CC-14-1869 e3 � 1�q r f,-rMAAI- Miami Shores Village aec 7
, Building Department artment
�U n 2 6
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
1 INSPECTION LINE PHONE NUMBER:(305)762-4949
- �Gi FBC 20 L Q
BLISINI Master Permit No.-n-
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2 Ave
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Barry University _T�l D Mrd S;04,6phone#: q-,>jq go 1z
Address:11300 NW 2 Ave
City: Miami Shores State: Florida Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: JWR Construction Services Phone#: 954-480-2800
Address: 1311 W Newport Center Drive Suite C
City: Deerfield Beach State: Florida Zip: 33442
Qualifier Name: Jerry DuBois Phone#: 954-480-2800
State Certification or Registration#: CGC034031 Certificate of Competency M 180-2092
DESIGNER:Architect/Engineer: Gallo Herbert Architects Phone#: 954-794-0300
Address:1311 W Newport Center Dr. Suite C City. Deerfield BeachState:/FL Zip: 33442
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition M Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Buck Stop Interior Renovation
Specify color of colo�r�jthhru tile: t
Submittal Fee$ °r`hll J Permit Fee$ U�� CCF$ CO/CC$ SO ` 03
Scanning Fee$ J� Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ 0 ! CT� Double Fee$
Structural Reviews$ Bond$ 1
GO
TOTAL FEE NOW DUE$ i 7 7( '
(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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In a absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ,�� � Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was
acknowledged before me this The foregoing instent was acknowledged before me this
day of �/�` 20 by 10 day of /�iY zo 14 by
NIL. ( F +'lwho is personally known to Jerry DuBois who is personally known to
ame or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
` 1
Sign: _ (L Sign:
Print: 7& ri X Print:
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Seal: `9'00Q'pQ�P� COQ /////// Seal: �'c, MY COMMISSION#EE876792
EXPIRES June 05,2017
�.�45 �1s,2�i�9�� � 1 asaotss
Vlans
,APPROVED B$� Examiner Zoning
3P / Structural Review Clerk
(Revised02/24/2014)