Truss permit app._v1BUILDING
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) 76241949
FBC 20
Master Permit No.L
Sub Permit No
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION Q SHOP
CONTRACTOR DRAWINGS
10B ADDRESS: 561 NB 106 Street
Ci : Miami Shores County: Miami Dade zip:
Folio/Parcel#: 1 1-2231-014-0140 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): David Benjamin Phone#: 305 332-3812
Address: 561 NB 106 Street
City: Miami Shores State: Florida Zip: 33138
Tenant/Lessee Name: N/A Phone#: N/A
Email: davidbenjamin7@yahoo.com
CONTRACTOR: Company Name: Mlran Construction, LLC Phone#: 786 925-0084
Address: 2640 Hollywood Blvd, Ste 200
City: Hollywood State: FL Zip: 33020
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 500.00 Square/Linear Footage of Work.
Type of Work: ❑ Addition ❑ Aiteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Trusses
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ 1 CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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 $2SOO, 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
I
OW AGENT
The foregoing instrument was acknowledged before me this
rJadayof becrmillr 20 .20 by
�qv t tl 32N tuwt rn who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: -
Print:
Seal:
0*8000004
APPROVED BY
(Revised02/24/2014}
SH WE L FULFORU
Notary Public - 51ate of Flonda
Commission a GG 075064
My Comm. Evfm Feb 28, 202I
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
-1:2 day of -I0.4-L,%A e� 20 —2 [ by
.1UI10 M. Miranda , who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:' Chantal Whalen
SSION 8
EXPIRES: July 1E, 2022
Plans Examiner
Structural Review
as
Zoning
Clerk