FW-14-2756 (3) Miami Shores Village CF11V
Building Department JUL e8z0'5
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B�• -
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20l/
BUILDING Master Permit No._1 7
PERMIT APPLICATION Sub Permit No.
*UILDING ❑ ELECTRIC ❑ ROOFING M/REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Z 3 2
City: iami Shore County: Miami Dade Zip: ( 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO t�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): iA44 Phone#: 7O ?0/' ?3
Address: �2 3 72 1 1
City:_&(.Aa'/ ;2i7 f�,TL/L State: �' �� Zip: 1
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: ® �n--� Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace] ❑ Demolition
Description of Work: J�-� �' ���a�C f� (��7 t• d1 7y
t
P
Specify color of color thru tile:
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$ 1
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 approved and a reinspection fee will be charged.
Signature Signature
NER or AGtU CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20��� by day of ,20 ,by
Q , who is personally known to ,who is personally known to
me or who has produced�2ED1 _ as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY NOTARY PUBLIC:
Sign: Sign:
Print Notary Public state of Florida
Print:
My Commission FF 082753
Seal: �w,� Expires0U1=0t8 Seal:
0I r
APPROVED BY IZ/7 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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BY DATE
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ropedy Address: 237 N.E. 102 STREET NOTE
cTaTE an S: - D S OT LINEED .
MIAMI
MIAMI SHORES, FL 33138
RBCEwTiFICg :I THATTHMSOUNDWSURVErISATRUEAND CORRECT
REPRESENTATION of A w RlARED MY DIRECTION.THM CDAAPM WATT+THE R�u@AUDA M.E.Land Services,Inc.
TECHNICAL STANDARDS. FORTH By THE tE OF FLORIDA BOARD OF PROFESSIONAL LAND
suRVEtraRB IN cHAPrE 1T.FI �MINI THE CODE PURSUANT TD 4Tzo2T,FLORIDA STATUTES. 10665 SW 190TH STREET
SUITE 3110
MIAMI,FL 33157
SIGNED FOR THE FIRM PHONE:(305)740-3319
TiGUEL S S1Alf �� P.S.M.No.5101 FAX:(305)669-3190
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