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DS-12-1529 ECt—IV Miami Shores Village E® Building Department ___AUG 3 'z G I y "' /,� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 lx •ww Tel:(305)795.2204 Fa::(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 A � FBC BNG Permit No. PERMIT.APPLICATION Master Permit No. Permit Type: BUILDING = -ROOFING JOB ADDRESS: c7 /v 6 City: 1Vliatm Shorrc ly: iami Dade Folio/Parcel#: © �P' Is the Badding Histork�Y es NO. V Flood Zone: OWNER:Name(Fee Simple Titleholder):_�9/} ��n �, y�' Phone#: c :5 7 Address: �' ` ST city:— /Y!:07 f'// State: ,t-�� Tenant/Lessee Name: y rc�, �P�—� 3 /1 a I.l • c,� /.� �Ec /Y"Zcs s Phone#: C1.S �'s'�' /a / Email: cp • 4 int►ooc� �Je.Y pri� Inc.. CONTRACTOR:Company Name; ?ay i n Tn / �a, Phono#:.�QS' (o�� 9x88 Address: /` i h f re e--i" City: 6no r' Ol State:_E10✓'/ /�li Qualifier Name:_Mie_I.1 Z'P' Phone#: 74?6—a State Certification or Registration EmaCertifica,t�ea ocf Co mpetency#:—c RQContact Phone#: il Address: 1 �s�7 ar, 1 cow, DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ � � � � ...., Square/Linear Footage of Work: (� f dot-V Type of Work: OAddido OAlter ONew ORe air/Re lace ODemolidon Description of Work:. c► P P Color thru tile: ces Submittal Fee$ �� - Permit Fee$--/,,, CCF$ ScanningFee$ CO/CC$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) Bonding Company's Address M .- City'- State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State UV �P Application is hereby made to obtain a�pennit to do the work and installations as indicated. I certify that no work or'instapation 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 CONDMONERS,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. IcWARNING TO OWNER: YOUR RECORD A NOTICE OF COMMENCEMENT MAY RESULPAYING TWICE FOR IMPROVEMENTS - TO YOUR PROPERTY. IF YOU INTEND T- 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 nosted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of posted notice, the inspection will not be appy ved and a reinspection fee will be charged 0 S' lure ignature 1,71A 1 -.41 Owner or Agent 4ntractor The foregoing instrument was acknowledged before me this_-e: he foregoing instrument wads acknowledged f da ,20 L2,by //�!>/���?P/� 60/,XPi:L-day of ,2t��y 4 Y who is perso ly known to me ar-whe-has-predused- who is perso lly known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sip: Print: ign: .. Print: ! e--�4,6 ••• My Commission Expires: �v,uti Notary pubic State of FloridaM ommissiob Comm DppB$6820 . c Lois H Wells f MY Commission EEo20003 E)q*es 11/9/2012 oQ fres0812312014 : s `41 of o ExP Florida Notary Assn.,Inc C APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)