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REV-17-2200BUILDING PERMIT APPLICATION BUILDING 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 ❑ ELECTRIC ❑ ROOFING ElPLUMBING MECHANICAL PUBLIC WORKS JOB ADDRESS: /Z25- pa— 7? .5'�%Aelr City: Miami Shores County: RECEIVED AUG 31 ZP1'I S4L? FBC 201 EN1 Master Permit No. Sub Permit No. REVISION ❑ CHANGE OF CONTRACTOR ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: 33/3v Folio/Parcel#: 703 170 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: a OWNER: Name (Fee Simple Titleholder): �L%%�iv ��/S/rj F/A0 !mono*:- 7S/— 9333 Address: d2 2 r 4t/ G ©J2 S7 City: tiCf Cylll State: _/ Zip: 'j./3' Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 0 Address: 7/O.SG4., /G S T• City: !(l'). -e..-! f Qualifier Name: % c. i j,.e /fre.d .L'Z State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: Phone#: 3(f State: �/ Zip: 33/sr Phone#: 5-- 7% — TO Certificate of Competency #: _,O�$5O17t 3-3 Phone#: .41 / si r City: State: Zip: Square/Linear Footage of Work: New ❑ Repair/Replace v -e w ❑ Demolition Specify color of color thru tile: Submittal Fee $ Scanning Fee $ CC, Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 8( , "1 • C 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 ori 01 ER or AGENT The foregoing instrument was acknowledged before me this days `-' �U , 20 l , by , who is personally known to me or who has produced identification and NOTARY PUBLIC: take an oath. as Sign: 2021 Print: Seal: APPROVED BY (Revised02/24/2014) Signature The foregoing instrument was acknowledged before me this day of,41.i sr , 20 /7 , by /j/,‘1 /Avi , who is personally ovrn -- me or who has produced as identification and who did take an oath. NOTARY PUBLTt4 yR,••4;;, ROD • • 'S MY Sign: Print: Seal: 1 ALVAREZ ON 0 00090533 $ •4, 2021 ********************************************* **************** Plans Examiner l ********** /'Coning Structural Review Clerk rTh 1 100.30' (R) RECEIVED AUG 31 1017 No Access 0,L OnF _. '+-0.65' C6. 11000 • • 30 yF .i .' ro•••••: F•-r.ao t»+iD.85' nc. • • 1••• ;• ••• 4e.1a .0:!e . • • • • • • •• •• jJR.0 c O,c fes 5/65 Wuteri' Imjk AP{1 1.10' Enc. 0.25' Sed' 8,6r -k �Q11P -►12' 1 r9` ASPHALT PAVE1IF 92ndET Dedicat 5 ©,0,. • • • • • • • • Ail deararrcerand/orenaaocrrrun b shown hereon are of apparent nature. Fence ovmershfp by mat means. Legal ownersKp of fentfes not determined • Noted 4 • Underground Destructures. if any, not located a Rat of Ptcerd • g U st,flac are based o on +see p right-of-ways of records. • Lends shown hero0n was not � ,� �7' REVD. • Legal desc + p by client. is not a certification of title. wring, easements, or freedom from encurnbrancei • 'Msme .� is �Y tome land o is not shown�on this be found 1n the P� records ofms's couity. ASSTPACI NOT.REV:E11VED. • There BOUNDARY De 8Yitbn E for the exduslve use of the emits n-" her' . The CetUuate does not exceed of .love • t��ie�s survey nes been u ��o,�/r�/��str www in wy sextet sho!. be made withal t the prior • ries ,.S � w� based V�+ � rriiiri{ir� foundon rice r;Eld. 9 W W� • `•"7 ... 1