REV-16-2086 Miami Shores Village
Building Department 7BYL
g 016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 u-'
FBC 210,L4S 'Ce
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. f t L 2W(o
UILDING ❑ ELECTRIC ❑ ROOFING /REVISION ❑ EXTENSION ❑RENEWAL
F-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: .4d, pt-7- loe g-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-7-/3 -®ll-®a!r® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ A1-Ay►1 iyi s®✓ue Phone#:----sax: (09-,"f
Address: .3-0 ,N7 /0e tC
1%.A
City: *w State: „>!C Zip: A��
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: O�ZI sJ&v 6N4&0!4. Phone#:," �S�
Address:j a e jW wif Yaelayf- 7Vir p �
City: A®/I- State: Zip: f-7/7/
Qualifier Name: -/0lst- 44$/&4p Phone#:��
State Certification or Registration#: Certificate of Competency#: Germ ®®d'1y�
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip::
Value of Work for this Permit:$ M, 0�3 Square/Linear Footage of Work:1 �' J
Type of Work: ❑ Addition F�Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: ���
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ d3 O�) CCF$ CO/CC$
Scanning Fee$ 03 Radon Fee$ . CJS DBPR$ cR ' Notary$ (14
Technology Fee$ ®. Training/Education Fee$ (') 2® Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I I °
GO
(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 s posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature" .f Signature
rAGENT CO TRACTOR
The foregoing instrument wa acknowledged efore me this The foregoing instrument was acknowledged before me this
_ day of20 / ,by 9!; day ofiv� 20 by
1 i n 6 ,who is personally known to Jf1? m2 ►�r J who is personally known to
me or who has produced Quit, W 142--0-40-J±— W-hff 0= me or who has produced Sir as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
a
Print: Print:
Seal: := UTHSMA
MY COMMISSION#FF 172019 Seal: _" = MY COM► �aE
• �;
EXPIRES:January 18,2019 7' P; EXP ON#FF 172019
q , Bonded Thru Notary Public Underwriters SAFaP,. �� IRES:January 18,2019
ed ThN Notary Public Undem ter,
L �
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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,Fkr�nco�►}e +y "-- �" .TU?�aL�. A� 11 THOMAS J. KELLY, INC.
L.B. #6486
TMJ'pow SURVEYORS-MAPPERS-LAND PLANNERS
ood— o0�'A,&rASc Af / 'b 6 110'48125 5W 120 STREET PINECREST, FLORIDA 33156
Cor� (786) 242-7692 DADE (954) 779-3288 BRWD
14PZxuw bA47'e (786) 242-6494 DADE FAX (954) 779-3260 BAWD FAX
'p DATF FIELD WORK ISCALE -- I SURVEY NO.