RC-15-2874jz.q s -287y
PERMIT**
‘S- 2c--6-1-1
CONTRACTOR: $\L-� c Q L_
SUBMITTAL DATE: 11 11-3 ICS
ADDRESS: 1
1'3 '-.°"1 'S. -"r
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
cu,Do(L. 36k5" --K
ZONING
PLUMBING
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STRUCTURAL
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1
MECHANICAL
ELECTRICAL
Dla 119f
BUILDING
PERMIT # T2c.6- 2 -IL-+
CONTRACTOR: -NL=F (4-_--;1caA."�
SUBMITTAL DATE: 1 1 1 !S \ tS
ADDRESS: 1 o--('-3 1
NAME:
RESUBMITAL DATES:
PROJECT TYPE: cl__0011_, 36i5'i
ZONING
PLUMBING
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STRUCTURAL
MECHANICAL
ELECTRICAL
\DU i 19f *4'''-
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION UNE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: 3 Nu 1 O' 3 Si
City:
NCV 13 2015
FBC2011
Master Permit No. RC -a 1 2819
.kb Permit No.
❑ REVISION ,XTENaSION
❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
❑RENEWAL
❑ SHOP
DRAWINGS
Miami Shores County:
Miami Dade Zig:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder):SRP / 1S SOD I lcL-1 g
U l�
Address: a'` �.) 9F► C,r--E JZ.
city: I -F Loud eg-clai
State:
BFE:
NO
FFE:
: SQ -c - SS ( C
FL
Tenant/Lessee Name: Phone#:
Email:
t,I41,1((1
CONTRACTOR: Company Name:1j /41/ 1c C .
Address:* -1 00. 5 Vv 12. �-
City: l 1. ( Q 1 State; F Zip:
Qualifier Name: 1 FRC a r t.z . I? --O 5 Phon 0C
na V7
State Certification or Registration #: ( Q. 1 S 10 Certificate of Competency #:
Zip: 33309
16cs
Phon
1s0 523 cr3oy
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $ 5 e 0 00
Type of Work: ❑ Addition D Alteration
317(0
513 4oq
Phone#:
Stat: Zip:
Square/Linear Footage of Work:
D New ❑ Repair/Replace
Description of Work: 'in all 3 0I.sk s Or) glooc
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ ® Permit Fee $ 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)
•
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 estim
promise in good faith that a copy of the notice of commencement and construction li
whose property is subject to attachment. Also, a certified copy of the recorded notice
for the first inspection which occurs seven (7) days after the building permit is issu
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
Signature
value exceeding $2500, the applicant must
w brochure will be delivered to the person
mencement must be posted at the job site
the absence of such posted notice, the
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrumentnwas acknowledged before me this
day of ! \ , 20 )S-
, by el day of ,�Ot ob i L , 20 15 . by
1 Ckr ,(, gcrt- '�® , w o is personally kno % >� lS ��=�r'c'7✓ Driver
is personally known to
me or who has produced as me or who has produced 4 1 D l er l -i - as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign: \'N
Print:
Seal:
Sign:
-_ = print:
NADINE AUSTERFIELD
Notary Public - State of Florir]§eal
My ccmmiaeion Expires Plov 7, 2017
Co,ItmI:tsion s:` FE 5:351
APPROVED BY Plans Examiner
(Revised02/24/2014)
Structural Review
MARISOL HIDAL 0
MY COMMISSION #FF023893
EXPIRES June 4, 2017
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