EL-18-3484BUILDING
PERMIT APPLICATION
❑BUILDING E/LECTRIC
RECEIVED
Miami Shores Village NOV 19 1018
Building Department C�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 1 _
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
Master Permit No. [ I Ls _Su &�
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: q _I q WE;, cam► ?i tac.f-
City: Miami Shores �327
����^^�� ��rrCounty• Miami Dade Zia: 3� 3
Folio/Parcel#: � 1lM` on 0kW Is the Building Historically Designated: Yes NO
Occupancy Type: Load: %� �Co1,nstruction Type:
1,. Flood Zone: BFFE: FFE:
h
OWNER: Name (Fee Simple Titleholder): 1u Idid 3 VdIeVie. U bU—R I Phone#t, —49(0) 5ICJ— 233-4
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
�ecf r1 c
Address: A'1U P4W "1'"' �, lM&-t
City: r State: TLOy►coor Zip: 333111 1
Qualifier Name: —NN We Phone#: -i8ps) 713 d —iO4(R
State Certification or Registration M sf 1300�p I(n Certificate of Competency M
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Qwp . co Square/Linear Footage of Work:
Type of Work: ❑ Addition
., ❑ Alteration ❑ New Repair/Replace L ❑ Demolition
Description of Work: J s rAij *0 Ve1A&& Q W5 �f ri+rn5
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Permit Fee $ lrj�21 z::2 CCF $
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 63.10
(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
Zi
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 prowiot
is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the firspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection be approved and a reinspection fee will be charged. i1
OWNER or AGENT
The foregoing instrument was acknowledged before me this
13 day of VIXIy 20 %J by
---,who is personally known to
me or who has produced L � � O^ � _y' LA 1%0- +as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
1
Print:
Seal:
**ssss***sss***
APPROVED BY
(Revised02/24/2014)
�SSY MI�40 V*,z
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Sign
CONTRACTOR
The foregoini instrumenntt was acknowledged before me this
t 3 day of 1w Y , 20 t $ , by
C G L� who is personally known to
me or who has produced as
identification and whoAid take an oath.
NOTARY PUBLIC:
Print:
Seal: `o4�o�or,
• � 2, 2 s
—gW
Plans Examiner PllAia���� Zoning
"fill 1111111\
Structural Review
Clerk