REV-17-1321 Miami Shores Village 2
AY 2017
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Building Department
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138 --- -�®-- --
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 9-t4
FBC 2011
BUILDING Master Permit No.f::k) I -I -:�- — q q
PERMIT APPLICATION sub Permit No. kPV 1_1- 13 21
BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
F_JPLUIMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Z�( Z kjL q 3,4--
City:
,4--City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: d
OWNER:Name(Fee Simple Titleholder): \%A I�C,\ A Phone#: .0S 'C/q(1 _ 6 S l
Address: 1 ,C1 (l.� V L q
City: ,"'l{�+� 'ir'e SISState: C7-C, Zip: 3 3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 4c) ®(1�1�`�r Phone#:
Address:
City: State Zip:
Qualifier Name: Phone#:
State Certification or Registration M Certificate of Competency#:
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 IE6 Repair/Replace ❑ Demolition
Description of Work: I t\ 0 '`"-� -e—
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Specify color of color thru tile:
a�
Submittal Fee$ N Permit Fee$ ` 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)Ch)ch occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a pr eRng'areinspection fee will be charged.
SignatureZ Signatu
61-1
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instru nt was acknowledged before me this
day of 20 1- by day of 20 by
i •t'• (A who is personally known to _Xis personally known to
me or who has produced 1D. V%V'Qf �c c°QnS'� as me or who has produced as
identification and who did take an oat identification and who did take an oath.
NOTARY P ELIC: NOTARY PUBLIC:
2
Sign: Sign:
Print: )`Q Print:
Seal: �, Y myPRIET Seal:
MYCOMMSSIONOFF214031
ES:March 25,2019
Bonded Thru WWW Puma Unde wribru
APPROVED BY �" I — 1Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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&NCf?UACHMENT NUI&S:
A NORTH SIDE OF THE SUBJECT PROPERTY,BRICK DRNEWAY IS ENCROACHING INTO
® THE RIGHT OF WAY OF NE SSM STREET AND NEIGHBOR'S CBW IS ENCROACHING
8 WEST SIDE OF THE SUBJECT PROPERTY,IRON FENCE IS ENCROACHING INTO THE
ALLEY.
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