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MC-13-1101 ' Miami Shores Village MAY r p 2013 gBY... ................. Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. I �, PERMIT APPLICATION Master Permit No. FBC 20 CA ( LED Permit Type: MECHANICAL OWNER:Name(Fee Simple Titleholder): l Cu� l_ s� '0 IJ Phone#: � , 7 Address: C f/ =��? r/ . city: 11 11 state: F. , Zip: Tenant� s ssee Name: } Phone#: 3�1•�$�� Email: 1`115U' 2v` /i S�/M3�V� � C.o� JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: . Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: &2k �D� ' G Z 6"- 77ke- Phone#: Address: AIL 11.2— City: state K-( zip: Qualifier Name: )?w'0A4- Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phonek Email Address: DESIGNER:Architect/Engineei: Phonek Value of Work for this Permit:$2. 00;.AP10 SquareJLinear Footage of Work: Type of Work: OAddress DAlteration C ONew ORepair/Replace ODemolition Description of Work: *" IT *****«***«*******«*«***«*«««««*«*«**«*«Fees««*******«««**«*««««**«**«««««*****«****«**« Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ 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 City State Zip Mortgage Lender's Name(if applicable)� f LAbSr,Q!} BON K. Mortgage Lender's Address U 00"�2 t(L (YI.S F- - City r ''� State Zip 9 Application is hereby made to obtain a permit'fo o ��tions as indicated. I certify that no work or installation has commenced prior to the issuance of a permit 0 � a 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 of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature A&`1 � -� Signature 4/2��, 94,10 4 i Owner or AgentContractor The foregoing instrument was acknowledged before me this (� The forego in trument was ackno led be fo me this day of �� ,201by cul l 2-��um�, day of ,20 ,by who is personally to me or who has produced who is p sonall own to me or who has produced As identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: N TA P LIC: - - s Sign: cvj Sign: �s Print: Print: \. r ut^ pP �N r-%d LEE RACKL ` C m0°9\\ My Commission Expires: ; MY COMMISSION EE 863409 My Commissio ExpirEXPIRES:March 13 2017'fi Bonded Thru Notary Public Underwriters APPROVED BY Plans Examiner Zoning Structural Review t Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)