REV-16-2468Miami 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
SEP 0 6 2016
FBC 20i4
BUILDING Master Permit No. - C_
PERMIT APPLICATION Sub Permit No. \I 1(0 - ZL1 (Da
❑ BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL 0PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: / Z. T /' '36
City: Miami Shores
DRAWINGS
Count
Miami Dade Zi.:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone: BFE:
NO ‘,..7•'•
FFE:
OWNER: Name (Fee Simple Titleholder): 1_ Phone#:
Address: o .,12'J q6 $t .
City: 0" l State:
Tenant/Lessee Name:
Email:
Yl
Phone#:
(-�
CONTRACTOR: Company Name: `J cco CwvvSI. Cs.-•-?. Phone#: OT -65-07-
Address: /2Cie? NE /0 y Ck.
rtrt
City: �'(_ a70--P-e--7 State: Ti. Zip: -...3 73c'
Qualifier Name: /e ( e7Seel Phone#:
State Certification or Registration #: CC -Te- /5-0 S7 63 Certificate of Competency #:
DESIGNER: Architect/Engineer: . LaA,lit Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work: �41
Type of Work: [I Addition ❑ Alteration n New
Description of Work: feesj It of t �.Q�slAdy ()-r a-
�Repair/Replace
)A wS IMOD
Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 9. . OQ CCF $ CO/CC $
Scanning Fee $ 9- ob Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Bond $ , I •/
TOTAL FEE NOW DUE $ C Q 4 . W�
Structural Reviews $12J3 - a
(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.
Signatu
OWNER or AGENT
Sign
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
L day of 1)Li
� lb(J. , 20 i L
M1(110N I 1, U dtS,, who is personally known toI / , who is person wn to
me or who has produced as me or who has produced NO
by U day of Se 2(f ,20)(J , by
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
EX°IRES:..:l:a 21, 2017
•
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
as
r 1
Gy �.�. i..,�Zr1,�l�"�-.. .. Y
EXP RES: 21, 2017
Zoning
Structural Review Clerk