REV-17-1940lq
rc°
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
RECEIVED
.410113 t art
5'n
FBC 201
BUILDING Master Permit No. pc - .5-- 3
PERMIT APPLICATION Sub Permit No. 9 -NEN R - 10)U
❑BUILDING ❑ ELECTRIC ❑ ROOFING (REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
At
(A1 CONTRACTOR DRAWINGS
JOB ADDRESS: 7� ' .(W % 9j sT
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): £'t /-e. i`Z; TeX_ /& /j' 'T 5 (aphone#: fv - 55-9--S-49
%
r. 0 Y3 0� 53 .--i -2- '� �`1—� 6 1 4
Address: �+ c,�
City: *t l ck) € State: f Zip: 3 6-d d
Tenant/Lessee Name: Phone#:
Email: je.1(4 . f9//rj1 aoD S ®1 ^ c eem
CONTRACTOR: Company Name: a �4Y7L' (,1 be x Willa (ace. Phone#: 6 -3 s ---y y6VVC
Address: 9/7 Inca be 1—e c).“ 41 ur4 36 '"-
City: (01, r ce 1 e,c State: FI Zip: 3 3) 34
Qualifier Name: e 4 Grn. AD Ca SGn LJ' LiC. Phone#: "3.%1 —6Z)6
State Certification or Registration #: 6.6C /S/ 7 Z'i
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 comme, . ent must be p ted at the job site
for the first inspection - occurs seven (7) days after the building permit is issue : n the absence of suc - posted notice, the
inspection will not be '%ppro ed ana�a reinspection fee will be charged.
OWNER or AGENT
Signatur
CONTRACTOR
The foregoin instrument wasjacknowledged before me this The foregoing instrument was acknowledged before me this
:3f day of �%/ , 20 /7 , by 3 J day of 01 , 20 1 7 , by
27 C 5 , who is personally known to a 1'6:4/ ' , who is personally known to
me or who has produced L as me or who has produced t L. as
identification and who did take an oath.
NOTARY PUBLIC:
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
4000.1111.111111
•
MAYERSIFERNANDEZ
MY COMMISSION #FF991 944
EXPIRES: MAY 12, 2020
Sanded through 1st State Insurance
************************
*
Sign:
Print:
Seal:
APPROVED BY 161/1
Plans Examiner
MAYERS! FERNAND Z
MY COMMISSION #FFs :1944
EXPIRES MAY 12, 2020
tau tixxough let State Insurance
Zoning
Structural Review Clerk
(Revised02/24/2014)