EL-14-2078Miami 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
BUILDING
PERMIT APPLICATION
BUILDING g&ELECTRIC ❑ ROOFING
0PLUMBING ❑ MECHANICAL PUBLICS
JOB ADDRESS: t i►S /1,E
City:
Miami Shores
\ C E-7
( SEP 242014
B ._
FBC20I0
Master Permit No. Fc.14 -564-
Sub
c4Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
County:
Miami Dade Zip: "3"3r36
Folio/Parcel#: 11-32oC o 4 -462-0
Occupancy Type: Load:
OWNER: Name (Fee Simple Titleholder):
Construction Type:
Is the Building Historically Designated: Yes NO
Address: ° 1 15-6— -E E. (D &
City: 1-t L A.L ti 1 State:
Tenant/Lessee Name:
Email:
Flood Zone:
BFE: FFE:
Phone#:
Zip: 3'301D
Phone#:
CONTRACTOR: Company Name: CC
Address: 17,2t J.t4.g6( ANI
Phone#:C76(e> 4-7yr/
City: /" `I ,r� State:
Qualifier Name: n� l�-O OZ--
State Certification or Registration #:
Phone#
Zip: 33)1+
r_r
Certificate of Competency #:(1 i - OC)° )6e)
DESIGNER: Architect/Engineer: Phone#:
Address: City:
vtr
Value of Work for this Permit: $ 51/ 5 i Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ElDemolition
Description of Work: fEL (F 1 S IOC /Fop )\ L ( Z 5 t la1
State: Zip:
Specify color of color thru tile:
Submittal Fee $ CD Permit Fee $ 299 f 5 2 CCF $ 3 ' GDp v
Scanning Fee $ Radon Fee $ 2,9 • d q DBPR $ 29 ' t
Technology Fee $ Li • %O Training/Education Fee $ 1 ( '
2-0
Structural Reviews $
(Revised02/24/2014)
coIcc $ t
Notary $
Double Fee $
Bond $ 0
TOTAL FEE NOW DUE $ �Q CIC)f
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 insp ction which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledg; d before me this
5 day of 5_ , 20 _�, by
n to
\1- z , 61, , who isp
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
c..i Wil& .41G
CARLOS SANABRIA
Commission # FF 37673
My Commission Expires
July 18, 2017
Signature
CONT ACTOR
The foregoing instrument w acknowledged before me this
5 day of
IT;t9q a17ciaue( , who is
by
to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY P74-7 4/ Plans Examiner
(Revised02/24/2014)
,•:.1g1,!:`,:*CARLOS SANABRIA
=�
� *� Commission # FF 37673
qiii(Pg My Commission Expires
7,7,r. OF July 18, 2017
Structural Review
Zoning
Clerk