DOCK-01-22-247 CanceledMiami Shores Village
Building Department "V
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
7S6-
972
Tel: N LINE
E PHONE
Fax: BEE: (305) 762 BY.
INSPECTION LINE PHONE NUMBER: (305) 762-4949 _
CANCELLED FBc zo 01
BUILDING (Cgt&4ci by �E10 Master Permit No �—'b� 22 -ZCL�
PERMIT APPLICATION 7-2-2 - 3&9 Sub Permit No.
WILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-JPLUMBING ❑ MECHANICAL DPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: \y— t l \ G \T7 -Z \ X � \
City Miami Shores County: Miami Dade Zio:
Folio/Parcel#: //--j2bs +Daa6 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: yy
OWNER: Name (Fee Simple Titleholder): N
Address' /�N A/ L /t7�
Construction Type: Flood Zone: BFE2� FFE:
9N�y Cl� J1U Phone#:S�U7D606
City: Yi r CtM« Sh D r'0 S State:
Tenant/Lessee Name:
Email: 11anPN eC( 17D `- 6Lt>j, GtOw,
CONTRACTOR: Company Name:
Address:
Miami Beach Seawalls Inc.
17027 W. Dixie Hwy, Ste. 127
LL
`33/ 3,Y
City: North Miami BSta h..te. FL 33160 Zip
13Yi cvh mDre Nl"
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #: Lf ';' 7 7
DESIGNER:Ar/chitect/EnginIeler: O� Se'h� Y vhnnae' �jD> �jStl
Address• V L/o(/ -W l rl G"�
Value of Work for this Permit:
Type of Work: ❑ Addition ❑ Alteration
Description of Work: l.t n de 2 W G. ✓y-
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
City: ' ' ` , mil. State: 4 Zip: 33/ 7 , \}
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace ❑ Demolition
-1y �e ov�,-1 Q( tracIiT5 y&Vo-
Training/Education Fee $
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
10.1me] 0il►\'11111111111i0.1a-'11► ICU ITM14a101Oki IIVila:1i0:110A1A►l&11fe illiliM a 0.1019:1 0.1 rm I WL11111111111l►lr:1►1C
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.
RSignature Signature
or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrum t was acknowledged before me this
Lo day of 20 �'�— by '� 4 day of /, 20 Z L . by
p U r3aaaHgimown to rl I 7�1, w o is personally known to
l
me or who has produ ed as me or who has produced as
identification and who did take an oath.
Print: 4>A4-t1C Z-A •�
identification and who did take an oath.
NOTA PUBLIC.
Sig
Print: T Cs4A
Seal: Seal:
,�:••,C{i�, PAMELAS,DNRIANO
••.,•
y; '; � MY OOMMI3810N k HH 064960 sv'' " '`••�:; PMIFJAS. DARUWO
yid EXPIRES: February 2D, 2025 •: M' COMMISSION # HH GRgW
' 4+' Sonden`fhtuNoYbyWbNcUrderxdters =3;E.,,,,p:° EXPIRES:FebnN�aarryy2pr
r.sasr ......+..<.....se.+.:».+ wix9kR�:+k• ImAXT.�c
APPROVED BY Plans Examiner Zoning
1 q/ Structural Review Clerk
(Revised02/24/2014)