CC-14-388 (2) Miami Shores Village RFIc ,,IVED
Building Department Au s 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2010
B IL'`DING Master Permit No. <fe--3—1 t(-3
.4
PERMIT APPLICATION sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
!1 /� J CONTRACTOR DRAWINGS
JOB ADDRESS: / � /-5 L-ze
City: Miami Shores i County: Miami Dade Zip: 33/ 3�
Folio/Parcel#: 1 I J 2��l 1�� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: "V' lood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): �(/P� �l"CJrr� Phone#: )
Address: J �i
City: /14- State: 47� Zip.
Tenant/Lessee Name: Phone#: `3
Email: Q /�
CONTRACTOR:Company Name: !�'� I/ �9�js)�ZcC%� V/� r c 'Phone Z3, 7�j3'
Address:
City: ' Stater Zips:
Qualifier Name: f*ate rJ b Phone#:
#:
State Certification or Registration �� fe I r 96" d
g Certificate of Competency#: �
DESIGNER:rArch itect/rEngi�neer:
o' Phone#:7��`/��- �3
Address: City:Aitil% 7 z State:l4 — Zip:S'1?416
Value of Work for this Permit:$ Square/Linear Footage of Work: r 61: ��
Type of Work: ❑ Addition r� Alteratioon,, ❑ New Repair/Replace El Demolition
f��Description of Work: &Xf
Specify color of coor,thru.tile:
Submittal Fee$ "" -Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ r,
TOTAL FEE NOW DUE$ •V
(Revised02/24/2014)
Bonding Company's Name(if applicable) `r♦
Bonding Company's Address _
City State Zip
Mortgage Lender's Name(if applicable) R
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.
Signature �r) Signature
'NERorAGENT CONTRACTOR
The foregoing instr ent was acknowledged before me this The foregoing instrument was acknowledged before me this
(� day of, r/vs 7G 20 by day of 20 I q by
� ld who is personally knr wn to 'D717r'g� ii'�z who is personally known to
me or who has produced as me or who has produced_DLIPAWQ 16A IG:SO as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign•
Print: Print:
Commission#FF 032722 KATYA G
Seal: •= Seal: _ a�''••, ONZLF3272]2
= 70� Expires July 2,2017 Commission#
pF rt;{�`• Bonded Thu Troy Fein Ineuma 800385-7019 's9:
' Expires July 2,Bonded Thu Troy I*I
APPROVED BY Plans Examiner Zoning
,AJ46ib Structural Review Clerk
(Revised02/24/2014)