REV-16-1081 Miami Shores Village
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Building Department YAP7�6
ED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 I JTel: (305)795-2204 Fax:(305)756-8972INSPECTION LINE PHONE NUMBER:(305)762-4949 _ r J
FBC 20
BUILDING Master Permit No. 2 4 � -?;?5
PERMIT APPLICATION sub Permit No.IT C Y I b f)
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING Q MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
r� CONTRACTOR DRAWINGS
/1
10B ADDRESS: 99257 �/ 43 t4 U
City: Miami Shores County: Miami Dade Zip: 33/ 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): '9�141-t 014,& Z2P-1 Phone#:X05 yRTCV?CEP
Address: .35 �1 /��►.3�� T
City: / �� � Sr/DC/s",r State:_�Fz Zip: 3��a
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Mechanical & Air Conditioning Services Corp. phone#: 3052191929
Address: 137 W 11th St
City: Hialeah state: FL 33010
Qualifier Name: Osbel Rodriguez Phone#: 3057266715
State Certification or Registration#: CMC1250511 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ .r��I�m_ cs, Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ Neyv ❑ Repair/Replace ❑ Demolition
Description of Work: < e&41C7& e5d a4alb
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)
'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. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT 11jr CONTRACT/R;7V
The foregoing instrument was acknowledged before me this The foregoing ins rument was acknowledged before me this
Z 5 day of --J-0 `1 20 14:- , by ' S day of �1 20 1( by
yea!G, who is personally known to IDS� 4 >4r-LA %-V-CZ- ,who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: ign:
,.•" "� � JOSEFINA GEREZ ""•,,, FIN EZ
Print: ida Tint: tea o
=•: :• My Comm.Expires Sep 30,2018 •=My Comm.Expires Sep 30,2018
Seal: ;; A;= Commission#FF 164325 ea l: ;air Commission#FF 164325
• •�n�ua ` WWedt National Not sn.
11 B,Bonded through National Notary Assn. ''FOF` through Notary
APPROVED BY Iaminer Zoning
Structural Review Clerk
(Revised02/24/2014)