EL-20-1395BUILDING
PERMIT APPLICATION
❑BUILDING OTLECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
_�EIVED
V 7 2020
BY:
Tel: (305) 795-2204 Fax: (305) 756-8972 �i 1
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �\
FBC 20 ,1
Master Permit No. �-63 - 20 "(� 3
Sub Permit No ��` � B- Zo - (3-9
7 ROOFING ❑ REVISION ❑ EXTENSION �ENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1OS5 �� dD Co vr�
City: Miami Shores p��n County Miami Dade Zio• .�� /
Folio/Parcel#: � I zz 31 t)1S1.11n1./lJ Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type:,_Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): U
Address: /0 <-51� �y //
City: ,t��ni1 <17D s' A� State:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:6_17 6 2 /4-)
City: 1-14A (
Qualifier Name: mod" i e
State Certification or
DESIGNER: Architect/Engineer:
M
.1ne
_Phone#: 241ro _ 2 9'A-'7Z Py
xate: i Zip: SlJ / 5
P Phone#: -7116 — %,P %-2ji'r2-�-
#: �%?DD �Certificate of Competency #: / / 6 �0003 c��
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Zip:
❑ Demolition
CCF $ CO/CC $ _
DBPR $ Notary $
Double Fee $ _
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
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 COMAI"CEMENT."
Notice to Applicant: As condition tot a issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good fait hat a c y of th notice of commencement and construction lien law brochure will be delivered to the person
whose property is s jed a hme . A1s , certified copy of the recorded notice of commencement must be posted at the job site
for the first insp n w h uis even (7j d s after the building permit is issued. In the absence of such posted notice, the
inspection will n e pro d a a efnspection will be charged.
Signature Signature
4( NE rA T �NTRACTOR
The foregoing instrument s ac ow d before me this The foregoing instrument was acknowledged before me this
day of . 20 > U by `1 day off 'T 20 �;2_ ? by
l� who is personally known to ► ` I ho is personally known to
me or who has producedas me or who has produced >` C !�� as
identification and who did take an oath. identification and who did to t .
Y" OTARY PUBLIC: o'PY ° `' NOTARY PUBLIC: is BARB MARIA RIOS i BARBARA MARIA RIOS
:?� •��': Notary Public - State of Florida '_ • �' - Notary Public - State of Florida
Commission p GG 310756 '+�s` Commission Y GG 310756
'For tti`. M
My Comm. Expires Apr 12, 2023 ���� � Bonded Comm. Expires Apr 12, 2023
Bonded through National Notary Assn. ded through National Nota Assn.
Sign: g ry ign:
Print:�l�/�jf� rA Print:
Seal: Seal:
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk