PL-14-2148 (2) Miami Shores Village 7AUG
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Building Department 272a1510050 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. --q3
PERMIT APPLICATION Sub Permit No. ?L ILA 21 Cf 6
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
■❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ 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: FIFE:
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:
S
CONTRACTOR:Company Name: ki #4 g-TE ol—d A-1 G A t& 44 PI141 Phone#: 7d-i6 7 01P(13 52
Address: IS"S 0 f /0,1/- �rY�4" _L—
City: 1j-l�-t r State: � Zip: 231 -2,4
Qualifier Name:�-;!2uj /r 6L4 to Y � Phone#:
State Certification or Registration#:tf/moi c y l / 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: ❑■ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Plumbing 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$
(Revised 02/24/2014)
.1--
,--`
Bonding Company's Name(if applicable)
Bonding Company's Address
City State f 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 Signatur
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowled ed before this The n?
g instrument was acknowledged before this
day of rJ 20 ,by -� day of 20 by
who is personally known toSv �, who is personally known to
me or who has produced as me or who has produced 6Z as
identification and who did take an oath. identification and who did take an oath.
NOTARY P LIC: NOTARY PUBLI
J,n
Sig 4 / Sign:
Print: ( Print:
Seal: ^v`' MAGGIEGARCIA Seal: MAGGIEGARCIA
MY COMMISSION M FF 048923 '
;.: MY COMMISSION MFF 048923
EXPIRES:October 20,2017 �• a: EXPIAES:October 20,2017
%? Bonded Thio Notary Public Urndermitea pF t4 Bonded Thru Notary Public UndenvrAers
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)