WS-18-1714Miami Shores Village t � :,— .0
Building Department (JUN210050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY—
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING CAMC ELLED FBC 20V
Master Permit No. I's ") l
PERMIT APPLICATION Sub Permit No.
❑13UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
[]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
(��[/ �*- CONTRACTOR DRAWINGS
JOB ,ADDRESS: r / / 7 �� I
City: R1iGmi Shores/ County: Miami Dade Zip: �� ) �3
Folio/Parcel#:1 /{3 Z D G oo l oci Zo Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Nam`/e (Fee Simple Titleholder): w a-,nA,7 1r Phone# Ll5 < o Z
Address: 94117 /l e 9-Ht �
City: / -[1 u-rn I"
Tenant/Lessee Name:
Email
CONTRACTOR: Company Name:
Address: q0Z Su)
State:
6,15
�11 C�.es
Phone#:
Zip: 3 3 13 J
City: _/y t t ell/I J / State: Zip:
Qualifier Name: &q 161,o- r%i eki // 4 PhoneMN15)
State Certification or Registration #- G�� i 1 !2 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �1 City: State:
Value of Work for this Permit: $ j 15,Qcl� - 00 Square/Linear Footage of Work:
Type of Work: ❑ A tion / ❑ Alteratio ❑ New ❑ Repair/Replace
Description of Woyk: Q f�'f r'J - '�� l 7 _ L�/ YZC�c� r� d
Specify color of color thru tile:
Submittal Fee $ SOon Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
Zip: _
❑ Demolit
CO/CC $
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.
Signature LO kLv-�
OWNER or AGENT
The foregoing instrument was acknowledged before me this
5i f day of 7-Y14L 120 1 V , by
ti dl✓l1 4�r, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
CONTRACTOR
The foregoing instrument was acknowledged before me this
Z� 5 t day of 5(111�1
,20 ,by
,0&1,a1-nMM1C4d1 bwis personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal: I , J' MEI EXPIRES March 15. 2021 f Seal:
15, 2021
***********************************************************************************************************
APPROVED BY v' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)