WS-14-2200Miami Shores Village
T Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
UILDING ❑ ELECTRIC ❑ ROOFING
'RECEIVED
OCT o7 n14-
FBC 20l®
Master Permit No. Uj S 104-22
Sub Permit No.
❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone: BFE: _
_1 ► . 1
OWNER: Name Fge S
Address: /J�
City:,1 L
Tenant/Lessee Name:
Email: llilQ�`
Titleholder:
Q,( Jj
State:
CONTRACTOR: Company Name: Phone#: _
Address:
City: State: Zig
Qualifier Name: e#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address• City: State:
Value of Work for this Permit: $ I5 00 • Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New t1[-- Repair/Replace
Description of Work: a ✓T 64 �u11n ✓ LAOAl��
2cx�:>A' v� S
Specify color of color thru tile:
NO
FFE:
7&1--0(73
-✓313rs
Zip:
❑ De olition
'�•sis
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 $
(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 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 even (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved an reinspect on fee will be charged.
OWNER
The foregoinginstrument was acknowledged before me this
01 day of QC M 20 0� , by
MffZ1 r1,- who is personally known to
me or who has produced 'J'S 'PA33?d4,—X c•9'� as
identification and who did take an oath.
NOTARY PUBLIC:
0%%J1111iJJ11JJii
mIenis //"/
...........
Sign:
Print:
b'
= ` F�,3p e
Seal:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of . 20 , by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
'
PERMIT APPLICATION FOR MIAMI SHORES VI
M V E
10050 N.E. 2nd Avenue•
Miami Shores, Florida 33138 • Phone: 305-795-2204•
Faq -7 f $8 4
Date �I '1�.
'
JoAddress it �/
JobAddress
' `r 9�6
i_ Tax Folio
Legal Description
Historically Designated: Yes
No
Owner/Lessee/Tenet
-
Master Permit #
(®
a`
Owner's Address _J
✓
��
Phone 0 73
Contracting Co.I�QMWAJIEVA/6--
Address ig� d&4
6AA4b 91L 440-&
Qualifier
/l
� � f)D2W
SS# U i ' V® Phone
State # e AACOO _ Municipal #
Competency #
Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE -INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL _`�, ROOFING
WORK DESCRIPTION:
Square Ft. J A ®n Estimated Cost
V
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF k4ENCEMENT AND YOUR FAIL I) SO MAY RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and onthe-ittached addendum (if applicable). I certify that
all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required
for all disciplines.
OWNERS AFFIDAVIT: certify that all the foregoing information is accurate and that all work will In done in compliance with all applicable laws
regulating construction Ad zoning.9Furthermore, I authorize the above named contractor to do rhe work, a
Notary as to Ow
My Commission
FEES: ERMIT 15
Condo
President
Commisi n# D3 2008
Exp: Jun
[�tla�ic I3ondiag Co., Inc.
C.C.F
3
FA
Signature of
Notary as to Contractqf or 0wp%1WdetJJi(ia maiia 0A1"µ Datd
My Commission Expires --V ' = C0mmission#DD32 207
'�• v<� EAires:111II ,
' s •... • ice,• BonledTlnu
AZ1aiticBonding
APPROVED: TOTAL DUE
Zoning Building Electrical
Mechanical Plumbing Structural Engineer