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Miami Shores Village
Building Department MAY 04 zoos
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY'
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 t ��
FBC 20!
BUILDING Master Permit No. 4?—C-q - 15 -2?-ct
PERMIT APPLICATION Sub Permit No 1(a ^ L90:6
❑BUILDING ❑ ELECTRIC ❑ ROOFING M/REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C ! � ) (��y CONTRACTOR DRAWINGS
JOB ADDRESS: 64- � W -I"1
City: Miami Shores County: Miami Dade Zip: a5l SO
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:
Address: 86 K)f-= (c)
City: �� 1540 / State: "' Zip: �J?J16
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �--�5��� �� � Phone#: S � �� 1
Address: I t ( l Vt-43E-7 �°- 1��` r�j= X03
City: State: zip: 3
Qualifier Name: Ti�� -C a L^_1—i5<1 � Phone#: 3W5 �Q� oaso
State Certification or Registration#: CCtC 05(R l 5 5 � Certificate of Competency#: o
DESIGNER:Architect/Engineer: LEIS-0,0 Phone#: 305 ?,C(S 8700
Address: (� (11 �. GOR9C.) '_-S City: 15&X
_City: FI- Zip: 351 S�
94
Value of Work for this Permit:$ Square/LinearrFF000tage of Work:
Type of Work: El Addition El Aker
terAtion ❑ New 5 Repair/Replace ❑ Demolition
Description of Work: V-Z-"Ol/G=--/ai=P(.L'C'.;—= ger5== '3 [ 000
Specify color of color thru tile: N/b.
Submittal Fee$ Permit Fee$ l CI ,qa 'JC F ( 4 • V v CO/CC$
Scanning Fee$ .�� Radon Fee$ DBPR$-- 0 , Notary$ `•l7'
Technology Fee$ LAQ-• 4 0 Training/Education Fee$ i -rrw C) Double Fee$
Structural Reviews$ o�� '�� Bond$ q
TOTAL FEE NOW DUE$ ��� •1 1
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address --�—
City _25>_>_ State —o— Zip -- —
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address r,'—'"'
City —'is'— State Zip —0 —
Application
--o --
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-sttbject-to-attachment..—Also,-a certified copy-of the-rec rdedwatice of commericemerrt-must b-epo-3te-d—at-the job-yit------
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.
Signaturel4Signa uqJA
WNER o GENT NTR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
q day of 20-1(s by day of 20 16 by
who is nPrconally known to -dm -Tel'�S(Q_ who is personally known to
aLp or who has produced_ IV K as jive or who has produced AA as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign Sign:
Prin : ifflomk Print: fflamlei
Seal: Seal:
JENNIFER MORALES
Commission #FF 77775 c��`� B'�': JENNIFER MORALES
_ c Commission# FF 77775
My Commission Expires o° My Commission Expires
A 01******* fo► S +1***DNeu�QR#�Q#* rl��** ********************* *14r "i•Y�** �L� ibY� fl �*1** **********
APPROVED BY \ �3 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)