RC-16-1224l
BUILDING
PERMIT APPLICATION
WUILDING ❑ ELECTRIC
Miami Shores Village RECEI F
building Department 14,-1
SQ050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY:
INSPECTION LINE PHONE NUMBER: (305) 762-4%9
FBC 20 iiq -
Master Permit No. Ee-1 _ ( 2—
Sub Permit No.
(� ROOFING REVISION M EXTENSION (RENEWAL
[]PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS:
b 3 .57,
[] CHANGE OF ❑ CANCELLATION M SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: Is the Building
Occupancy Type: Load: - Construction Type: 1
OWNER: Name (Fee Simple Titleholder):
Address: i% A` O g
city:&i f ,S� fl >; s' State:
� r
Tenant/Lessee Name:
Email: /
CONTRACTOR: Company Name: y0 k 1 J
Address:
City: �i,egc� State.
Qualifier Name:
'_
Designated: Yes NO
BFE: FFE:
%-,s'4,YR
11 Iff17-
L_ L 7 Zd3
State Certification or Registration #: Cmac' I,bpi 3:U Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: --City: State ZIP:
value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work; ❑ Addition Alteration ❑ New .❑ Repair/Replace ❑ Demolition
Description of work:
Specify color of color thru tile:
Submittal Fee $ c. Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $__0
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Roviews $ _-- -- --"'
TOTAL, FEE NOW DUE $
Bond $
(RevisedO2/24/2014)
nding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State 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 on 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 `
/1 �,A - -
OWN R or AGENT
The foregoing instrument was acknowledged before me this
3 day of Al a 1201G , by
l r B ��&�p_ who is personally known to
/j%A
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
/3 day of 20 /k , by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
' ' Sign: -
Print.
z
Print:
Seal:
; ;
• :E(ZBond77elthrough
ANTHONY 01 ifl(
Seal:
, ,
•SION
0
•
FEBI,.
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. • •
1st St* rllYNl�a
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APPROVED
BY _
Plans Examiner
Structural Review
If
t , PIR
W 01 g�
FEB xi,h 1st gill
6
V Zoning
Clerk
(Revised02/24/2014)
Miami Shores Village
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
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
M.
EC 0 6 2018
�FBC 20 [4
Master Permit No. f v�� ` ( 2 2-
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [CANCELLATION ❑ SHOP
,c CONTRACTOR DRAWINGS
`
JOB ADDRESS: 'f /`� �= l 0
City: Miami Shores County: Miami Dade Zip: 3 F 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): r 1-0 C ry . S r..,Phone#:
Address: �jg D M �: i0 ?i Ci 57 yy
City: �` : u.v4. S G.a �� S State: Y zip:
Tenant/Lessee Name: Phone#:��
Email: o J-t" AA", -ma e)
CONTRACTOR: Company Name:
Address:
City: State:
Phone#:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition
Description of Work:
City: State:
Square/Linear Footage of Work:
❑ Alteration ❑ New ❑ Repair/Replace
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $ Notary
Double Fee $.
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
n
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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
Q C o is personally known to
me or who has produced'�k---PAVEi—" LA1JC7NSt- as
identification and who did take an oath.
NOTARY PLI IC:
Sign:
Print:
Seal:
=m
APPROVED BY
MY COMMISSION # GG 238273
EXPIRES'.
TR; : September u , 20
22
Bo,dW
The foregoing instrument was acknowledged before me this
day of , 20 , by
, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
W
***********************************************************************************
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
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