RF-18-369Miami Shores Village RF
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY• -
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPFCTION LINF PHONE NUMRFR_ 13051 762-4949
BUILDING CANCELLED
PERMIT APPLICATION
2018
Master Permit No. —?(0I
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [—]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores / County: Miami Dade Zip:
Folio/Parcel#: �'�� h - 6) 0 — 0056 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleho1de1r�1: l0, C \ 11S Phone#:_
Address:__
City: G� 1 �Y W �l -S State: Zip:
Tenant/Le see Name: Phone#:
Email: i ��'1� 4 l7-1 —�
CONTRACTOR: Co
Address:
City:
ny Name:
one#:
-5-�
e: Zip: :::�� I � Z.
Qualifier Name: 5 Phone#:
State Certification or Registration #: 12 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State: �j/�Zip: _
Value of Work for this Permit: $ U Square/Linear Footage of Work: Z OU d
rt _
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: V VICIMET—
Specify color of color thru the:W�
Submittal Fee $ Permit Fee $
Scanning Fee $ _ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
0
_Z �
CCF $ CO/CC $ '
DBPR $ Notary $
_ Double Fee $ _
Bond $ JZ_
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.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
?—day of 20 by
ho is personally known to
me or who has produced as
identification nd who did to n oath.
NOTAR PUBLIC: �� 11 i
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
Signature
CONTRACTOR
The foregoing instrument was acknowledged before this
day of 20 , by
I S ho is personally known to
P Y
me or who has produce as
identification and who did take an oath.
_
Prini�
IJ
DAN EL P REZ
\\
Seal:
t 6;-,,
DANIEL PEREZ
_
2c•\';
N ary Public - 5' e` Pic a
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Plans Examiner
Structural Review
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Zoning
Clerk