RF-15-1121Miami Shores Village
0400'aaLE® Building Department
.. 10050 N.E,Znd Avenue, Miami Shores, Florida 33138
Tei: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINEPHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING
['PLUMBING
❑ ELECTRIC f ROOFING
0 MECHANICAL ❑PUBLIC WORKS
RECEIVED
MAY 1 015
BYz
FBC201(j
Master Permit No. (✓h— 1 1 2J
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑RENEWAL
O CHANGE OF' ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10 3 6 2' E. Ave
Gty:
Miami Shores
County: Miami Dade.
Zip:
Falco/Parcel#: Is the Building Historically
Occupancy Type: Load:
Construction Type: Flood Ze
signated: Yes
OWNER: Name (Fee Simple Titleholder): )7 k' A a. t z c }11 L' M Ft) r cd Phone#:
Address:
)oar i AJ, E . Ave
NO
FFE:
City: i YV
State: F
Zip:3 e
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: "—P01 t'++ e. r v cc r c y erhte .
Address: 1 '% g3) C„--, c +'�t 131 t t At wy t i Gt iv i r ( .
City: Ki 0. vv. State: Ft.
Phone#: 3r7S 5S,) 97 5'
Qualifier Name: S'J %). & CC) t Vv e
Zip: 3 i 5 7
Phone#: 3(...s 5,r,.) 77
` a 2 �C -. • Certificate of Competency #:
DESIGNER: Architect/Engineer: - Phone#:
Address: City: State: Zip:
Value 9f Work fpr. this Permit: $ '.00 gaare/linear.Footage of.Work• SType of Work: 0 Addition 1:2Alteration ❑ New epai; Replace 0 Demolition
Description of Work:. TF' A CU):L&� 1.5C I.,. 4 k. R4 Sry,4v e ,_::-A- VA l i e
Rt`p'ta4 1;'.c4 -i' Lead a.. +t.EedPJ tic/ lAryl/ 4t: R -F Fetf a...--€ 441e,t'
1e, odhria,„,0s4-
Or 4-0 c'd e , ttII +al i brt.c-14 S elal orF
Specify color of color thru tile:
arri
tc-
L
T;. I'e tk14L A f,”
. 110'..51 fee
Submittal Fee $ G0_100 Permit Fee 5 _` bO CO CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ Y )q • 9 0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company''s Address A
City State Zip
Mortgage Lender's Name (if applicable) f
Mortgage tender's Address
f\i
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 o building permit with on 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 obsence of such posted notice, the
inspection will not be approved and o reinspection fee will be chorged.
Signature
. )1\ U --HP
OWNER or AGENT
Signature
CONTRACTOR
The fooing instrument was acknowledged before me this The forregoi ; instrument was acknowledged before me this
day of ./ /� ffij'�i
, . 20 `5 , by t 2 day of , 20 / $ , by
It
9 f ortu B 41 C4,lr 'o is personally known to Sul .f i. 'jt epetil lti.v' , who is personalty known to
CM n 5-e,
me or who has produced /f D rr,`j/if'5 L- • e �s me or who has produced
identification and who did take an oath.
owl jjRY PUBUC:
SINE
I cam: Com Exs
GE
JAN.
y 0 '•.•p /8%.' ' t�
ES CO AO
APPROVED BY
(Revised02J24/2014)
identification and wh
NOTARY PUBLIC:
Print: r'f Q G I ! o
• •i•
°V Notary Public State of Florida
Ippolito Romano
4x. • Commission EE129147
iron 12/08/2015
/fit!.
Seal:
Plans Examiner
Structural Review
as
Zoning
Clerk