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PW-16-1540BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC 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 REC F:IVED JUN 0 2 2016 FBC 20 Master Permit No.PW (t, -- t H0 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL IVPuBLIC WORKS ❑ CHANGE OF CONTRACTOR . /T / JOB ADDRESS: % 7cC c4l/�� ' HA City: Miami Shores County: Folio/Parcel#: / 1 — .0 Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: City: Tenant/Lessee Name: Email: iami Dade ❑ CANCELLATION ❑ SHOP DRAWINGS 9e Buil}pg Historically Designated: Yes Constructio"n'fype: Flood Zone: ate: y NO BFE: FFE: Phone#: CONTRACTOR: Company Name: / ?PC, f� s Address: 570/ W ,9V� /r City: / 7 - /J (gyp P State: F1-CYI l Qualifier Name: `,_ 6OF State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ 7, Ow ,0V Phone#: Zip: )3g,L-r 9rtf Ss8-76 Phone#: L % /J-OF333 �l Zip: Phone#: Certificate of Competency #: Phone#: Square/Linear Footage of Work: State: Zip: Type of Work: ❑ Addition ❑ Alteration New Senn Repair/Replace El Demolition Description of Work: 4/2571,9 / C ! / .1) 43 � 2 V /( /71i,we and ' Specify color of colo%%rthru tile: Submittal Fee $ 3Q +DVr� Permit Fee $ 156` 6� CCF $ 3• to , . Co/CC $ Scanning Fee $ 9` ©0 Radon Fee $ 2-- 2. DBP�R%$� 2 Notary $ te Technology Fee $ Cf- �•/ Training/Education Fee $ - t/ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 1231 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 Signature ��� �-✓ 4. &. OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by ' day of �/ Lf,0 e- , 20 /6 , by e• -•-j SC/5 V C7fi i e, who is personally known to , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLI • Sign: Sign: Print: Print: Seal: Seal: ******iii*i******+L*********** *M*************************R*#SRR*********ii#ii*****i*iii*****i************ *** APPROVED BY /( -3"((E Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk