PL-17-128BUILDING
PERMIT APPLICATION
II
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 n ELECTRIC n ROOFING
PLUMBING MECHANICAL
PUBLIC WORKS
JOB ADDRESS: P.S 0
City: Miami Shores
Folio/Parcel#: /1 3),06-0)11- 39 00
Occupancy Type: A-3 Load:
REC Ell TV
,1AN 17 2017
BY._ 4.--/
F BC 20 CL -t
Master Permit No. C U LS
Sub Permit No. e k
n REVISION n EXTENSION (RENEWAL
n CHANGE OF n CANCELLATION n SHOP
CONTRACTOR DRAWINGS
County:
Miami Dade
Zip: 3133
Is the /Building Historically Designated: Yes NO
[�
Construction Type: veJl 3 Flood Zone: 4i BFE: +9.0 FFE:
OWNER: Name (Fee Simple Titleholder): 46ft( 1- rna�o�n (resp0
Address: 12-5° IV ti q6, Shred
City:
Phone#: q.57% 9)5/--5353
"oi iii c5hoState: �L
Tenant/Lessee Name:
Email:
4-:
CONTRACTOR: Company Name: JOS `fern 'FLw
Address:
L-',\coln e4
CEP
Phone#:
Zip: 33/3%
'PIu+ri bt ni.-nc. Phone#: %J7"'6,3Z-/3/
City: 1(L3 O c( State: 7 L- Zip: 33o
Qualifier Name: NO(I'risVA 1- 60.0 V . Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: Ail lob
Value of Work for this Permit: $
fG /'-i 2-(0 310
Vcko6411f QA -r
Tr'u cc
Certificate of Competency #:
Type of Work: Addition ❑ Alteration
Description of Work: We re.V c+n4
Neea °V-5 p lr,ni -- Yc.,nG
oirviweu
Specify color of color thru tile:
City:
Phone#: 3°5-3/0-- '5)30
I`aNri Jhares
Square/Linear Footage of Work:
State: Zip: 33133
❑ New L_Iitepair/Replace
vr
nem toai-(n a.nd
❑ Demolition
.5(A -ciao,/
ao,/
w o. }Q ✓ L�.ec. e ✓
Submittal Fee $ Permit Fee $ 36/0. `'
Scanning Fee $ Radon Fee $ `=' �'
Technology Fee $
Structural Reviews $
(Revised02/24/2014)
CCF $ CO/CC $
DBPR $ . '-y Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ v
1 fir)
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
OWNER or AGENT
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me
!.).— day of 74-(1V A421 , 20 /7_ , by
h3 day of ANv> y
,20 I7 ,by
\Du\ Cr4asro , who is personally known to N`J'fInc1 f\ , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
ANIELA ORZA
MY COMMISSION # GG 007871
EXPIRES: August 27, 2020
Bonded Thru Notarry Public Undervrtiters
APPROVED BY
(Revised02/24/2014)
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
ANIELA ORZA
* *= MY COMMISSION # GG 007871
s ; d EXPIRES: August 27, 2020
• ,g•r i; QP •` Bonded Thru Nota Public Un r tern
*****
nm
.n`
***********
Zoning
Structural Review Clerk