WS-19-1941Miami Shores Village pZcr,zV1FD
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AUG 2 2 �919
Building Department BY:
\ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 444�0
!� Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 t
BUILDING Master Permit No.4c _ (3-�y o - olq
PERMIT APPLICATION Sub Permit Nou/S au' — I G! — 1 .41
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/ wi c CONTRACTOR DRAWINGS
JOB ADDRESS: a � N,� 1 �.7�/`Q'�
City: Miami Shores County: Miami Dade Zip:33 R
Folio/Parcel#:1 l 32_01013,22?0 Is the Building Historically Designated: Yes NO X
Occupancy Type: SfN� Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Names (Fee Simple Titleholder):
Address: I N� q9
City: A' JA1 S6erBs;
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: 2.Q2-0 i4-YI�f rely
City:
Qualifier Name: W 1� S
State Certification or Registration #: Ci
.0 i r
State: F L Zip: 33 13 8
M
E L Zip: 33D2.0
Phone#: -!5+`3" 1-19995
LS _Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
City: State: Zip:
Value of Work for this Permit: $ 13.1500, 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition [ Alteration ElNew ❑ Repair/Replace ElDemolition
Description of Work: ALeA/ I //;v 011415 4 jDors
.3 0900-z S
Specify color of color thru tile:
Submittal Fee $St) • (n Permit Fee $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
r—
TOTAL FEE NOW DUE $ t 5 3
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 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
ER or AGENT
The foregoing instrument was acknowledged beforemethis
day of
20 / by
ho 's personally known to
me or who has produced le &— s'-as
identification and who did take an oath. —
Signature
CONTRACTOR //
The foregoing instrument was acknowledged before me this
5'0 day of CA- 1 20 J by
c
rle�
o is personally known tome or who has producedV .�(,, as
identification and who did take an oath,-t-50,00
NOTARY PUBLIC: NOTARY PUBLIC:
Sig
n:.
n: Print: Print: J c�,
Seal: __.—�..u_.- Seal:
y'sa"""•°"- JOSEPH FILS DALGER `c4 y0"- - JOSEPH FILS DALGER
"; MY COMMISSION # GG064164 My COMMISSION # GG064164
EXPIRES March 26, 2021
EXPIRES March 26
�aFti' , 2021
********** ***************** *** *** **** ***************************** ****************************** *****
APPROVED BY
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk