MC-17-127Miami 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
1 7 2017
FBC20f-(
BUILDING Master Permit No.P C -
PERMIT APPLICATION Sub Permit No. 'VI c' i -1 Z.73*
El BUILDING
-
❑BUILDING ❑ ELECTRIC n ROOFING n REVISION ❑ EXTENSION CRENEWAL
(PLUMBING 1?1 MECHANICAL ❑PUBLIC WORKS E CHANGE OF f CANCELLATION ❑ SHOP
��`" CONTRACTOR DRAWINGS
JOB ADDRESS: /a50 Af. 96
City: Miami Shores County:
Folio/Parcel#: 11— 3,1o(c - ON- o 0
Miami Dade
Zip: 33) 3a
Is the Building Historically Designated: Yes NO
Occupancy Type: R'-3 Load: Construction Type: 1...v -e -t 3 Flood Zone: /I ' BFE: 1-'14° FFE:
e<►1gvlpo
OWNER: Name (Fee Simple Titleholder): �I t(?'1 bQ.0-,Q,� * Cres�o
Address: ))...S--0 /v 1 g6 64ree:t
City: i%%/Q/vvlgr?5 State: �L--
Tenant/Lessee Name: 4.44)
Email:
CONTRACTOR: Compan Name: Csknt n Me. ukctrll &c-
Address: ! == _ l 11 5t .‘5r !'c
City: filli9t/VYJ l /4C -I.. State:
n----
D)ftW C.kanirl
Phone#:
q q -9a9
Phone#:
Zip: 33/ 3
Qualifier Name:
Phone#:
305- -%s- /7) -
Zip: 33/ '
Phone#: SOS-- 3 s- / 7
State Certification or Registration #: 4G 0 '- (5 I , . [ Certificate of Competency #:
DESIGNER: Architect/Engineer: V (C ( ,J . !2)(v Cf.._-CPhone#: JUS 3(C'- S3b
O
Address: 3� 1,..16 iOt 5T/nr�+t?€ �J City: //3 41i Jco(?S State: fZ--Zip: 33/3g
Value of Work for this Permit: $ -lt 000. Square/Linear Footage of Work: /I pl.1 L
Type of Work: `" Addition ❑ fAlteration ❑ New
Description of Work: T/14-1ClTl o 11 0- net.,) dud- Woe_ + C' o r me r(*- lid 1
bo< i-oOm exGta.uSt- n 6/. ion 42)44- c&s-kr»
U_mepair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 3 \ 5` b CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ , r�
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 commencement must be posted at the job site
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.
Signature
WNER or AGENT
The foregoing instrument was acknowledged before me this
/01—. dY\
ay of / Q L30.rr' , 20 , by
IlXU`Q �4 o ,owho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
;arr %"''•. ANIELA ORZA
46. MY COMMISSION # GG 007871
EXPIRES: August 27, 2020
,,,p,;Vs °"• Bonded Thru Notary Public Underwriters
APPROVED BY
(Revised02/24/2014)
CONTRACTOR
The foregoing instrument was acknowledged before me this
/3 day of
.dew
ck. n u
,20 11-- ,by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
L 1 lans Examiner
Structural Review
1M" ANIELAORZA
•;*c MY COMMISSION # GG 007871
r-'�`� •dE EXPIRES: August 27, 2020
%S° C°:' Bonded 'Nu Notary Public Underwriters
Zoning
Clerk