MC-14-2147 (2) T _
Miami Shores Village � �' P" F
Building Department AUG 27 2815
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 _
Tel:(305)795-2204 Fax:(305)756-8972 —�-
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. ft -Ol
PERMIT APPLICATION Sub Permit No. kc - 14- 21 q-+
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 766 NE 96 street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):Lisa Guinovart Phone#:2014630015
Address:766 NE 96 street
City: Miami Shores State: FL Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: fJ /VL 5` /��/C,1' M� ,f�r�%�C&C- Phone#: "7�:c` ��F Y3 3 c�
Address: /Cs 46 r_ S&-) 106
City: ,d/ r /� _State:
Qualifier Name: -f�.J �-� (>�C��Y� Phone#:
State Certification or Registration#: i,A 9!- Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑E Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: mechanical revision
Specify color of color thru tile:
Submittal Fee$ () Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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. An the Bence of such posted notice, the
inspection will not be approved and a reinspectio fee will be charged.
Signature A A Signature
OWNER or AGENT COJVTfj/aCTAR, r
The foregoing instrument was acknow ged before me this The fore oing instrument was acknow dged before me this
26 day of v 20 by day of I!� �(�5 20 by
LK,• h,/-,,12/APS2 ,who is personally known to whojjis personally known to
me or who has produced L as me or who has produced _6L_ as
identification and who did take an oath. identification and who did take an oath.
NOTARY P LI NOTARY PUBLIC:
Sign- ! p , Sig Q
Print: 4� (1 �i Cll¢ Print:
Sealr:PY -, MAGGIEGARCIA Seal: ""°y ;. MAGGIEGARCIA
MY COMMISSION#FF 048923 t- MY COMMISSION#FF 048923
w;
,:a
EXPIRES:October 20,2017 EXPIRES:October 20,2b17
?' Bonded Thru Notary Public Undenwriters Bonded ThN Notary Public Undenvr tars
Af 4...
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APPROVED BY Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)