RC-09-18-2530 Canceledc-�
BUILDING
7UILDIT APPLICATION
ING ❑ ELECTRIC
Miami Shores Village
SEP 24 2018
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 II
INSPECTION LINE PHONE NUMBER: (305) 762-4949
CANCELLED FBC 201 y J
Master Permit No. J< /
Slab PermifiVo:PC 1 P/ - 2S3o
❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
al /// Ze r.
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Constructs/on Type: �� Flood Zone::/ BFE:
OWNER: Name (Fee Simple Titleholder):46 2� 1 �-S 7 IeWyreS ZZC-Phone#:_
City:/ra E.Cl C State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: 00�0 SW City: rn
Qualifier Name: r0
State Certification or Registration #:
DESIGNER: Architect/Engineer:
of
M
me
FFE:
/ I
Value of Work for this Permit: $ 1500 Square/Linear Footage of Work: tw
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF
DBPR$
CO/Cc $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 22S • oc)
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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 ob ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
14-141, �' >� rN� ,tom, n�,� �2� Ric- JJ
r _
SignatureSignature g h�
OVW16R or AGENT CONTRACTOR
The foregoing instruCme'nt,,was acknowledged before me this
day of rye/ " 20 X� by
4�CA $ QV.2 , who is personally known to
me or who has produced QL,Y.Y� j, L i c- _ as
identification and who did tAe an
Print:
The foregoing instrument was acknowledged before me this
20fi"
day of 20 I , by
AZArO IP401011 who is personally known to
me or who has produced IIIVQY' [I Cecil" as
identification av(d who did tad'e an
Sign:_
Print:
Seal: �' ' Y MY COMMISSION N FF 19W Seal: V _
* EXPIRES: January 22.2010 c
Bonded I%Bu 1NoluySmka �r1y •######################+R##5r��########Y#Yfifi##Y;fifififiifi###Y####i##fi#####Y###
APPROVED BY Plans Examiner
Structural Review
Zoning
Clerk
IRe#1sed02/24/2014)