EL-18-313u Miami Shores VillageREC
Building Department F .o � 7 0
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 $Y'
INSPECTION LINE PHONE NUMBER: (305) 762-4949 /.,
�f FBC 20 I `T
BUILDING yet, Master Permit NO.�I P,
PERMIT APPLICATION Sub Permit No. �-
,D`
❑BUILDING 7�ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
' q 3T.
JOB ADDRESS: a' S 1 0� q l V �
City: Miami Shores County: Miami Dade Zip: 3213'8
Folio/Parcel#: � (- J a10(o - 3 3 (-�5 D Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: . Flood Zone: . 4E: FFE:
OWNER: Name (Fee Simple Titleholder): 4e^j P_Y qf eMk(jVC Phone#.` 81.-')'V-
Address: 6,57 tlE J( -ryf �
City:Mi*m; Sra,2_5 Stater Zip: 3�135
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
E Lv
` P 3
l to c- Phone#:
30.5. C(�� . 3303
Address: -73 3 ( NW
34
5?T2-et-,—
'
City: M I A M/
State:
r-Lo M_ % 0 A
zip: 'A S I OZ
Qualifier Name: 0 0A a V
rQ�Q.VGI
Gc.
Phone#:
State Certifica ' or Registration#: �5-R. /30 /5* 2.7 (o , Certificate of Competency #: 14
EODD S0 7
DESIGN : Architect/ gineer:
Am
pih -' LAIW
T �- Phone#:
'30
Address:
1
City: ri/4--i S j•j7Jyk State: F-t_ Zip:
Value of Work for this Permit: $
,ram" y�
" " V
Square/Linear Footage of Work:
/
Type of Work: ❑ Addition
Alteration
❑ New ❑ Repair/Replace
❑ Demolition
Descrilation of Work:
( S 17" C "L kT X( S7-7 10A-T1✓l
VD M A-M # Z
Specify color � qr tl " & the x� 1 • 1
5�,��.cFrrfl (
Submittal Fee $:«.�».:••*�^� - Permit'Fee'$i�`� 1�d
Scanning Fee $'T _ Radon Fee $ 2 . 45
Technology Fee $__ Training/Education Fee $
Structural Reviews $
CCF $ • CO/CC $
DBPR$ �• Notary;
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 2 i Cj 3
(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.
"WARNINGTO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO'Y6UR'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 sdbject 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
OWNER or ZENT
The foregoing instrument was acknowledged before me this
clay of%C'.%rl�j r�-,�� . 20 17 by
I -I ENft� pr�2Nir who is personally known to
me or who has produced as
Signature
s e `
CONTRACTOR ,
The foregoing instrument was acknowledged before me this
day'
'of hL��'EMb 2 V 20 1 % by
OWtQ� I�GLVGLtw. who is personally known to
me or who has produced
as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: _ Print:
Seal: „a`•'"Y"'*�.,
CHASE CAMPBEIi Seal: :?����� JACGIUELINE GARCIA
MY COMMISSION FF200055 � �: MY COMMISSION 0 FF224570
de EXPIRES: February 17, 2019 = ��p` EXPIRES Bonded Thru Notary Public Underwriters ' , oin,.� April 2-t. 2011 +
44UP 39b-0' 53 rleridsNu �' mwce..on _ j
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APPROVED % Plans Examiner Zoning
Structural Review '. Clerk
(Revised02/24/2014)
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