Building Department
1700 Convention Center Drive, 2
nd
floor
Miami Beach, Florida 33139
Telephone: 305-673-7610
www.miamibeachfl.gov
I , acting as agent (owner, registered agent, or legal representative)
and I (general contractor/ sub-contractor),
do hereby attest that the construction costs indicated herein are accurate for the construction project located at:
_.
Master Permits:
Total project cost: $
Stand alone and sub-permits
Building cost (excludes roofing, windows, railings, and MEP) $:
Roofing $:
Windows $:
Railings $:
Electrical $:
Mechanical $:
Plumbing $:
Other $: Description: _
Under penalties of perjury, I declare that I have read the foregoing affidavit and that the facts stated in it are true.
Registered
Owner/Agent or GC
:
Signature of Owner/Agent or GC (for Sub-permits)
Registered Contractor:
Signature of Qualifier:
The foregoing instrument was acknowledged before me, by means of The foregoing instrument was acknowledged before me, by means of
☐ physical presence or ☐ online notarization, ☐ physical presence or ☐ online notarization,
this day of ,20 this day of ,20
by , who is personally known to me or by , who is personally known to me or
who has produced who has produced
as identification. as identification.
Notary Public, State of Notary Public, State of
County of ____________________________________________ County of ____________________________________________
Printed Name Printed Name
Commission Number: _ Commission Number: _
My Commission Expires: My Commission Expires:
Revised October 12, 2020
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