Town of Cutler Bay
Building Department
10720 Caribbean Blvd., Suite 110
Cutler Bay, Florida 33189
Tel:(305)234-4193 Fax (305)234-5873
PERMIT APPLICATION
Permit No.
Master Permit: Job Address: Unit No.
1. Owner Information 2. Contractor Information
Owner Name: Company Name:
Address: Qualifier Name:
City ST Zip Address:
Phone No. City ST Zip
Phone No.
Owner Builder Yes No License No.
3. Permit Type: (Check One Only) 4. Type of Improvement: (Check One Only)
□ BUILDING □ CHANGE CONTRACTOR
NEW CONSTRUCTION □ ADDITION ATTACHED
□ ELECTRICAL □ EXTENSION
DDITION DETACHED □ ALTERATION INTERIOR
□ MECHANICAL □ RENEWAL
LTERATION EXTERIOR □ REPAIR/REPLACE
□ PLUMBING/GAS □ SHOP DRAWING
□ PAVING/DRAINAGE □ SIGN
□ ROOFING □ ZONING
□ PUBLIC WORKS □ OTHER
5. Architect/Engineer: 6. Legal/Use/Work:
Name: Folio No: No. of Units:
Address: Lot: Block:
City ST Zip Subdivision: PB/PG:
License No. Current Use of Property:
Phone No. Description of Work:
Estimated Value: Work Classification:
Square Footage : Residential Multi-Family Commercial
Application is hereby made to obtain a permit to do work and installation 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 ELECTRICAL WORK, MECHANICAL,
PLUMBING, SIGNS, WELLS, POOLS, ROOFING, SHUTTERS, WINDOWS, FURNACES, BOILERS, HEATERS, TANKS, and AIR
CONDITIONERS, etc. I understand that in signing this application I am responsible for the supervision and completion of the
construction including scheduling of inspections and obtaining final inspections in accordance with the plans and
specification. WARNING TO OWNER: Your failure to record a notice of commencement may result in you paying twice for
improvements to your property. If you intend to obtain financing, consult with your attorney or lender before recording your
notice of commencement. Owner/Contractor 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.
Signature of Owner or Authorized Agent Signature of Qualifier
Print Name Print Name
State of Florida, Miami-Dade County State of Florida, Miami-Dade County
Sworn to and subscribed before me this day of Sworn to and subscribed before me this day of
20 . 20 .
By (Seal) By (Seal)
Personally known or ID Personally known or ID
NOTICE: In addition to the requirements of this permit, there may be additional deed restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as Water Management Districts, state agencies or federal agencies.
Issuing Clerk: Date:
DISCIPLINE APPROVED DATE DISAPPROVED DATE ZONING
PW FEES FEES $ (√)
Zoning
Building
Fire
Structural
Electrical
Mechanical
Plumbing
Roofing
P/Works
Flood
(# )Violation
Plans out Date Clerk Check -in Date Clerk
Base Permit
State Radon
Code Compliance
(% Concurrency)
Total
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