REV-16-1217514(16 i s
Miami 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) 762-4949 Ing(
FBC 20t+
BUILDING Master Permit No. iF —// /S"--Zr99
PERMITAPPLICATIOI\Iii{J i r / Sub Permit No. ll�`(1°�
❑BUILDING D ELECTRIC ❑ ROOFING 'REVISION ❑ EXTENSION ❑RENEWAL
MAY 0 6 2016
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / O 9T% /✓S 92 Tb -f /
City: Miami Shores County: Miami Dade Zip: c33/ad' •
Folio/Parcel#: //-32,05:-027— 09/ 0 Is the Building Historically Designat4kYe a h:) 1NNO %.---'--°
a
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
•
OWNER: Name (Fee Simple Titleho1dd ) �'!/f 2 view f4/ L Le Phone#:
Address:
CIO/ /1/kV ,P
City: ^1/01,14,/
State:
Zip: J3O/(S-' .
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: '76 W $W /341 G�
Phone#:a0S^ij23-5/
City: jt4 /a <''u State: a
Qualifier Name: /4 / awe/ PaGtrD1-2
Zip: (, / d'J
Phone#:
State Certification or Registration,#: C.; c... C., /yZ (4 1 -Certificate of brtt cM
DESIGNER: Architect/Engineer: he -
Address: City: State: Zip:
Value of Work for this Permit: $ / 5-72
. n o
Type of Work: ❑ Addition ❑ Alteration
Square/Linear Footage of Work: fl O
❑ New
Description of Work:
77 sh 0 w R Daifu 104/x'&21 (57undaAice /22O/1z9 ops
2 Repair/Replace ❑ Demolition
Specify color of color thr'ui
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC$
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
DBPR $
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 oftherecorded7ratice of commencemerrt must be post-eePt the job7sife
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.
GENT
The forgoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of / / ! ag 20 7 • , by X day of /11.441, 20 clay
J ,P7t �`l PP.1S l , who is personally known to / // •!hb is personally known to
Signature
CONTRACTOR
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
***********
CRISTOBAL GARCIA
4: MY COMMISSION # FF974867
-r • EXPIRES March 24, 2020
•4b.
007)3984183 FtorldallotarySerrka.cam
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
.�s111 •
*********************
APPROVED BY Plans Examiner
Structural Review
(Revised02/24/2014)
CRISTOBAL GARCIA
MY COMMISSION 0 FF974867
EXPIRES March 24, 2020
398-01
03 FloAdtNofny9wlp oenl
Zoning
Clerk