REV-16-411, 166 NW 110th StIR vt'lft y(
ING
,NICAL
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BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department F B 12 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
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INSPECTION LINE PHONE NUMBER: (305) 762-4949 --rN
FBC 20N S
Master Permit No. (�5� �f /fi`Xt -30
Sub Permit No. --vim 16-q l I
`BUILDING ❑ ELECTRIC ❑ ROOFING k REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
II ,,.. }} CONTRACTOR DRAWINGS
JOB ADDRESS: I (0 W
W `t u sttee-�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO -
Occupancy Type: i%Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Io&a H u P_TADS Phone#: 'M 2.5Z ' 13 Z-
Address: 1610 >IN W I 11D Sr '1�
City: Al AfA i .51 a{LC5 State: FV Zip: c3 3 6 u
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: Qluiye R Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
one#:
Certificate of Competency #:
Phone#:
Zip:
Address: City: State: Zip:
Value of Work for this Permit: $ �� 000 =J Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: q 0'" rjj KA jr1Ver✓5!y PI -I Ae iiode r.
Specify color of color thru tile:
Submittal Fee $ 0 Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $ S • lJ�
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
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'subje'ct to attachment. Also, a certified copy of the recorded notice of commencementmust be pbsted'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.
ER or AGENT
The foregoing -instrument was acknowledged before me this
/.� day of / 20 by
/1)11) �2rrle) who is personally known to
me or who has produced /�^�� as
identification and who did take an oath.
NOTARY PUBLIC: �J
Print:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign-
Print:
Felliciaiciano
of
, Joanna tv1 F�oFlorida
08275
Seal: �� p�� My CommissionFF Seal:
CF ao _ Expires 01/12/2018 3
as
APPROVED BY C Plans Examiner 4 Zoning
r
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RFrr:IPT
PERMIT #: M` y l/ DATE: 03 /0� 1.2ol
1, 1c) �f 4j'- .W,
o Contractor
❑'owner
❑ Architect
Picked up 2 sets of plans and (other)
Address:
0 -w, Sf r�l t,,Y,
11;!�s L / ,U/?
From the building department on this date in order to have corrections done to plans
And/or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Departmejq to continue permitting process.
Acknowledged by:
PERMIT CLERK IN
RESUBMITTED DATE: 3 6
PERMIT CLERK INITIAL: '-5`