DS-14-1490 Miami Shores Village c ,
`Eo
Building Department artment JU 2 14
CA�CEl10050 N.E.2nd Avenue,Miami Shores, Florida 33138 ,
Tel: 305 795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20LCD
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.-DS lel x`4010
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORzkX;;A0❑ CANCELLATION ❑ SHOP
DRAWINGS
JOB ADDRESS: %"U!k Ne Sly .00A M
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:
OWNER:Name(Fee Simple Titleholder): I e1E Phone#: 3=e g7L 0&�
Address: dt$o UV EM4
City:_ _ .. � State: . Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: C%E Phone#: —7er= . T .
Address: —1qt2n nAk.MNV . ZVMn AOO
City: M L41 `I -State: E7 Zip: 014,
Qualifier Name: l® ps*k1z Phone#: 5
State Certification or Registration#: Gd%e— `T262 ()Certificate of Competency#:
DESIGNER:Architect/Engineer: Wl PAZ.W,. -52 OEM Phone#: 's
Address: A-SQ1_ City: MAW State:qL—Zip: 3-31
Value of Work for this Permit:$ 10010 Square/LinearrFF000t'age of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New E!r Repair/Replace ❑ Demolition
Description of Work: 1j2RQ-,4Ljri
Specify color of color thru tile:
Submittal Fee$ 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)
4'
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 fo Irq ildr�j 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 J "4Signature
OWNER or AGENT C ACTOR
The foregoing instrumentas acknowledged before me this Theforegoinginstrument as
acknowledged before me this
f ay of e— 20� ,by day o 20 , by
0rcr whojs personally known to Get? w o is personally known to
me or who has duced 4A-` 6AYas me or who has produced �'f as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB IC: NOTARY PUB IC.
Sign: Sign:
Print: Q z- Print:
1111"� �'.Pa Pie' ALFONS A.Jt E EZ
Seal: Al ALFONSO A.JIMENEZ Seal' _ Notary Public-State of Florida
+ Notary Public-State of Florida + »cc My Comm.Expires Jan 2,2017
r •5
9re o oQ My Comm.Expires Jan 2,2017 �IFOFF��p� Commission#EE 862114
'„OF II- "111111111
111111, Commission#EE 8621
*
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)