REV-17-501 Miami Shores Village
RECEIVED
p
BuildingDepartment
FEB 2 7 W10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(305)756-8972
c�3�D INSPECTION LINE PHONE NUMBER:(305)762-4949 ']-
J FBC 201y SA
BUILDING WMAM Master Permit No.1G –%)
7BUILDING
IT APPLICATION - Sub Permit No�yI1 —:501
❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
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CONTRACTOR DRAWINGS
JOB ADDRESS: L-
r
City: • Miami Shores County: Miami Dade Zip:
Folio/Parcel#: l zo(lo ( 33� Z� Is the Building Historically Designated:Yes NO
Occupancy Type: \1�1�>Load: Construction Type: �J��i.� Cod Zone: BFE: FFE:
/
OWNER: Name(Fee Simple Titleholder): I ��P_S�'� U/yU,p.-f✓?/�tJ Phone#: 7�
Address: JV 3 N
City: State: Zip: �3 I3
Tenant/Lessee Name: �P( Phone#:
Email: /� G u [c
CONTRACTOR:Compan Name: 6-L*-a, qim Grp ,orT Phone#: t 1 I�JS.� 3W7
Address: )-3t:. c�`CCrT Nc Lz-
City: c State: Zip:
Qualifier Name: VC J, 614 ,111- Phone#:
State Certification or Registration#:-_ G� (SZ 30�y Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition r Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:_ ( �4�i ,+.--�,a; �i; u , Iu��-i-vd,tec�i•nrr nom-•
Il 7F?11}S 1�
ell
�i'
Specify c+plbr,0 r t'h" dile:
5.^
Submittal FV" to ° Permit Fee$ CCF$ M Co'/CC$ -
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding'Corhpany'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. E.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR 2PROPERTY. .IFYOU 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 inspectio ich occurs s (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will ve nd a reinsp tion fee will be charged.
gnat re _ Signature
OW r T CONTRACTOR
The foregoing ns ment was acknowledged before me this The foregoing instrument was acknowledged before me this
X17 day of 20 7 by by
/ �day of 20 �)
_ @L'QH4j'S�who is p^ er_sonally known to /SGC. �": f'�'-- w�h 3 " er-stagy .own
me or who has produced as me or who has produc as
identification and who did take an oath. identification and w o /takeath.
NOTARY PUBLIC: NOTARY PUBLIC:
C
_2�_
Sign: Sign:
Print: Print:
Seal:
EIAZASETH ELORRUkGA Seal: _
:..
MY CONIUM ON 0 FF9S3= A OldswN
• Ce W 1 G6�J001
�4w►�i9e-0•a� EXPIRES January 25.2020 s " 21,2Gl0
oo�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)