ACT-10-21-2822Miami Shores Village
BUILDING
PERMIT APPLICATION
Building Department o l 2.9 2021
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-89721r:
INSPECTION UNE PHONE NUMBER: (305) 762.4949
FBC22^Q Z ()
10
Master Permit No. \ ''--
Sub Permit
1 1Al BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
F-IPLUMBING ❑iMECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1130 d ue, Campus -Mall Area
City: Miami Shores County: Miami Dade Zip: 33 t
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: 'Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholc
11300 NE 2nd Ave
City: Miami Shores
Tenant/Lessee Name:
Email: Jyao@barry.edu
Barry University
State: FL
305.899.3995
33138
CONTRACTOR: Company Name: 1. 'f ) ✓ U Phone#: r S q -q? ' "M c{U
Address: q l-1 S. U- e-S c A ..Jt
City: Vyre
Qualifier Name:
330IV
State Certification or Registration #: 4 ' 113 5 t4O S®Q Certificate of Competency #:
DESIGNER: Architect/Engineer: !"IASbdaq ,[`TGIr PS Phone#: 3o5-4�R�9495
Address: C 20 U Alin IS A L�L City: 00h,-4 State: Zip:
Value of Work for this Permit: $ _ 3200 Square/Unear Footage of Work:- 1 Or OOO
Type of Work: ❑ Addition ❑ Alteration El New ElRepair/Replace ❑ Demolition
Description of Work: T-R-M17�c-, rI !e. vt,
Specify color of color thru the:
Submittal Fee $ —17D'm Permit Fee $ Sb- cr> CCF $ Z • yb
Sunning Fee$ 1? •(O Radon Fee$ 2.00 DBPR$ Z
Technology Fee $ r• od
Structural Reviews $_
CO/CC $
Notary $
Training/Education Fee $ 1.2.0 Double Fee $
P? Z 7d • CDC;. Bond $
11�•01111
3
TOTAL FEE NOW DUE $
(Revised02/24/2014) I
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
Signature
OWNER or AGENT
TRA
The fofegoing instrument was acknowledged before me this
G
The foregoing instrument was acknowledged before me this
day of 0 c dog 20 2� by
:fig day of =�K� e f 20 -i ( by
II i
S� A ZN ;Lwrg S'1 / , who is personally known to
p
GE (-a( 10 ,Qvho is personally known to
has
has a -I 8 0 2V ooy- (�
m, r who produced as
me or who produced ;?33a as
Identification and who did take an oath.
identification and who did take an oath.
NOTARLIC:
NOTARY PUBLIC:
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Sign:
Sign:
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APPROVED BY Plans Examiner Zoning
Structural Review
Clerk
(Reviwd02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RFCFIPT
PERMIT #: A O r- 10-2/- 282-Z DATE: (0 J2c)2)
(Name)
❑ Contractor
rz-Owner
❑ Architect
Picked u sets o plans and (other)
Address: 1150O 4.e 2 ave
From the building department on this date in order to have corrections
done to plans and/or get County stamps. I understand that the plans need
to be brought back to Miami Shores Village Building Department to
continue permitting process.
Signature:
(SIGNATURE)
PERMIT CLERK INITIAL: cr I '-�
RESUBMITTED DATE:
PERMIT CLERK INITIAL: