RC-12-1926 R
Miami Shores Vill Je
age CIOZ C' ane
Building Department -- - . s
(� 1050 N.E.2ad Avenue,Miami Shores,Florida 33138
G V` Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC� 20
�\ �
BUILDING V Permit No.
PERMIT APPLICATIO4KCELLED
Master Permit No. 13 -� 192(x►
Permit Type: WELDING6
JOB ADDRESS: o w
City: Miami Shores County: Miami Dade Zap;
FolioMarcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):_ -7l wl (P 2 79YI
Address: S 1 0-�;
city: 01 -?t--V i State: �J� —zip:
Tenant4xssee Name: phone#:
Email:
CONTRACTOR:Company Name: t042 V, Yl b /ems hone#: 91 c6 3 7(o 3�2 q 7
Address: G
City: "q ✓►1 , L, slaw _
Qualifier Name: An Aevi10 Q'✓l S e Phone#: 3 �/
State Certification or Registration#:- (,(a(- 1�� 1 (0(4q:&gficate of Com cy#:
Contact Phone# rJ Email dress:
DESIGNER:Architect/Engineer: 0-se C6 Phone#:
l0.152
Value of Work for this Permit:$ SquardLinear Footage of Work:
Type of Work: OAddition OAlteration ONew ORepair/Replacie-_, ODemolition
Description of ork:_ V-4 C�/`e✓� V�—�_� Cc,c� r �ff�y�.-
Color thru tile:
Submittal Fee$ O Permit Fee$��Z.. CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ ')
c
` Brading 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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC.....
OWNER'S AFFmAVIT: 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. n of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 1 Signature
0 t dit ctor
�ing instrument was acknowledged before me this!(---' The fore ring instrument7ausknow dg before this��
,by - day of ,20Q"
by
Qom , =•mown to me o o has produced who is p o H kno to me or who has produced
As identification and who did take an cath. as identification and who did take an oa
WCs NOTARY P
Sign.
14
Print Print:
My Commission Expires: 2 t My Commission Expires:
N
Co�y
APPROVED BY Plans Examiner Zonin
Structural Review Clerk
(Revised 3/12/2012)(Revlsed 07/10/07XRevised 06I104009)(Revised 3115109)