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Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
JOB ADDRESS: 5 15 j
FBC 20
Permit No.
Master Permit No. o
ROOFING
City: Miami Shores County: Miami Dade Zip: -22_
Folio/Parcel#: II " 32-C 6" 013, % 2 0
Is the Building Historically Designated: Yes 5 NO P< Flood Zone:
r
7 Ll23
OWNER: Name (Fee Simple Title
Address: / NE 9
City:
Tenai
Emai:
CONTRACTOR: Company Name: Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Arch%itect/Engineer: - s p � �- � P� 6- e Phone#: S — 3 P -5v 3 C)
Value of Work for this Permit: $ Squa
Type of Work: ❑Addition n Alteration IfiNew
Description of Wor4:
Rd1
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Footage of Work: 9 K2
ORepair/Replace r"` ODemolition
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State
Zip
Application is hereby made to obtain a permit to do the workand 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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 ins rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection A e ppro a an a Bins tion fee will be charged
r�'
Signature Signature
.� Owner or Agent Contractor
The foregoing instrument was acknnoo/wledged before me this c� —
day of �� �' , 20 / by f�co��z
who oiionally kno o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC: �®
Sign:
Print: lCyr a-7 c?
My Commission Ex
OLGA MORALES
MY COI"SSION / FF06906i
tea` mss: .
APPROVED BY
The foregoing instrument was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
Plans Examiner
identification and who did take an oath.
NOTARY PUBLIC:
Sign.
Print:
My Commission Expires:
Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No: O -C 2-6
Page 1 of 1
Structural Critique Sheet
9 (0.,Lq lr-JL �U CLA-CL 6-
5 i I
M
STOPPED REVIEW
Plan review Is not complete, when all Items above are corrected, we will do a complete plan review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and Include one
set of voided sheets In the re -submittal drawings.
Mehdi Asraf