REV-19-1818RECEIVED
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) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑O ELECTRIC ❑ ROOFING
A Uj 0 6 19
BY:
� 01
FBC 20
PC—O s - 1'�T_ 1-5—
2 1-0
Master Permit No. P-7 t_ c'6 ` 1e-_7 - 1`3
Sub Permit No.-ecUJ d 9 v 101 - ) 8
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 278 NE 103 St
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-3206-013-4860 Is the Building Historically Designated: Yes NO x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): HB Growth Properties LLLP Phone#: 954-774-4616
Address: 17071 W Dixie Hwy
City: N Miami Beach
State: FL Zip: 33160
Tenant/Lessee Name: na Phone#:
Email: azorapropertymgt@gmail.com
CONTRACTOR: Company Name: 41(cg k.,o ` L �� ECG C Phone#: IStl 1) i't)
Address: 101w iG0 4V6.
City: S:.t, State: Zip:
Qualifier Name: n v yJ 6 U.1 L-M 4:ft, (, q Phone#:
State Certification or Registration #: Cc 1D ZO G 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 the:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $.
Double Fee $
Bond $
TOTAL FEE NOW DUE $
0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) na
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 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.
001
Signature
E)WNER-or
The foregoing instrument was acl owledged before me this
�7 day of 20 �, by
(' I Q)Z ')1A nc
me or whh has produced
NOT
Sign:_
Print:
Seal:
who is personally known to
and who did take hh oath.
as
Signature
CONTRACTOR
The foregoing instrument s acknowledged before me this
't.IAD day of
20 `Q by
who is personally known to
me or who h#s produced %Vias
identificatio►i and who did take An oath.
NOTARY
Sign:_
Print:
Seal: T* 0 0i;
08 ?4
at
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APPROVED BY 4 Plans Examiner
Structural Review
########
Zoning
Clerk
(Revised02/24/2014)