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RC-14-425 Miami Shores Village ICE' VFr) ° Building Department JAN Ia 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 My_� _ INSPECTION LINE PHONE NUMBER:(305)762-4949 ---"" FBC 20 BUILDING Master Permit No.PC - 114 425 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 1`1 � �gV�• 6tA— City: Miami Shores County: Miami Dade zip: Folio/Parcel#:11 - 2136 - ( - 6)1 21 Is the Building Historically Designated:Yes NO X Occupancy Type:_R Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): R VAJ P FMIY 501,0t-104hone#: 505-907- 4045- Address: 840 N F. ZW ky- City: MIAMI -5kyres State: Zip: 331 38 Tenant/Lessee Name: Phone#: Lj Email: nn �^ tG 4" e CONTRACTOR:Company Name:ytrl 7wdi'I0J5tM)(,D_Qt�.,j#Shone#: �;t) -�,1�'y29g1- Address: 4-700 !! UW 172 0,4-- City: M l aM 1 State:_ Zip• 3?Z l'D Qualifier Name: M All o f-hm k-!2 A. Phone#: 3©t5 24t V- State Certification or Registration#: Certificate of Competency#: CGC 5 O 9 �¢�✓ DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition obescription of Work: �ZWYX ld/Fo Specify color of color thru tile: Submittal Fee$ Permit Fee$•�� Vim! CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ a) (Revised02/24/2014) r Bonding Company'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. "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 Signature 0 NERorAGENT CONTRACTOR The foregoing instrume t was acknowledged before me this The foregoing instrumen w edged before me this ��day of 20 ,by c,V day of 20 by 157 who is personally known to U ✓ ho is personally known to me or who has produced as me or who has produced as identification and who did tak an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ►off, Notary Public State of Florida Notary Public State of Florida Maxine Y Gomez Sign: M ign: r� My Commission EE 839239 '7�4 My Commission EE 839239 or po Expires Print: 'torwo'E Expireso9/3 /' rint: Seal: Seal: *ss**rs**r**************�******* **r* ***''*nn•*r**r*r******************r********s***********s**rsr**«#**s***** APPROVED BY ` NV Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,SNOR ES p� Kc. Miami shores Village Building Department �ZORtIDp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.KC 14-if-6 Owner's Name (Fee Simple Title Holder):914MI Fl-9 50L PDA5 Phone F07-404V Owner's Address:%4 0 Ae 2"k AJ E City: (fir I/4-M 1 cjbQ CZ;S State: � Zip Code: $ Job Address (Of where work is being done): 109W !Jl�•' City: Miami Shores State:—Florida Zip Code: Contractor's Company Name: 607 Fl L2T { N G Phone#: 194 Address: 3841�ii tAW JV IN, City: UI 94 t N L A e4AXP F- 5 State: F-t- Zip Code: 3-3, 1 &6 Qualifier's Name : lYeF ,.E_ (., l4NtQ jTLel ZZa Lic. Number: CQC i5 1241a(o Architect/ Engineer of Record Name: T ak Al k) tWE Sal Fi Phone#: Address: City: State: Zip Code: Describe Work: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal ' volvement. Signature Signature Owner or Agtaknowledged Contractor or Architect The foregoing inst ument wa befoWill/- The foregoing instrumen was aknowledged befor me y J this day of ,20�by this�_day of , 20t5by Who is personally known tom or o has produced who is personally known t me or who has produced as indentification. as indentification. Notary Public: Notary Public: Sign: Sign: Seal: �er „ Notary Public State of Florida Seal: K4pNotary Public State of FloridaMaxine Y Gomez e Y GomezMy Commission EE 839239 mmission EE 839239 orfloExpires 09/30/2016 Og/30/2016