PL-16-2237 (4)� Miami Shores Village
\\(17()\:)(%`'� Building Department "A N "�''
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B9-6t9
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 S 7�
FBC 201
BUILDING Master Permit No. 4:2•e V -1-4—
PERMIT
--PERMIT APPLICATION Sub Permit No. pit 8.-/6-.22 39
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION 0RENEWAL
['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 151 I'D IY E IO't S
City: Miami Shores County: Miami Dade Zip: 33/39
Folio/Parcel#: II - cl,oi 32" 0 31-0360 Is the Building Historically Designated: Yes NO _2(,__
Occupancy Type: Res Load: Construction Type: Plumb Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): bait C7 L. cha Phone#: 7? -4. -??7- 99zo
Address: I r5 I, N 6 1b' SI -
City: Miami % r -es State: FI., Zip: 3l3�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Math I n ?torn n4 Ot Mi l .•vti,Tucjhone#:305-65z-3o3I
Address: x011 cIS NE /b elate._ vJ
City: Wor4.11 MiCs 44; &44JI State: F'- Zip:33/74
Qualifier Name: Eet) r L T `talker Phone#:5:4-632—&73/
State Certification or Registration #: Cr -e.048292 Certificate of Competency #: [ 2 — $ 7 % ? 2 D
DESIGNER: Architect/Engineer: Phone#:
Address:City: State: Zip:
%•* f41) pr this Permit: $ Q Square/Linear Footage of Work: O
A
Type of Work: it Addition ❑ Alteration E New ❑ Repair/Replace ❑ Demolition
Description of Word: I- 9 ` o �Flo (2 ,r1 I 1 i`1 0 S �p //L "7i �,al��„ °� D qC�►,y��� ,
6G11'lvee� �i�r. ! h
9
s-
°-... /
`, 40.R.40.31P
Specify.cb)or of color thru tile:
Submittal Fee $ Permit Fee $ CCF $CO/CC $ `°,�.1Vilt1'4 « f l o,^°
Radon Fee $ DBPR $ Notarya°
Scanning Fee $ $ ., P , ' , ,
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ W q
(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.
Signature Signature
OWNER or AGENT ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
24 day of Zar►.Vw41 , 20 l'-1 , by
Q ' iV hoc , who is personally known to
me or who has produced — DL
identification and who did take an oath.
NOTARY PUBLIC:
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Prin •
�ec6.2017
— Seal: NO FF 070697
• NOTARY
PIRIUC
•
as
41.
ac{ day of 7241.0049 , 20 17 . by
Ed(,t)p,r',d. \Qt t , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Met)? ee
yPrint Q,((€Sly Nkeel ePAI
1/ Seal: �j
es
• My Comm EW
pec 6 2017
•
NO FF 010897
NOTARY
i PUBLIC
•
•
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17E OF
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440.4,8”0124.20********** *******************************************************************************
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APPROVED BY i',3‘1 Plans Examiner Zoning
(Revised02/24/2014)
Structural Review Clerk