PL-17-18021 Miami Shores Village��,F
Building Department JU 1 117
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 R�
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2-014 Srt�
BUILDING � n 1 Master Permit No.? I — � U0 Z
�V a
PERMIT APPLICATION— �_Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
;KLIU M B I N G ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 4 r N w c? Ci S TR t c I
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): J lJ i S 64 0 Phone#: 3 D'S) 7-f.4 oC6--%j
Address: 6 1 0 6— S W 100 S f p—cc
City: AA/li' CK6-.s f All
FL, Zip: •33 1 S 6
Tenant/Lessee Name: Nl Phone#:
Email:
t� Olzc.�
CONTRACTOR: Company Name: M,A I AIL, 6Al I- P4 U M B /#J% Phone#: 3o5- 62. 4
Address: 17400 AVE
City: IA l A'lyt l &"ek4i 5 State: FL . Zip: 31 4 O!C-
Qualifier Name: 61I -5 l r1 O A C2 AAA 11 A• 6 D Phone<305,/ 7Q & �Z 'S /
State Certification or Registration #: Certificate of Competency #: C F C d -r 77 4 Z
DESIGNER: Architect/Engineer:
Address: G City:
Value of Work for this Permit: $ y Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace
Description of Work:
Sped r, or o co or thra tilq:
Submittal Fee $ —cD6 paid Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews $
Radon Fee $
Training/Education Fee $
Zip:
❑ Demolition
4 e 4 5 9,0U) U PAAJ
a,
CCF $ _ - CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
(Revised02/24/2014)
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. 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 sub' o attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspe on w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will nqf be ap rovedAnd a reinspection fee will be charged.
Signature
ER or AGENT
The foregoing i trum nt was acknowledged before me this
rI � V day of 20 , by
g//j2ILL 5 CAO rr , who is personally known to
me or who has produced D L. as
identification and who did take an oath.
NOTARY PUBLIC:
CONTRACTOR
The foregoing instrument was acknowledged before me this
[/day of 20 by
14A who is personally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
SignW!'Y�Ill ",'�..i Imo%%%i��%Print: i low
«� «�ps
APPROVED BY A- VC /'i Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)