RF-16-1370PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
REcIV
MAY 1 \9 2018
BY:��l
SA
FBC 2//014
CANCELLED Master Permit No. "" t3-7
Sub Permit No.
Ln/ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [—]MECHANICAL ❑PUBLICWORKS
JOB ADDRESS: l d g v ail C / 0 CL--�
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:. - Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): �Eo/�G�s' !�- (l/ �-FJ¢U Phone
- • / t
Address: � ff
ity:► + j/ d iff l S #0,41'1 State: �L Zip:
Tenant/Lessee Name: Phone#: ,
Email:
CONTRACTOR: Company Name: S14%�`,J odd Lo19�iC Phone#: �QS' W C�
Address �� S(...5 Cl n �i�D� - T
City: ! OCf,
Qualifier Name:
rG State: Zip:
Phone#:
State Certification or Registration #: CCC / 2 V3 V Certificate of Competency #:
DESIGNER: Architect/Engineer:
Add
hone#:
City: State: Zip:
Value of Work for this Permit: $ �, %y -W Square/Linear Footage of Work: 3ov
Type of Work: ❑ • Addition ❑/ Alteration ❑ New [Repair/Replace ❑ Demolition
Description of Work: )2-Q% /2 b0�>_'E,
DO SA./.44 L/n oLc. r� ar.nnpi� o
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 $ _
(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—A-Iso,-a-certified-copy-of the-recarded-rratice-of commencement-rrrost by pDyte-d-at the job-.�ite---
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.
Cam__---
Signature Signature - f --------
OWNER or AGENT CONTRACTOR
The f egoing instru was acknowledged before)) me this The foregoing instrument was acknowledged before me this
day of 20 l0 by day of 20 L� , by
who is personally known to '(BAN 0kf/JLt1N4 J ao is personally known to
me or,who has produced ih t wkmL as me or who has produced r"%._.V�- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC: I "wA1111
s f)�
jo
NN
Sig in AASign: 5S
Print: ) Print: _ : X N %•,'y,.
=� :2
Seal: Seal: ��j :ors °t'ye •:
,p•1`Pv•'rAngela Dou las-Griffin 00 V,X . :k
•....•
COMMISSION 1 `EXP RES MAY 20, 2016
r*****���*�►*s;�i.�'(`A'if�.,�`fl�f1�"**ss*ss*r*s*s**.***#s:**#*.:�.�*s*#******s�*#***sss**rsrss****s**ss***�,
�nnu�o COm
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)