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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 p� 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)