WSW-09-20-2127 CanceledRF,CEIVED
Miami Shores Village
Building Department B
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 1
CANCELLED FBC 201*�
BUILDING Master Permit No. (At SW��'�"`Z
PERMIT APPLICATION sub Permit No.
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
ADDRESS: �� y �C l0 LI !) I
JOB
3
city: Miami Shores County
city:_
Miami Dade zip: 3 3 /
J
Folio/Parcel#: II Z 232 [�a —UX 10/Is the Building Historically Designated: Yes NO
J
Occupancy Type: Load: Construction Type:
Flood Zone: BFE:
(d
'IFFE: /
OWNER: Name (Fee SimpleTitleholder): / / $ G" k V— Phone#: l/7�'
Address: i�� �� ►v /�Dy T
7pl�.Li
5�
City: / �(t I�Iix� S/-� � S State:
L Zip:
!J
Phone#: &70 - 9'r(.
Tenant/Lessee Name:
Email: �r �( ✓ IrQ 4 / S B /Y✓tGt c LO✓lY�
Q
QCONTRACTOR:
Company Name: Miami Beach Seawalls Inc.
Phone#:'
t, r
Address: 17027 W. Dixie Hwy, Ste.127
q.
North Miami Be§j%fL33160
Zip:
City:
v�rc �/ (oZ
Qualifier Name: (� n rt�- � (
Phone#:-;5
of Competency #: & a 77
State Certification or Registration M _Certificate
DESIGNER: Architect/Engineer: _
Phone#:
Address: A
/,, City: —State: —Zip
G COO Footage of Work: 1
Value of Work for this Permit: $ `t' 1 Square/Unear
Type of Work: Adddtition ❑ Alteration ❑ New
❑ Repair/Replace ❑ Demolition
Description of Work: ? ✓ m E91; � A uD
Specify color of color thru tile:
Submittal Fee $ __ Permit Fee $ _
CCF $ CO/CC $
Scanning Fee $ Radon Fee $
DBPR $ Notary $
Technology Fee $ _ _ _Training/Education Fee $
Double Fee $
Structural Reviews $ __ .___ _
_ Bond $
TOTAL FEE NOW DUE $
(Revised02124/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City N
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
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
li-- day of S P�li� fi 20 Z by
Z�t C, (L e Q ✓ ✓ w/ho is personally known to
me or who has produced � i D Ls as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: JAME A. DIAL
y g'� Notary Public - State of Florida
'•® Commission N GG 985015
My Comm. Expires Aug 28, 2024
•�ktkX�MY�i
APPROVED BY
cC�
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
i day of S LJO � 20 Zd by
3 r• cv. ✓tc"f—�ti ( who is personally known to
me or who has produced
ho did take an oath.
PUBLIC:
Print: I &W1 V C 09
49
Seal: PAMELA S DARIANO
R:
My COMMISSION p GG056077
ti
EXPIRES Feb"" 20. 2021
Plans Examiner
as
(Revised02/24/2014)
Structural Review
Clerk