REV-02-22-401, 1020 NE 92nd StMiami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
EP BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
FEB 15 20
FBC20j-(�
Master Permit No.CC- 11 C-)1 R-
Sub Permit No';�eV-02- 2,2 ` (3 1
W REVISION ❑ EXTENSION [:]RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: 04b?, (D) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): "A;; Phone#:
Address: kG2,0
City: WvNittwki r, �:`� State:
Tenant/Lessee Name:
Email: J-4 '3 �p ('j r0- 0CAK -N
CONTRACTOR: Company Name:
hone#:
hone#:
Address: a'AV1J Zed _-DJ
7 a4
City: State:
Qualifier Name: Ph
State Certification or Registration #: (. &C, �� Z '�`6 S �l Certificate of C&mpetenc
DESIGNER: Architect/Engineer:
0
-3 VL 4
Address: City: State: Zip:
Value of Work for this Permit: $ (Cd Square/Linear Footage of Work: "
Type of Work: f Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: a 4 ^ —' (�� �� o�+��►aJ+� wee,
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF
DBPR $
CO/CC $
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,
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 appro ed and a reinspection fee will be charged.
Signatu
or AGENT
The foregoing instrument was acknowledged before me this
Q� day of J "� 20 Z�— , by
1� who is personally know o
me or who has produced as
NTRACTOR
The foregoing instrument was acknowledged before me this
�LA day of `� e � r � '' _ 20 by
who islersonally n to
me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: Print: eiv
Seal: ,?o;;�PcI DAVIDPUPO Seal: DAVIDPUPO
WMY COMMISSION # HH 136844MV COMMISSION # HH 138844EXPIRES• June 2,2025 _ EXPIRES: June 2,2025�;Bonded Thru Notary Pubk Under ''�o' ".`c' Bonded Thru Notary Public Under lero
######### #################### ###########
APPROVED BY Plans Examiner Zoning
kl)N,tl Z� Structural Review Clerk
(Revised02/24/2014)