MC-14-1788 Miami Shores Village c-FivFD
Building Department AUG 15 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel: (305)795.2204 Fax:(305)756.8972 ��'
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 LCO) g
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: MECHANICAL
JOB ADDRESS: �}
City: Miami Shores����ee�� County: iami Dade Zip: .n(3l k3
Folio/Parcel#:1 0.2 IJ 136- 3- 05HO
Is the Building Historically Designated:Yes NO I Flood Zone:
OWNER:Name(Fee Simple Titleholder)& A�t?)UWA Phone#:%b am— b,2y l
Address: 131 NW 110 &.
City: M=Q& to _QQ State: Zip:
Tenant/Lessee Name: 1=1 cg Phone#:
Email:
CONTRACTOR::Company Name: EoLlyi r;1 Phone . --
Address: !®125 w w i i b \.AiAy aI Q n
City: elu5l State: Zip: 1
Qualifier Name: Imo'AN,% V e Phone#: L
State Certification or Registration#:� I I I(aL4 Certificate of Competency#: ` ,�
Contact Phone#: Email Address: �t
1�[ � ,j o.► Q Irl
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$66 go slug ork:
Type of Work: ❑Address ❑Alteration ONew SepairlReplace ODemolition
Description of Work: _
�7CCF
Submittal Fee$ Permit Fee$ ti to $ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ pp
TOTAL FEE NOW DUE$ 1 a
Bonding Company's Name(if applicable)
Bonding Company's Address
City State I ED Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City S ate 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 inforjnatiorJ4 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 Signaturesk Vo 4
"VA6
Owne Ag t �� ��--- Contractor
The foregoing instru ent s ckno ledged before me this The foregoing instrument was acknowledged before me this
day of ,20,� day of ,20]4by MMIL ME3alEU -
who is personally known to me or who has 3roduc d L who is so y know me or who has produced
:a
gAr,
NOTARY PUBL -�. ' MYCOMMISSION#EE026451 ,�t gY Pu� ano►3ACITA:F2"51
��EXPIfdES Septei7fber 15,2014 1�TOTARY PUB I '. NAY ON#80153 rv1e�.com o EXP1am2014(AD7 3 F 'I
Sign: Sign
Print: Print:
My Commission Expires: � �� � �1� My Commission Expiresv
6 /
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APPROVED BY f2l1 Plans Examiner Zoning
Structural Review Clerk
Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)