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Process #: ______________ Total Due______________ Permit #: ______________

City of Miami Building Department Permit Application Job Location Folio Number: Job Address: Legal Address: Unit No: Commercial Owner

Owner Lessee Information Owner: Owner’s Address: Phone: E-Mail: Lessee: Lessee Address: Phone: E-Mail: General Information

Zip:

Residential Dry Run Contractor Lessee Contractor Information

Contractor’s License/Registration No: Contractor’s Social Security Number: Oualifier’s Name: Company’s Name: Address: City: State: Zip: Phone: E-Mail: If this is related to another permit, you must provide :

Proposed Use of Building: Current Use: Job Description: New Construction Total Cost: New Construction Sq. Ft: Lineal Ft: Remodeling Total Cost: Remodeling Sq. Ft: Lineal Ft: Units: Floors: Height: Gallons: Master Permit Number: Plan No:

Threshold Inspector

Bonding Company

Name: Address: Phone:

Name: Address: Phone: Permit Type

Building Mechanical/AC Electrical Landscaping Electrical Fire

Engineer/Architect Information Engineer’s Name: Address: Phone: E-Mail: Architect’s Name: Address: Phone: E-Mail: Building Permit only

Plumbing Plumbing/Gas Roofing Sign Roofing Mechanical Elevator

Change to Existing Permit Change of Contractor (CR) Change of Qualifier (CQ) Re-certification of Plans (RC) Plans revision (RV) Completion Permit (CP)

New Construction General Repair/Remodeling Change of Occupancy Change of Use

Addition Misc. Building Demolition

I understand that separate permits must be obtained for other items (i.e. electrical, plumbing, roofing, etc.), unless specifically covered by this permit. In signing this application, I am responsible for the supervision and completion of the construction in accordance with the plans and specifications and for compliance with all federal, state, and county laws applicable. Owner’s Affidavit: I certify that all the forgoing information is correct. Owner Certifies that the aforementioned Contractor has the authorization to perform the work as specified above. Lessee’s Affidavit: Lessee certifies that he has full consent and authorization from owner of subject property to perform the abovementioned work and to hire above captioned contractor. I have read the information contained in this permit and understand that any misrepresentation may constitutes fraud and could void the permit. ________________________________

Signature of Owner/Lessee

_______________________________

Signature of Qualifier

________________________________

Print Name

_______________________________

Print Name

State of Florida, County of Miami-Dade Sworn to and subscribed before me this ____________ Day of ________________, 20__. By _________________________________________ (SEAL) _____________________________________ Personally known or Produced Identification, Type of Identification produced __________________

State of Florida, County of Miami-Dade Sworn to and subscribed before me this ____________ Day of ________________, 20__. By _________________________________________ (SEAL) _____________________________________ Personally known or Produced Identification, Type of Identification produced __________________

FOR BUILDING DEPARTMENT USE ONLY Job Code:

Certificates Required: □ C.O. □ C.C.

Plans: □ Yes

No. Of Sheets:____________ □ No

Tracking required

Application Received by:_______________ Date:_________ Permit Authorized by: ________________Date_________

Rev 2/02

City of Miami Permit Application  

General Permit application for the City of Miami

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