REV-19-365DECEIVED
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
F B 1 5 2019
BY
FBC 20
Master Permit No. RE I'
y
Sub Permit No.a\)-6?
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: —013—L.11'7 6 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 51—C *AA/, (7"k"y i -A)To Phone#: 71't'- pia_-. e 2 kei
Address: Asa (/,e �i G/c-r
City: &" j s B r C State: F4 Zip: 3-4
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: AL -a ,i2 > L2Z-4±2 �"j - ;l"I ti r2 Phone#: 3,, 2-Po c c
Address: to. r 64 s 4a N I A.c 9 /7
City: ,(,{; n. i S P/Lu State: f-,2 Zip: 3a i �!
i
Qualifier Name: s F. S. u i Diu ,ti S Phone#:
State Certification or Registration #: c PG / 4-5- 3 9 Certificate of Competency #: �
DESIGNER: Architect/Engineer:
Phone#:
Address: City:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition Eli Iteration New ❑ Repair/Replac
Description of Work:
State: Zip:
e ❑ Demolition
_j
Specify color of color thru ta'1&
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 4l - exD
(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 po d notice, the
inspection will n t e proved and a rein ection fee will be charged.
I
Signature 4'' Signature
OWNER or AGENT C TRA�Q
The foregoing instrument was acknowledged before me this
I Z-day of /-�fi— 20 / c1 by
Sfe e, A-21yg Afv, who is pars a y mown
me or who has produced
µY F
identification and "A -di
NOTARY PUB lC:—s�
♦F Of f
Sign: 1
Print: /�''✓��-S+f✓! I
Seal:
ee TERE�j AQLIINONES
kMY 119610N # GG 078130
EXPIRES: March 1, 2021
Bonded Thri Budget Notary Services
The foregoing instrument was acknowledged before me this
2 day of T c , 20 1 S by
--J 6x who is personall xiHFn to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: �(—
Seal: *o....... *MYCOA"SS10N/GG076110
EXPIRES: May 14, 2021
y *0 n°13afd�a T1ru Budget NOWy St ,&a
APPROVED BY "—� ��� Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)