REV-18-3408 (2)Miami Shores Village No o8'2018
Building Department BY.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 _ T
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT AP TION
❑BUILDING LECTRIC ❑ ROOFING:
FBC 20N
Master Permit No. �-:F'vj
Sub Permit No. CJ d
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: t 1 5,- I") I ��
City: Miami Shores County: Miami Dade Zip: . �.2S1SCD
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):� g ��C �J� (( �aS%� Phone#:
Address: i') t�; OLO tocl, S"l�
City: N\ 1 Prrt:1 '!5-Hn (, Q5 State: F-L, Zip: 313 ( S 0
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: 3 G Z S 5
City: I n AZ
Qualifier Name: /�cU
one#: —4 Po (0 V_sS `l 8 q 3�:T
State: - Zip:
_` "�� � �Z Phone#: 30S da 864 ZZ
N _ /p�
State Certification or Registration #: C 500 �C7��c Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition AlteratioNew ❑ Repair/Replace
n
Description of Work:..�1''n�
—Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(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
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. h �
Signatur@�!,�� l_11?� Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of 1V�VV\"ti 20 U by
C-N-)f `-46a 1 �-Ze f who is personally known to
m Forho has produced as
identification and who did take an oath.
CONTRACTOR
The foregoing instrument was acknowledged before me this
_,Lday of � �sz- 20 1 � , by
�.
who is personally known to
e or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: NOT
Sign
yPriv
Seal: ,..���� BETSY D. PEREZ
Notary Public - State of Florida
• . ' ° Commission # FF 182380
d "t My Comm. Expires Apr 3, 2019
# # # # # # ki�ifit.�i# N�AnM#sM� Metldial Netsrv�a
Seal:
**************************************************
G
APPROVED BY 1-WA"mvl% Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)