REV-16-1529 Miami Shores Village
Building Department ��N o 18
10050 N.E.2nd Avenue,Miami Shores,Florida 33138183 Y_
Tel:(305)795-2204 Fax:(305)756-8972 --
INSPECTION LINE PHONE NUMBER:(305)762-4949 -'L
FBC 20Ns�
BUILDING Master Permit No. Sep k I
PERMIT APPLICATION Sub Permit No.�V I (oI�2�
ER6I1-DING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ]RENEWAL
[PLUMBING ❑ MECHANICAL [PUBLIC WORKS [] CHANGE OF F-1 CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: S�
city: Miami Shores County Miami Dade Zip: 28
Folio/Parcel#: V -a2-ars - S Z`60Is the Building Historically Designated:Yes -;NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): T:)Ccri+ Sn ii )n Phone#: -1'&g Ze-1 a b'32fe)
Address: 3% 101
City: In ry,w SIoretS'_, State: F=1..,_ Zip:
R,
Tenant/Lessee Name: rQ Phone#:
Email:
CONTRACTOR:Company Name: 1.2LMInd--A P'ois i rpt_• Phone#:°
Address: `)aoo Fj &j as --14- [lam',
City: State: �i3nC:)- Zip:
Qualifier Name: Phone#: �C� `�• �`�7�
State Certification or Registration,,#: (2L�3)G.1 d45C oC'tCertificate of Competency#:
DESIGNER:Architect/Engineer: ti-Jgn -I e% Phone#: -1057-,'50-Spl�$�
Address: 1 _4S z4Z4 1 2-9 :W-ry • City: �41,-,13c� State: T- .- Zip: 17l
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ q Permit Fee$ 1 QC) CCF$ ` (On CO/CC$
Scanning Fee$ 1 Radon Fee$ 24� DBPR$ Notary$
Technology Fee$ I Training/Education Fee$ Double Fee$ :--
Structural Reviews$ Bond$
�P
TOTAL FEE NOW DUE$ I
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address 1
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address M 1
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 reins ection fee will be charged.
Signature Signature
OWNER or AGEN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 I by day of M 20 140 by
�-t} Swii'�1n who is rsonally kno to �1� who'is ersonally known o
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: f Print: "ar
Seal: Seal: *` A MMTIr
q� f *= MYG01 JL_
MIARCGS A.MAn rjEEZ = oS.Ui%r I F 0JR98
I_+ MY GO��h'�SS�CN FF 008969 f - B EX, 14�a ;V;a;� ,5,2017
EXPIRES:f iaV i 2017 a Thru hb(ary Pwnli;UndenvMe�
APPROVED BY ' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)