REV-16-2770 Miami Shores Village [DECEIVE®OCT 13 2016
Building Department '
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Jka_
Tel:(305)795-2204 Fax:(305)756-8972 T
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201V
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.? ._.v(
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 33' A)6 c::�K3 V
City: Miami Shores County: Miami Dade Zip: 313
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: _f Flood Zone: BFE: '76'e
FFFFE:
OWNER:Name(Fee Simple Titleholder): yC4 Cmd f*ia u(QS taCU d 0 Lx t,(� Phone#: 20� `6 o �%-s
Address: ',7'0 AI `:3 P t
City: State: fL Zip: 3-2713�C
Tenant/Lessee Name: /� Phone#�U S— 6 Uy —y C'/ 6 j
Email: �C(Tc ( d�/yrl v 1� �aMq, I• l.0 �lil
CONTRACTOR:Company Name: ����C� YT(Z 4 L-TOlZ f CAP Phone#: 30 S IL/1l
Address: q1vo w (3_ dr 77- __�_a�
city: — T "'g f State: L zip: 331 Sy
Qualifier Name: lay'2" Pe"- 3 19u"i-aeQl Phone#: 3a5
State Certification or Registration#:C6C '1 ZZ 6 3 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City State Zip:
Value of Work for this Permit:$ e--1/ Square/Linear Footage of Work: q ST f
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Re//pair/Replace ❑ Demolition
Description of Work: !Z'
Specify color of color thru tile:
Submittal Fee$ Permit Fee$_ t{ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ . �� DBPR$ 2• C •'3 . Notary$ 5
Technology Fee$ Training/Education Fee$ r • 0 0 Double Fee$ -49'
Structural Reviews$ Bond$ 46r
/�
TOTAL FEE NOW DUE$ V 1 D40
(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 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.
Signatur _V"h� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before m this The foregoing instrument was acknowledged before me this
day of-07M � 20 .by day of UgW— 20 ,by
���5 I������(�"��-w-Figs-iersbonally kno�w/n(t�{o�������- �� o is personally known tQ,
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB I NOTARY P LIC:
Sign: Sign:
Print: f n _ Print: o
Seal: Seal: ragDL�QvExpires
ary Public State of Florida
dia Alvarez
�pPr a�® Notary Public State of Florida Commission FF 156750� Sindia Alvarez "°r 09103/2018
° * M Commission FF 156750
APPROVED BY l` Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)