REV-20-53Miami Shores Village
ENTERED
4'
F
BUILDING
PERMIT APPLICATION
Ming Department
2 d Avenue, Miami Shores, Florida 33138
( 05)795-2204Fax:(305)756-8972
O LINE PHONE NUMBER: (305) 762-4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
JAN 10 2020
BY:
FBC 20 Master Permit No. - (:)9 Q - 212(0
Sub Permit No.,e��
❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C� k CONTRACTOR DRAWINGS
JOB ADDRESS: I 1./ g 114� S•{)—
Folio/Parcel#:_
Occupancy Type
OWNER: Name (Fee Sim
Address:
City: q0nn`
Tenant/Lessee Name: _
Email:
Load
CONTRACTOR: Company Name:
Address: Z ;o P/ W.
City: i ti
Qualifier Name: lizLI G
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑
Description of Work: 0 \
_ Construction Type
Miami Dade
Zi
the Building Historically Designated: Yes NO
Flood Zone: BFE: FFE:
L sA
> 3 - If A. fs
�- Zip: 3 f �-
y Phone#:
Certificate of Competency #:
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
teration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ `t'3 -on
(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
Zip
City State Zi
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 attachmen so, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occur se 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a eins ction fee will be charged.
Signatu
or AGENT
The regoing instrurneaLwas acknowledged before me this
dayvfe LL by
wholm personally k own to
J
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
d y of 2 by
' who is p rsonally I�ow o
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: a _ A
APPROVED BY E I 11-3 �C--- Plans Examiner
Structural Review
;,� lion � 6631�45
ExPhs: Ma<leb 20, 2023
Zoning
Clerk
(Revised02/24/2014)