REV-19-3001BUILDING
PERMIT APPLICATION
BUILDING ELECTRIC
,I E12ECFIVED
D C 18 2019
BY:
a066 FBC 201
Master Permit No.��"
Sub Permit Nc. R1QQ-1 2,1 310`l�) 1
❑ ROOFING REVISI [--I EXTENSION ❑RENEWAL
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
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 8 q Q L t (DZ_ 5A
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):
Address: P-3::Z IVC� 15I
City: 1a(Yl I `n0V_eA State: Zip:
Tenant/Lessee Name: Phone#:
Email
ZZWN _
CONTRACTOR: Company Name: ' lJ -Cy- C k� (t �°I - Phone#: 78G 3� S3�
Address: k 0 O Z N W OM CT -
City: M k A w � State: Zip: -.2.
Qualifier Name: rJ (Zt f1Jlk 1012r (A00 S Phone#: _7 66 39 0 ( S 3Z
State Certification or Registration #: C'(=� <�{ z 5 gS Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
ne#:
Value of Work for this Permit: $ 5.) L). Ilt) Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace
Description of Work: 1-t+-cl+tt.S Of_&IrJL j"G S lC E MAIC_tIZ
Specify color of color thru tile:,
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
State: Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $ _
Bond $
(Rev1sed02/24/2014)
TOTAL FEE NOW DUE $ 1 I 0 - 30
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
E.
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 w rged.
Signatu
OWNER.6r AGENT
The foregoing instrument w,, dss acknowledged before
//m��e this
N
day of 0\1' 20 by
who is personally known to
me or who has prod
identification and who didltake an oa
NOTARY PUBLIC:
k
Print:
Signatu
The foregoing instrument was acknowledged before me this
ZS day of noyerA6-er 20 by
rC vwtayc- \7te-k--AOS , wh persona y nown
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal ;?►= ZENEIDA MATIAS Seal:
MY COMMISSION # GG088579
EXPIRES April 17, 2021
APPROVED BY �) /07 �y Plans Examiner
A V%
Notary Public State of Flonda
Alejandro Garcia
My Con"isslon GG 187807
Expires 12/1312021
Zoning
(Revised02/24/2014)
Structural Review
n
E
Clerk