WS-16-2100a
BUILDING
PERMIT APPLICATION
QBUILDING ❑ ELECTRIC
❑PLUMBING ❑ MECHANICAL
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
JUL 2 6 2016
BY:
FBC 20
Master Permit No:4e;�
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Sub Permit No.
❑ ROOFING ❑ REVISION EXTENSION
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: 174 NW 100 Terrace
❑ RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#:1131010230270
Occupancy Type: Load:
Is the Building Historically Designated: Yes NO X
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): Friztner Blanchet
Address:174 NW 100 Terrace
BFE: FFE:
Phone#: 305)587-3950
City: Miami Shores
State: FI Zip: 33150
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1,100.00 _ Square/Linear Footage of Work: 0
Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition
Description of Work: Changing front and side windows in home.
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Phone#:
Specify color of color thru tile:
Submittal Fee $5-(nip00:),.' Permit Fee $ 1 SD ` CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $ rJ
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ (�
TOTAL FEE NOW DUE$ 'I S 'RV
(Revised02/24/2014)
Banding 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 recorde
for the first inspection which occurs seven (7) days after the building per
inspection will not be approved and a reinspection fee will be charged.
Signature doe
°l'►=�• commencement must be posted at the job site
h
l Bence of such posted notice, the
Signature
OWNER or AGENT CONTRACTOR
The-�foregoing(1instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
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10050 NE 2 AVE
Miami Shores, FL 33138
305-795-2204
305-756-8972
www.miamishoresvillage.com
mo
Shores
Please let me know if we can close permit WS16-2100 with WS16-3074.
Arlenis
Owner: Fritzner Blanchet
305-587-3950
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