REV-16-700 ,� to
Miami Shores Village
Building Department 4BY:
o1s
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 (gyp p�
BUILDING Master Permit No. 4
PERMIT APPLICATION Sub Permit No. v Co
r—IBUILDING 0 ELECTRIC F-� ROOFING ❑ REVISION EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF F-� CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2nd Ave. 1A)lEstw
kin
City: Miami Shores County: Miami Dade -Zia. Ir0�
Folio/Parcel#:11 2136 000 0050 Is the By Historically Designated:Yes NO
Occupancy Type: Load: Constructionf�Type: Flood Zone: BFE: FFE;.
OWNER:Name(Fee Simple Titleholder): G Phone#-: "�K Viet 11K
--- Barry University 11300 NE 2nd Ave.
Address:
City. Miami Shores State: FI Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Tirone Electric, Inc. Phone#: 954-989-7162
Address: 6151 Pembroke Rd
City: Hollywood State: FL Zip: 33023
Qualifier Name: Curtiss Morgan Phone#: 954-989-7162
State Certification or Registration#: EC0003059 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 E Q Alteration ❑ New L❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile: yy
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)
� a
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur AJAVIrM Signa re /
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
fY day of MA '20��by 2 day of February 20 16 by
c�l lulS �L who is personally I v+ o Curtiss Morgan who is personally known to
mfr who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sig Sign:
Print: Print:
Donette Villegas
Pub%8tm of F*daDONETrE A.
Seal: ie"J Yea Seal: i+ Y,� s: MY IONNFFFt 81029
�g My Commluion RR 188481 :* `
�!q Expku 11/121201$ T ,, d= Bo��� �r 4d 2018
� o,,• pub6cU�envritera
APPROVED BY ;�,��"�i�.�/ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)