MS ELECT_v2 (2)Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (.345) 795-2204 Fax: (30S) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING Master Permit No.
PERMIT APPL�ION Sub Permit No.
F-]BUILDING
F—] PLUMBING
JOB ADDRESS:
[V(ELECTRIC
F7 ROOFING
F-1 MECHANICAL CHANGE OF
CONTRACTOR
q�c;3 Lo A-Jc'
City: Miami Shores
FoII Parcel#: i l
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder);
Address: q <7A A c L*41 Aor
City:
Tenant/Lessee Names 6-t
Ema i I : W�Fo� PA
CONTRACTOR: Company flame: _
ou ntv;
FBC 20
(�. L - a i - 2- 1 � 9�_ oo
[:] REVISION F7EXTENSION 7 RENEWAL
F-] CANCELLATION SHOP
DRAWINGS
li I "1 + e +
Is the Building Historically Designated: Yes NO {
Construction Type:
-State:
01
0 joy� 0A'ZTP<_
Address:
EmaiL _Uf A1 �� t 0m,
Qualifier Name: 1� �[�ll.�" O�-
State Certification or Registration -#:
��' 1300 q 0[ (1
Flood Zone: BFE:
FFE:
Phone#: �'" IJ( -- ��.
Zip:
Phone#: q c7 � � �'' � -7
Phone#;
Phone#9s4 1q3 �-Wr
Certificate of Competency ##:
DE I NER. Arch nner: Phone#:
Value of Work for this Permit: _ 4 ��Square/Linear Footage of Work:
Type of Work: E:1 Add tion Aiteration ❑ New ❑ Repair/Replace
Description of Work: O� � - # L,
Specify color of color thru tile:
Submittal Fee
Scanning Fee
Technology Fee �.�
Structural Reviews
Permit Fee
1:1 Demolition
Gt1R�A-S Lv� ✓�-i O�l.�� +- i.
CCF
DA Fee S DB PR
Training/Education Fee
CO/CC $
Notary $
Double Fee $
- - - - - - - P&Z Review - 13ond
(Revis-edO4/26/2024)
TOTAL FEE NOW DUE
Bonding Company's Name (if applicable)
Bonding Companys Address
City -
Mortgage Lender's Name (if a pplicable)
Mortgage Lenders Address
city ---- State .—
ZiP
Application is hereby made to obt-ain a permit to do the work and installations as indicated. I certliN that no work. r ire taklat-lon has
commented prior to the issuance of a permit and that a ii work will be perfo*med to meet the standards of all laws regulating
construction in th Is jurisdiction, I understand that a saga rate R erm i.z must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, FTC..+_Y
OWNER'S AFFIDAVIT. I certA that all the foregcifng information is accurate and that aIJ work w4l be done in compliance with all
applicabJe lavers regulating construction and zoning,
"WARNING TO OWNER: YOUR FAILURE RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE E FOR IMPROVEMENTS TO YOURPROPERTY. IF YOU INTEND
D
TO OBTAINFINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT4
*.9
Notice to Applicant: As o condition to the issuorrce Of u b0ding perMIr With 00 eStiM0ted vofue ex-ceedi g 2500, the appficont must
pro Mise in 9ond faith thot a cc, pv of the notice of co rp rri en cem e n t anEf construction flea "a w brochure wili he delxverpd to the person
whose propel f's sub eCt to atrachmenr. Also, a certr` ed copy of the recorded nat#ce of commemce errt Must be posted at the}0b Site
for the first ins eal'an which 1 seven () dcys after the building permit is issued- In the absence of such posted noUcef the
mspecti on wifl not ve rr an d a re spec rry ra fe e ;11 he charged,
signaluT
+
0 ER v AGENT
The foreS64 i nstru m nt %v� s ac knowledget! before meth i
- day o .- ---�� b
l�
or who has produced
y46entj .Cmatjon -and Vjho did take an oath.
NOTARY P U B LIC:
r�
3
Sign!—
Print -
AI
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Sea 1: ,•� 1` E�,, H
ELCRRIAGA
r Y i '
Y
Y
M%0.2Jf!1r_0+ �ai JAY ]i4Wa -Lt nn P%n
APPROVED BY
Signature V v — T
CC N TO R
The fore o instrument was acknowledged before me this
day q �� r 1
- - -- --- -- r y
15 perSor�ll r�
rn a or who has produced
identif ication and who did t4e a oath
NOTARY PUBLIC:
ant.
Seal:
Plans Examfner
Structural Review
00
0�,�. ND DI A TEIN
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0M M1 $SJ ....yF HH 5 ■ 145 r
+ Commission E ices 512112028
- - zoning
Clerk
Revised0412612024)
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