EL-18-311BUILDING
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
FBC 20
Master Permit No. B� rJ- 1 Z ' 0 - -NP3
Sub Permit No. F. L I I C - _3 ``
❑BUILID ING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUM BING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 150 NE 94 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-013-2970 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: _Flood Zone: BFE: _ FIFE:
OWNER: Name (Fee Simple Titleholder): Stefano Carnlat0
Address: 150 NE 94 ST
City: Miami Shores State: FL
Tenant/Lessee Name:
Email
Phone#:
Phone#:
Zip: 33138
CONTRACTOR: Company Name:aFZ(�5Id,&j RbWF;2 4 C'C�ff%COL Phone#:_��•(?/(e/
Address: ? �_T o -T-
City: 1 iA t SEA H State: FL Zip: ,3,30/0
Qualifier Name: J U(MAAII) n AL✓,4(2,F 2-- Phone#: _ / ti -2 /4o1_
State Certification or Registration #: (nn �—`?U >% Certificate of Competency #
DESIGNER: Architect/Engineer:
Phone#:
Address: City:
Value of Work for this Permit: $ ) '' Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
Description of Work: Pool Pump and Light
Specify color of color thru tile:
Submittal Fee $ tO:. ; Permit Fee $ :3 t5 0 r4r0 CCF $_
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $�
TOTAL FEE NOW DUE $ 2(�_
(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 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 ins ection which occurs se n (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n tV e ppproved and o reinn pection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
ri
day of f� �L1�l���i 20 i by
0—
��
� 'Ic" 1„C,f fo who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
i
Print:
Sea
"I'll
AMARILIS SOLARES
:�?•=
MY COMMISSION # GG034902
APPROVED BY
Signature
CO
�7
The foregoing instrument was acknowledged before me this
day of E�6 , 20 JR, by
A2M4NDp A( yAaF niho is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
Seal:
Plans Examinei
Structural Review
as
Clerk
(Revise d02/24/2014)