WS-17-2630BUILDING
PER IT APPLICATION
7UILDING ❑ ELECTRIC
Miami Shores Village RECEIVEL
Building Department NOV 0 3 1017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972�(�'
INSPECTION LINE PHONE NUMBER: (305) 762-4949
_ FBC 21D
DNS Master Z& 30
Master Permit No.
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10010 N L I Q
City: MiamiShores
2 ``County: Miami Dade Zip: �313v
Folio/Parcel#:I I � o (o ' 01 ✓ ' 1 4\4'1 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: 2 FFE:
OWNER: Name (Fee Simple Titleholder): rand) c-e V i C i 1"6\ Phone#: G3a �(] 7 - 8`r 1
38
Address:
( UO) IU C 1 'qy V _
City: I"/li ami Sh oy eS State: Zip:
Tenant/Lessee Name:
Email
ne#:
CONTRACTOR: Company Name: pleLisic)o 1 boy' Phone#: D 90 ` "T 1 -6 `-7
Address: I ?y Ll J � W .�T- /,,
City: I" `� Cj M, t State: �1 Zip: _5 a f elf/ �i►?�
Qualifier Name: r V 1 1 (� Yyi � ni 3ej) Phone#: ��U! 4� 5_ --7 a `�
State Certification or Registration #: ) 33 Q __7_1a Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: _ City: State: Zip:
Value of Work for this Permit: $ a/y `� `�t Square/Linear Footage of Work: u �'
Type of Work: ElAddition ElAlteration El New epair/Replace ❑Demolition
Description of Work:
Specify color of color thru tile: 1
Submittal Fee $ & P MD Permit Fee $ I 1 O CCF $ � � CO/CC $
Scanning Fee $ "1 Radon Fee $ 'z_ DBPR $ rL Notary $
Technology Fee $ �.-yl Training/Education Fee $ iu O Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $ —4'
(Revised02/24/2014)
Bonding Company's Name (if applicable)
A
' Bonding Corpany's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
ME
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 on 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 te- , \,T'- � c" Signature 0wL "
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CONTRACTOR
The foregoing instrument was acknowledged before me this
oZ day of (16vS Q_AF_e. 20 1-1 by c�, day of 20 1 `1 by
Cr' Amwcz VIE:?? —A who is personally known to Mt L-wa&\ bJA�6O who is personally known to
me or who has produced
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: V�! Sign:
Print: t.4tr i-i S Print: r
Seal: Notary Public State of Florida Seal: � � Nota=Hunftss
William Huntress WilNaMy Commission GG 137785 g� My C
as
�L Plans Examiner Zoning
APPROVED BY �"I
Structural Review Clerk
(Revised02/24/2014)