ELC-14-1860 Miami Shores Village
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 BY
FB 20
BUILDING Master Permit No. , ' q('6<
PERMIT APPLICATION Sub Permit Y- l qcc�
BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION F] 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 Phone#:
Address: 11300 NW 2 Ave
City: Miami Shores State: Florida zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C Davis Electric Phone#: 954-432-4334
Address: 1701 SW 100 Terrace
City: Miramarzip: 33025
Charles E. Davis JR. 954-432-4334
Qualifier Name: Phone#:
State Certification or Registration#: E00001038 Certificate of Competency M
DESIGNER:Architect/Engineer: Gallo Herbert Architects Phone#: 954-794-0300
Address: 1311 W Newport Center Dr. Suite C City: Deerfield Beach State: FL zip: 33442
Value of Work for this Permit:$ 12,000.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition X Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Interior Bucky's Cove
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$ 0
(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 if
OWNER or AGENT NTRACTOR
1
g n
The foregoing instrument was acknowledged before me this Tf as acknowledged before me this
day of .20 by 25th day of August 20 14 by
.who is personally known to Charles E. Davis JR. who is personally known to
me 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:
Sign: Sign:
Print: Print: ;�: SUSAN J.BENNETT
Geffiffli
99ion#EE 21749
Seal: Seal: : Expires September 25,2016
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)