REV-17-238416\4°
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 aLECTRIC ❑ ROOFING
0PLUMBING 0 MECHANICAL 0PUBLIC WORKS
JOB ADDRESS: SO Z titti=,
City: Miami Shores County: F-( Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes
RECEI\TED
OCT 2017
BY:
FBC 20 I I-
Master Permit No.RC \-1
Sub Permit No. PV f 2.384
141• REVISION ❑ EXTENSION ❑ RENEWAL
0 CHANGE OF 0 CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
•
Zip: f .JCo
Occupancy Type: Load:
Construction Type: Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 0'40 /AC ` • ( Phone#:
Address: `i 3) er, 'CEJ (, �� (� e C
City: frt (- "- rJ Q State: -Fyo 1i Zip:
Tenant/Lessee Name: Phone#:
Email:
303--;OL(e r O e,
CONTRACTOR: Company Name: UOL)-t o 3 C Ix
Address: (4 (.=:1 r`-131-/ (j9(
City: 0-4A't.-'E l
1 one#: S J
163-1-01\-3(
State: Zip: O'i2 .
PnQualifier Name: -'-1-01\-3`to 4\CD \ ►- Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $
Type of Work: ❑ Ad 'tion ❑ Alteration_/
Description of Work: ^ (,.fie. r W
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace
❑ Demolition
•
Specify color of color -14:''' e: ; .f: .. : .,,,., .,?1'(,<a
Submittal Fee $�: Permit Fee $ 4•` �'!®P CCF $ CO/CC $
Scanning Fee $ R . u.: Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ &L-4 •
Structural Reviews $
(Revised02/24/2014)
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 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.
Signa
The foregoing instrument was acknowledged before me this
5 day of Qe / , 20 / , by
8116411(10 (!fit) , who is personally known to
me or who has produced / /O12/61 9/2111e72,' Cicfr as
identifica
NOTARY
Sign:
Print:
and who did take an oath.
Seal:
iQs,:.n" P /.6
ELM IRA LOPEZ
* MY COMMISSION t FF 072394
EXPIRMena , 2018
„ea Ft Bonded ThruES: Budget Nota21ry Servkes
*********************
APPROVED BY
(Revised02/24/2014)
*
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of A Oe / , 20 / ? , by
T
No Haps*. , who is personally known to
me or who has produced 17015 64 PR/itz Lir l as
identification andid take an oath.
NOTARY P
Sign:
Print:
Seal:
C9-4! 4G Plans Examiner
i�1MM
_` MIRALOPEZ
MY COMMISSION t FF 072394
,ice EXPIRES: Mang 21, 2018
Zoning
Structural Review Clerk