REV-17-106 Miami Shores Village
Department ����c�� - '-- -
Building p JAN 1 3 »17
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 20
BUILDING Master Permit No.RC`l®-/6 2993
PERMIT APPLICATION Sub Permit No. 9: v lq - tc(P
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING M MECHANICAL DPLIBLICWORKS F-� CHANGE OF ❑CANCELLATION ❑ SHOP
J �/ �*, CONTRACTOR DRAWINGS
JOB ADDRESS: 0 2 /� dY F °7--4- /h 'f® , eer
City: Miami Shores County: Miami Dade Zip: 13 L,3
Folio/Parcel#: 1/3Z ao —06/ -3 0 70 Is the Building Historically Designated:Yes NO
Occupancy Type: SF/2 Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):
d/l)ke�' r ������ Phone#: 301-3-*3 '���
Address: �� N/-t9�� rree7- /�
City: m l C m/ jh®rel State: P-1- Zip: .33 D e
Tenant/Lessee Name:: Phone#:
Email: I/I.rdC ov /,V/Gi�0�7d/'.e 160" -
CONTRACTOR:Company Name: �/-U4�
!®
91—UE C (CA t Phone#:_730-15-5-10 13
Address:
City: ttC A tLe [ State: �Z Zip: 33 (t33
Qualifier Name: �o s-g E Pt)72 Phone#: 30.5- Yid �/-346,�
State Certification or Registration Me fa f3or1Y .� Certificate of Competency#: ll E®oo oo .a
DESIGNER:Architect/Engineer: Phone#:
Address: / City: State: Zip:
Value of Work for this Permit:$ <'j �0 Square/Linear Footage of Work: 7
Type of Work: ❑ Addition L Alteration ✓❑`New • ❑ Repair/Replace J ❑ Demolition
Description of Work: l r /1 � c �i�(N��7 1"® ODS' ,(��r® � 2
ai/.�,
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 062 CCF$ 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 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 R or AGENT C RACTOR
The foregoing instrument was acknowledged before�me this The foregoing instrument was acknowledged before me this
day of--t-Cl 20 1( by Z") day of MtN447j011 20 11 by
V In(nn+ L*N0 s personally known to� •s C ,7y kpJvlB who is pe�sonallpe��yknown to
me or who has produced f'�PS7�1 ,. 3 as me or who has pr duced as
identification and who did take an oath. identification and wh did take an oath.
NOTARY PUBLIC: NOT4RYPULIC:
Si Sign: /
Print: •;v...k MAHARpJKGONZALEZ--flSSteN 0 GG 944602 print �/7
•'�`� EXPIRES:November 2,2020
Seal: b
`-� • Seal:
QF�o? BondedThruNotaryPubllcUndetwrtterS p� B�� ILIANAALVAREZDELACAMPA
* * MY COMMISSION K FF 943556
EXPIRES:Match 6,2020
APPROVED BY !V&' *1/�' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)