EL-16-2146 Miami Shores Village
Building Department JUL 2 g 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 —'-
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20N�
BUILDING Master Permit No. �
PERMIT APPLICATION Sub Permit No.
❑BUILDING CK EL ' I G ❑ REVISION RENEWAL
LA I
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELSHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0-6-3 y '6 a_T
City: Miami Shores County: Miami Dade Zip: _:33/ 30
Folio/Parcel#: 1/.AZO Gam® /,42-9 2!® Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): g Ai2;;e_-1V14-A)-0AZ Phone#:
Address: 95.3 y,6F 96 s 7
City: X,'14 rel/ Ali adp-S' State: /c7J Zip:
Tenant/Lessee Name: ��� Phone#:
Email: l
CONTRACTOR:Company Name: 1,1A 9(/ JIP ,—PZ_E7-G772 A:�_,-.7-4)Or-- Phone#:
Address: A2-
City:
2City: "fze-x� l State:�� Zip: �-1/7
Qualifier Name: Xie x� wo 41� � Phone#:C�®5 ��ie
State Certification or Registration#: 30e!5��ep" / Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ /,3Oa Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition
Descri tion of Work: �//��� . �/Tt/��'7 Dl a 2® e-co
e
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ Z,//®O CCF$ CO/CC$
Scanning Fee$ " 013 Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ 0° 40
0 Double Fee$ SCJ
Structural Reviews$ Bond$ r7l
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,perrhit and that all work will be pe d t Be4ti, t�1��d' ards of all laws regulating
construction in this jurisdiction., f urld0'sta'Odl that a separate permit must ct # _ L PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, F�. ITf:RS;'?ANKS,AIR CONDITIONERS, ETC.....
_J
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 approv and a reins ctior fee will be charged.
Signatur Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument as acknowledged before me this The foregoing instrument was acknowledged before me this
/ day of c/I 20 by day of r�c/ .ri € ,20 / ra by
who isp Y ersonall 'known to who is personally known 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.
NOTARY PUBLIC: �t111lIfllyls NOTARY PUBL
Adbl0�o,��o
Sign: Sign:
Print: =�•� o�� �e = Print:
9'
"JZ�:a; _ ELVIS BAYONA
Seal: y s OM,axcs ��v Seal: my conNusslorr#>r21ns2
////*••:,d�dX3��.•' S�ay�� ��Qa° EXPIRES:July 11,2019
Vb
APPROVED BY � �!!��/� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)