EL-20-941nnlami snores village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 7624949
BUILDING
PERMIT APPLICATION
❑BUILDING t ELECTRIC ❑ ROOFING
Master Permit No.
05/21 /2020
FBC 20 17 5TH
RC-5-17-1288
Sub Permit No. EL-05-20-941
❑ REVISION ❑ EXTENSION ❑ RENEWAL
[JPLUMBING MECHANICAL []PUBLICWORKS CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ` IV G� 49
1 S 4_
City: Miami�County:
Shores ! r Miami Dade Zia: ( �
Folio/Parcel#: , 11 �zV 10 c) 1 `y � �Tt1 i/ io Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 440 , l`- 1?C,4y Je- Phone#: .306 -75I - k5i)l
Address: S
,^^,A� �y
City: VM A M State la Zip: 3 ,31
Tenant/Lessee Name: Phone#:
Email: (� fhdu, / �,/ (/�CONTRACTOR: Compan Name: 1N t�/ 1-e ( I- Phone#: ? f6 -. �`t ? - T � 76
Address: 73 G /
City: M fq''I State: Zip: _331 b
Qualifier Name: Ped v6 L c% Phone#: 7V6 SDZ - 3G-7
State Certification or Registration #: L d „:� 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 $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Rev1sed02/24/2014)
va Un 6 a o.anic to aNNna.au.c/
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 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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2-1! I day of MAY , 20 Zy . by
who is persona known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
It
749710RrPrin111;;?4.
uc yv — AJYc
Seal: epuolira3QK- -
µ01ta0VVS YI SA5139
Signature /,/,/ /
CONTRACTOR
The foregoing instrument was acknowledged before me this
2,0 day of , 20 Q by
t-C�,yrD L., who Is personally know
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
V-5 If 't'r,� Print:
0
Seal: -4 GELSYS M SARGENTON
o : Notary Public - State of Florida
Commission I{ GG 093420
My Comm. Expires Apr 11, 2021
************************************************************
APPROVED Plans Examiner
as
Zoning
Structural Review Clerk