REV-16-1024 Miami Shores Village
Building Department ir -
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 APR 1:8 101
Tel: (305)795-2204 Fax: (305)756-8972 BY,
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201,q s
BUILDING &gy� S � oMaster Permit No. " — S O
PERMIT A P Sub Permit No. 0;�V 110 102y
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
U31PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
tt,, '' CONTRACTOR DRAWINGS
JOB ADDRESS: W &K4.
City: Miami Shores County: Miami Dade ZipY/
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: G� Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Title older): Phone#: ��os 3 ys�66y
Address: ? /
City: �' State: Zip: "3317/,4
Tenant/Lessee Name: Phone#:
Email: J�/
CONTRACTOR:Company Name: ;I 9d Phone#:
Address: �C M�v/Id 3 1</ /D
City: State: Zip:
Qualifier Name: '�G ' 5 Phone#:
State Certification or Registration#: ew `V2 Certificate of Competency#:
DESIGNER:Architect/Engineer: _ Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ )O( l U V Square/Linear Footage of Work: //'z'e"
Type of Work: ❑ Addition
Alteration / ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color ru`>rile ' G `.
Submittal Fee'$ -.,Perm,it,Fee'$ 1 ' .� CCF$ 20 CO/CC$
Scanning Fee$ CK3 Radon Fee$ y DBPR$ �` 7 Notary$ �N
Technology Fee$ G3 Training/Education Fee$ G Double Fee$ •5�
Structural Reviews$ 92 Bond$
TOTAL FEE NOW DUE$ 2—3 - l
(Revised02/24/2014)
Bonding Company's.Name(if applicable) Al
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State i 1 " '' a` r! 4 /.Zip-,
_ {
,
Application is hereby made to obtain a permit to do the work and installations as indicated:' I certify that no v✓ork 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.
SignaturSignature
/ OW/R or AGENT CONTRAC R
The foregoing instrument was acknowle ged before me this The foregoing instrument was acknowledged before me this
—�day of 80wch 20 16 by _�day of 20 /4 by
\
1'►a-Ca e. I 'l G,Z who is personally known to 44yV-e-L who is personally known to
Me or who has produced as me or who has produced?LTz`Zo 7- 79-11as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: � Sign:
Print: �� YvkCLIrCA- Ja r Print:
00
Seal: .'"•"'""" "" Seal:
Notary Public-State of Florida
XIOMARAAULAR ;• My Comm.Expires Sep 14,2016
} MY COMMISSION q FF 186919 o`: Commission EE 832218
EXPIRES:January 1,2019 E OP
' Bonded TAruNo1 PubicUnderwri(erc ��° :•"• Bonded Through National Notary Assn.
S3:
* *******
APPROVED BY " 'Z� l r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)