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REV-16-2699 Miami Shores Village RECEIVED Building Department � g T o_3 201s_ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 \\ Tel: (305)795-2204 Fax:(305)756-8972 $Y' ` INSPECTION LINE PHONE NUMBER:(305)762-4949 �/ I FBC 20N BUILDING Master Permit No. V C 21 C,-5 Tv— PERMIT APPLICATION Sub Permit No.d_•.G V/b' 2x6701 ❑BUILDING •ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q , // CONTRACTOR DRAWINGS JOB ADDRESS: / X/F. `9 V C- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Z 055 ©(L: Is the Building Historically Designated:Yes NO Occupancy Type:Zo-57)b Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):?Q''-j�'-''9 'gyp S/L Vc3rl2-4 Phone#:V/- Address: Y595 IlC, /3 Ay 6 City: )41/A-'1!•XVIC:>O� V/ZZ-46 ;; State: 7"L Zip: 33 l-j g Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: {G/��7G✓I�G �L�G-'!d/ C lli�G, Phone#: -3�7` �9� Z Address: --/ ki to g6 4,-1e. City: >—� $a'c::�t7 -C-- 7ij�r Stater 3�J d ' Zip: Z Qualifier Name: ✓ LoLl o 5 Phone#:WU-3�(-7- o 1?6 State Certification or Registration#: /30t,--3 67e Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 7kj%.j ' Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: C—!L �S/2 CXJ�c/� f�OGtJ L2 Sc_=72 Y.' CC—: 6 u/s'Ti,►J Specify color of color thru tile: Submittal Fee$ Permit Fee$ tPy°i pjR CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 5-4 -co 1111-1 Al 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. AV4Signature IV4� Signa OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this d—` day of M 6t-9'-,20 l (o by 8 day of S�`�'T 20 /-6 by �b'°"'--0 S' ��{ ho is personally known to J�L'v /D'� 2�5 who is personally known to It I kms. me or who has produced S/116 Zti o -42 a `�C2s me or who has produced_ a:d & � vd.:c 4�. as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: %oldaPrint: J-4J I S L L 4 L Ll �00!ilet",,, JOSEFINA GE EZ r+r+•. Seal: ;a4�� Notary Public-State ofJAssn. Seal: a�'r LUIS DELVALLE My Comm.Expires Sep 3 ;.; :- MY COMMISSION d FF 949960 �..•' Commission�FF 16c� EXPIRES:February 17,202U` , Bonded Thru Notary Pudic Underwriters' �� Bonded t rouo National Not APPROVED BY 3r Plans Examiner Zoning Structural Review Clerk 2016-10-04 10:30 julio 5616834121 >> 1 800 685 7530 P 1/1 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT u 115 S.Andrews Ave., Rm.A-100, Ft, Lauderdale, FL 33301-1895—954-831-4000 {' VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Receipt#:181-3230 F' KINGWIRE ELECTRXC INCELECTRICAL/ALARMS/CONTRACTOR Business Name: Business Type:(CERT ELECTRICAL CONTRACTOFi� t;I+ Owner Name:JULIO TORRES Business Openod:10/25/2007 11 Business Location:521 NW 86 AVE State/County/Cert/Reg:EC13003678 PEMBROKE PINES Exemption Code: Business Phone: r Rooms Seats Employees Machines Professionals For Vanding Business Only Numbor of Machines: Vending Typo: 1I Tax Amount Transfer Foo NSF pee Penalty Prior Years Collection Cost Total Paid j 27.00 0.00 0,00 0.00 0.00 0.00 27.00 �r I THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and Is non-regulatory In nature.You must meet all County and/or Municipality planning WHEN VAUDATED and zoning requirements.This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location,This receipt does not indicate that the business Is legal or that it is in compliance with State or local laws and regulations. f Mailing Address: y; 521 NW TO6RES Rocoipt #522L-:LS-00008251 Paid 07/12/2016 27.00 PEMBROKE PINES, FL 33024 I 1 .:1 2016 - 2017 I RRnWARh f:fll INTY i n[_41 R�ISINi=SS TA R v(:FIp'I"