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REV-17-2194Miami 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 FBC20I`� BUILDING Master Permit No. (Z., 5-3 a PERMIT APPLICATION Sub Permit NE /4 - 2-19 ❑BUILDING ELECTRIC D ROOFING ❑ REVISION D EXTENSION ❑RENEWAL PLUMBING El MECHANICAL PUBLIC WORKS J CHANGE OF D CANCELLATION El SHOP CONTRACTOR DRAWINGS JOB ADDRESS: i y Anti 9,30-S4 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): <-ci� 1 a i %.'e /11/ S Phone#: °(� Address: / ?-0? I (A) • b� )t; W\/ -� / ( City: PI / m i �Y State: rff ,7 Zip: -3 21 Tenant/Lessee Name: \J C& CGtAJA- Phone#: Email: CONTRACTOR: Company Name: L e 1 ``e 1 �Z e# tct 5</GVe hon: `3©S 310-OS1Z Address: 'k' -fl -mut) &) 51- Pak City: mi it yvt i State: P‘ Zip: 'J) Z �o Qualifier Name: -Sc V e ii1. CYO 2 Phone#$ : 1}(4 -335('- b ` State Certification or Registration #: C, e 1-b0 1q7 r Certificate of Competency #: 1 o £ em d /0 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ --)2.0(,) Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace 0 Demolition Description of Work:-� Y�-1 cpA--- v ( moi 0 01/43 Specify color of color thru tile: -1 E; Submittal Fee $ Permit Fee $ A CCF $ CO/CC $ 1 Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revlsed02/24/2014) 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 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 deliver whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemem be p for the first inspection whi h occurs seven (7) days after the building permit is issued. In the • .sence o inspection will not be appr•� ed an < . r ' pectio, fee will be charged. Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this C5 day of 'k"JOS'- ,20 t)- ,by 5O12M. CVO cAraz. , who is personally known to me or who has produced s as me or who has produced—FL— �L-. ` f- t V Zs identification and who did take an oath. NOTARY PUBLIC: i • r : TRACTOR to the person ed at the job site posted notice, the 3 day of a5JS"J ,20 %7 ,by 7177()0(e5, , who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: MAYERSIFERNANDEZ MY COMMISSION #FF991944 EXPIRES: MAY 12, 2020 Bonded through 1st State Insurance ********************* APPROVED BY (Revised02/24/2014) ** ,y %die �o A G 'Pians Examiner Sign: Print: Seal: -Fefl"n°Y° i FERNANDEZ MY COMMISSION #FF991944 r.,^'RES: MAY 12, 2020 * * * �r,S�li;�lih�ii�ilisY i4F9@ **************** Zoning Structural Review Clerk