REV-16-3167Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 7624949
BUILDING
PERMIT APP'`,. CATION
UILDING Lj ELECTRIC ❑ ROOFING
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: /oro Nib PO r
Master Permit No.
Sub Permit No.
RECEIVED
NOV 18 2016
FBC 2011
tb-2a53
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I/REVISION REVISION ❑ EXTENSION ['RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County:
Folio/Parcel#: At/ 7 02g. 11 6 0
Miami Dade Zip: g
Is the Building Historically Designated: Yes NO N
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):
Address: /0(0 N1 /0 5" S't"
City: Al /AM / g ItiOf C1
lot 6. /ALLW'W1
BFE: FFE:
Phone#: 36
State: ®d
Zip: r3S /3 1
Tenant/Lessee
//it6 Name: A�I I/A
Email: PALLARA .0 1SeLL sating.Nistr
CONTRACTOR: Company Name:
Ad dr s0=
OINIVEle 7 W4h.
e_4 ta, k
State:
Qualifier Name:
Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Phone# & 4' L4,4,65
Certificate of Competency #:
ANNE' �i rAl1/A� Afle lI7! C`026. Phone#: 30r6rg 0940
City:CWONUTOa O / te: F Zip: ' 3)33
Square/Linear Footage of Work:
ElRepair/Replace
Address: 63 u Stru 2 'SS r
Value of Work for this Permit: $ SOD 00
Type of Work: ❑ Addition
Description of Work: �'4 T P
1111714 aile.keNT Cotte M c / 4' N drirten ree KI!
MO if, Oc4477'ONA
❑ Alteration
❑ New
iC 6.11A
❑ Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $ —c
Technology Fee $
Permit Fee $ >"j mo
Radon Fee $
Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ e - C)
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 ottachment. Also, a certified ropy of the -recorded notice of commencementrr= Ise postedorthe fob site
for the first inspection which occurs seven (7) d•• after the building permit is issued. in the absence of such posted notice, the
inspection will 'n'ot be -pro d and a reinspect' f e will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
ig day ofn�" ((-3�, by
fLCPI Gt3;� P1/4,
-�,�wtnooiis personally known to
me or who has produced 7 .
identification and who did take an oath.
NOTARY PUBLI
Sign:
Print:
Seal:
(T -(-BUJ
**************
APPROVED BY
(Revised02/24/2014)
o�PaYpr/p Notary Public State of Florida
•Sindia Alvarez
` . 47 My Commission FF 156750
*qtr 6********
e i—
Signatu
CONTRACTOR
The foregoing instrutas cknowledged before me this
17 day of 0c40 e fi ,20 % (p , by
JO.2 A.,, 7 1, (tO 1 , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
jay" 'iz JOSE MGUELDELACRUZ
MY COMMISSION # FF 016787
EXPIRES: May 12.2017
rtt Bonded Thio Notary Public
Plans Examiner Zoning
Structural Review Clerk