REV-19-1277Miami 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
BUILDING �as„ter
PERMIT APPLICATION
BUILDING L❑
ECTRIC ROOFING EVISI
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
JOB ADDRESS: I
IV Lk-) q �_
CONTRACTOR
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RECEIVED
JUN 0 41019
FBC 20)1 L6
Permit No. & L- (ol � -16 � 7
RENEWAL
SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name Fee Simple Titleholder): Phone#•J &� — � q
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Address %VJ 1)
City: M\ WOA J V li9 State: Zip: _ Z3) 5
Tenant/Lessee Name: Phone#:
Email: CONTRACTOR: Company Name: ///TA� A &" Phone#:�7 qa
Address: J l l�-� C_-/j___
City:
Qualifier Name:
State Certification or Registration #: 4 2,9) G Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Zip: -:�—? -�) / J Q
Address: City: State:
Value of Work for this Permit: $ O d Square/Linear Footage of Work:
Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
De •ption of Work: % % Jul V AJ �D ZAJl`�9
0(0 I'L4 Ad Q0 Q(J-7 (. iv
Specify color of color t u tile: 1 i,,
Submittal Fee $ Permit Fee $ 1 0 . t� CCF $ 13 • N D CO/CC $
Scanning Fee $ 3 0_0 Radon Fee $ �D,B�PR $ 2 Notary $
Technology Fee $ 2.56 Training/Education Fee $ 0'7,4:�' Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
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. 1 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 The foregoing instrument was acknowledged before me this �v
day of K20 � ? , by day'�
Aadof � pit- � 20 t "l , by
�i4 C,4 /mil I /A S who is personally known to �� �2►-44 , ho is personally known to
me or who has produced
identification and who did take an oath.
BLIC:
Print:
as me or who has produced
identification and who did take an oath.
NOT
Print:
Seal: �►'" Notary Public State of Florida
;� Jose Luis Saladin Seal:
My Commission FF 914315
a N* Expires W3112019
APPROVED BY
- /4 P ' Plans Examiner
olS ci�>AC.A-o,
�r0v N Notary Public State of Florida
Jose Luis Saladin
y 4, • My Commission FF 914315
,
1%, �d Expires oe131120IS `
as
Zoning
(Revised02/24/2014)
Structural Review
Clerk