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MC-17-1870 (2)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 BUILDING PERMIT APPLICATION ❑BUILDING 0 ELECTRIC ❑ ROOFING PLUMBING MECHANICAL DPUBLIC WORKS Master Permit No. Sub Permit No. RECEIVED JUL 201011 FBC 20N 12C -18(0 nuc -iR1-O ❑ REVISION ❑ EXTENSION E RENEWAL ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: \ L (v S S# City: Miami Shores County: Miami Dade Folio/Parcel#: i ©� — ®�- �— Q'i & Q Occupancy Type: Load: Construction Type: 9,e51 de/it-Flood Zone: OWNER: Name (Fee''Simple Titleholder): N �t �L �S C �- Phone#: �� �' & - �' Q Address: t ZI IV 5t City: Nt a&t S'c(Le `> Zip: 3 3139, Is the Building Historically Designated: Yes NO V BFE: FFE: State: FL Zip: 331 3 Tenant/Lessee Name: Phone#: Email: S1C^� e R C�'�� I �ogib., Phone#: CONTRACTOR: Company Name: PI CI Address: :3)(3):4-1 Sw \Ai AVC. kA 1100 City: O`v' 4' State: r L Zip: 1 b-2-) 1 1 GOC oIJ, Phone#: State Certification or Registration #: CRL \ 415 1 5 C. Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: an Value of Work for this Permit: $ 1 0 O . Square/Linear Footage of Work: 1 L 0 Type of Work: ❑ Addition 'X Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Re- COC-cLi kc, 1`\ K t N i Qualifier Name: - 0. rJ tu,c,two IC_ Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO/CC $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ 132. b-0 Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 334 ° 50 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 I .l r AGENT The foregoing instruJ mo'' �as acknowledged before me this j l day of � , 20 1 7 . by aitcd - !) ac C3; who is personally known to_ me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: tA. 61/441 l N �° Print: MCA.C.144 Seal: dig 1* MARiP4rd HADIUVICH •. a% s MY COMMISSION # FF 912304 y ''..g EXPIRES: December 23, 2019 Rf * *, Bonded Thru Notary Polio Underwriters ******************** APPROVED BY (Revised02/24/2014) Signature k A c‘i COi-T''^'CTOR The foregoing instrument was acknowledged before me this 11 day of . J , 20 J- . by Jk 0. tJ 6-0 g o � , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Cl R, Al L QQGLL/ G4\ Print: 1 "l Cl 91 Seal: aminer Structural Review *4� A ,40A-1; MY COMMISSION # FF912304 E,XPIRES: December 2019 ? Bonded Thru .Notary a tac Underwriters *********************************************** Zoning Clerk