ME-12-165 LL
Miami Shores Village JAN 0 20
Building Department Li�^=T
r 12d ri 1C44 4A,(_ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
'n P� INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.
PERMIT APP CATION Master Permit No.
FBC 20 dam'
Permit T e: MECHANICAL
DWNER:dame(Fee Simple Titleholder): AAi(P, F L DW F-,-4S Phone#: 36 S -17
Address: Cj D b /4e 1}-1-14 4 V c Lo
City: M r A M( 5 go fl-&'S State: Fd>ILIO/ Zip: 3 311 e
Tenant/l essee Name: A4 104 AP-L_ 0 f j E N 5 Phone#: 3®S _ �� 3 - 3 7 S T-
Email: lAt C/4-4F L . 01AJF n1S . SPRM e GA4A I.C. . C'oM
JOB-ADDRESS: g 0 6-7 N F 4T-k A\ Z- fLfl
City: Miami Shores County: Miami Dade Zip: 33 13 S
Folio/Parcel#: /I -32(30 -04-G -00 4-0
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: ACO-7Z-- e4q,-\)�'�� ,;o Phone#:
Address: ®f 4Z92 -�3 2r e
City: 4A 6,,Pi'�d State: r- L
Qualifier Name: ���-�� / �"' P1 a
1w
State Certification or Registration#: ! Certificate of Competency#:
Contact Phone#: -Email Address: 4Ile 0 •e_01-*1
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$_ low �/� Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ❑New ?ARepair/Replace ODemolition )
Description of Work: 0,0/v 14-a
-- > 6ittal Fee$ Permit Fee$ � CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
r
TOTAL FEE NOW DUE$
'� 1
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 o such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signatur l A -&,c Signat
V
T nt Contractor
The foregoing instrument
��was acknowledged before me this Iq The oregoing instrument was acknowledged before me this-,z3(—
day
hisday of _,20� lam,by rr�� day of o r ,20 a—,by
who is personally known to me or who has produced L who is personally known to me or who has produced
As identification and who did take an oath. f.'*`3 L(1S33gas identification and who did take an oath.
NOTARY PUBLIC: \�\\"\'1 II '/�/�, NOTARY PUBLIC:
_
Sign: o w = Sign:
Print = „ ' y- o' _ Frint : rr WELA M.H
�`6��� a• - 046386
: WtOMMUMN#EE
My Commission Expires: O� ' ti C Myomm
Ci r EXPIRES April 3,2015
i 0®• �D \e , Aded Thm Notary Rft Und&W tm
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APPROVED BY Ls Examiner Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)