SGN-14-600 C
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Miami Shores Village f
Building Department ;
I 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax: (305)756.8972 1B Y°• -
INSPECTION'S PHONE NUMBER:(305)762.4949 ------
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BUILDING Permit No.
PERMIT APPLICATION Master Permit No.<3_n" I Ll (000
Permit Type: BUILDING ROOFING
,) dOB ADDRESS: 9 8k N E d'd A ve
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER:Name(Fee Simple Titleholder): 1" 'io m; J 6r, CCn+r - L.LC Phone#: 305 - 8b4 -8885
Address: 110 71 "+ S+ A 3 0 9
City: a State: "�L. Zip: 3 1*1
Tenant/LesseeName: r° +; 1" ro b! t kkn M 4 LLC Phone#: 305'7079-5
Email: e.orge G,mp5;r\yo- ll ars . Gom
CONTRACTOR:Company Name: Phone#:
Address:
City: State: zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ Square/Linear Footage of Work: �• �n;�ff..
Type of Work: DAdclition ��AIteration ❑New ❑Repair/Replace ❑Demolition
-,*Description of W6rk:^ 4. / ;.A d+ of 400?- oka d wind w t?
l,.M5 `. 6 h,kl ran -
Color thru tile:
***************************************Fees********************************************
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$4H f)7)
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 ELECTRICAL WORK,PLUMBING, SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this 25 The foregoing instrument was acknowledged before me this?-5-
day of t Ai-CA,201�L,by day of MYWA4 20 a,by ?ArAteL
who is personally known to me or who has produced who is p=seaa lig k aow*+to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
'NOTARY PUBLIC: NOTARY PUBLIC:
4
Sign: /r Sign: �
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Print: ,ls - � Print: ((,O/9£J -Y JC1
My Corlmission xp rP`e`: RICARDO IRIARTE MY EX00ARDO IRIARTr:
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�y�y� MY COMMISSION#FF088736 - {�y�xyMY COMMISSION#0088736
't;F' dF EXPIRES February 2,2018 ?oAo?:' EXPIRES February 2.2018'
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised /f' 012)(Revised 07/]0/07)(Revised 06/10/2009)(Revised 3/15/09)
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