOWN
as
identification and who did take an oath.
NOTARY PUBLIC: /
Print: '`����������, -
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. Print
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Seal: ,
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NOTARY •'•. �y ' Seal:
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C.D�' PUBLIC �-A
REG # GG 157200. z =
PUBLIC
_ ; REG # GG 157200 : z Z
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MY COMMISSION: m
EXPIRES
• EXPIRS********************************s*
APPROVED BY L / • 11l01l2021,•' QP�
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�''•••`'' s Examiner
•FL
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' ning
ti Structural Review
(Revised02/24/2014)
Clerk