PL-14-2023 Miami Shores Village
� � ' �'
Building Department I SEP 16 2014
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 I
C�Y Tel:(305)795-2204 Fax: (305)756-8972
INSPECTION LINE PHONE NUMBER: 305 762-4949
FBC ZO LO
BUILDING master Permit Ivo. 0-44 —54-1"1
PERMIT APPLICATION sub Permit No. PL Iq— .2.o?s
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [:]RENEWAL
/ LUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
DRAWINGS
JOB ADDRESS..
City: Miami Shores County: Miami Dade Zia:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): S)CM .t1a1 �.5'l�t i l Phone#: 3W_71%0 08BY
Address: -WE Z= -A aD
City: N 7 State: , Zip: :33138
Tenant/Lessee Name: Phone#:
Email: t
CONTRACTOR:Company Name: REe ' �P ��— �f�'k�j,'1
Address: /Jl,/
City: !�66 I�,/ y State: TG— Zip: 1331
,)h
Qualifier Name: 647 a /0 7 Phone#:30 '�7 A
State Certification or Registration#: 012� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 0& 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$ Permit Fee$ � JO.x 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)
e
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 IMP OVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YJMtm� 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 bsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature ute, Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument as acknowledged before me this The foregoing instrur,� nt was acknowledged before me this
day f 20 by �7 day of ( 20 by
l� who is per Wally known to ����2,� ,who is perso nown to
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.
NOT*PT: NOTARY PUBLIC:
Sign• Sign•PrintNwe z- Print:
Seal: Seal: ?o��"."'��iRAMON0.CEULLOS
O�PHY PV C��i ALFONSO A.JIMENEZ * Ooo
* MY COMMISSION NFF 060780
.r• timet
+P` Notary Public-State of Florida r EXPIRES:October 7,2017
My Comm.Expires Jan 2,2017 +,E eomkdThruBudIONotar�rS Iq
;tdZue� a** ee**
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)