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REV-16-2726BUILDING 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) 62-4949 Mas PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: ' 1 NL. --s RECEIVED OCT�05p20' FBC 20I" er Permit No. (2_C`3-1167443 Sub Permit No. E' 4 ) (40 - 2 2 ❑ ROOFING © REVISION ❑PUBLIC WORKS ❑ CHANGE OF CO NTRACTO R �2 5( ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Constr ction Type: Flood Zone: y1-(7 ELT 4iii 6,-r u..c_ OWNER: Name (Fee Simple Titleholder): 1}T IL jR° Phone#: Address: 2.4-4 IU N b sly?. BFE: FFE: City: M 1 A I State: TC- o `2 IJ3 /g Zip: ()'3 '(� 5 Tenant/Lessee Name: Phone#:3 0 5 2 Email: I \V e, (r.o CONTRACTOR: Company Name: Address: �--� l 1,, 1 City: \i \\ P\-' ice'( Qualifier Name: first Phone#: l g 6 State: State Certification or Registration #: C.— I S'36.5 3 DESIGNER: Architect/Engineer: Address:pp,,��//�� City: Value of Work for this Permit 2 Cv • Zip: �•� l11 IP Phone#: ` _ 2-y Certificate of Competency #: C ' 3Q5-3 / Phone#: State: Zip: Square/Linear Footage of Work: 1_5 © yr Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: _ tELC- Kr (44) THE CCUUEPTE.1% f tt P2ooH Luj t 11 ❑ Demolition Z- //VG M. i �n ml /j Li) V k i (),4 t t /I t -s'14C- 'Ttc % o MT WALLS AkD -71— (ZiL. /Aics • Specify color of color thru tile: ,^ Submittal Fee $ Permit Fee $ (l7O CCF $ ( • $O Scanning Fee $ Radon Fee .$ Z. DBPR $ 1 ---- Technology Technology Fee $ 2 • u0 Training/Education Fee $ • COO Double Fee $ Structural Reviews $ i 7 0 750 • Bond $ CO/CC $ Notary $. • CX7 (Revikedro/74/711141 TOTAL FEE NOW DUE$ 2 �. ZS° 4 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 The foregoing instrument was acknowledged before me this btln day of 01 019`, V , 20�C� , by Po/� � .A.- t \o , who is personally known to me or who has produced LAINScL as identification and who did take a NOT Sign: Print: Seal: EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwriters Signature CONTRACTOR The foregoing instrument was acknowledged before me this 5-405N day of C 1 0c -Ob�� , 20 [4 , by I)CAN i d GV 1. N'SVeywho is personally known to me or who has produced : r a' _r LI C'&r\901/4. identification and who did take a .. • • gG NOTARY Sign: Print: Seal: Y;Py^' YANADY PRIETO : ,n ;t MY COMMISSION # FF 214031 •r.I .; L,: EXPIRES: March 25, 2019 ',trial," h°•• Bonded Thru Notary Public Underwriters as ********** .. *rk*** *-********************************************************1k****************** APPROVED BY —• `' I Plans Examiner iRnvimrrn9 n yulp2 Zoning Structural Review Clerk MIAMI SHORES VILLAGE tM,.l i_. 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R .414 ea rw 1y!I S)'r 4.42......i 1- -i-__e....,-,LAC Aviv ,, /! / 4Dff�a A6?i 6414 . - � P....__ RR,' _0.,.l . Li - AOOMON •_ -' �''t I A►PROV(O RSJICTEO RS/tNRSO TOCOUNC.Li wr M.O..% SV*•MITTEO TQ PtANNIMQ BOARD ?Lao .- RE:SURMIYTED TO PLANNiNO ROAR° gS11M1Y.xTwrr 714} XV Afar [OUHCII..................1 %-11.4.1. /Zt% 1Eevr�_ E RTI►tGATS 4. OCCt/PANCY N ,r..--.. •UIL.QING MOW AND INSPECTION RECORD -MIAMI 1MQRE5 V141AG • ••• • • • • •••• • • • •• • •• • • • • • •• • • • • •••• •••• • • • • • • •••• •••• •• • • • • • • •• •• •• • • • • • • • • • • • • • • • • • • • • •• • ••• • • • AIR CONO. A►, CLEAN inti! SLAG AN PLUMBING PERMITS & INSPECTIONS ri4acT:`,N h �v a .s. __. 2.. vrna .-A+y � _ _ I , f'►+Otr1E mMtrNo 5,CDL. 1 DATEI /t -t.- `�. t<EE$ /1 -t,E(*Loc. I ALTERATION _ I App_Ti_t. REPmns SPICtALS PERMITS PERMIT NO ----1--- OAT( 1 FEE 1 is s 1-----a TEMPORARY SERVICE PTiu TANK SEWER $QL_AI1 Hf.ATEq GA9 INSPECTIONS DATE BY RE•INSPECT SY RE.INSII CT1 SY ROUGMIND R • N. i RANOE CONN. TUB 0 TOP OUT [ • .4•,I: $ sEwER 1 to _No` HRan! QP,04 SEPTIC TANK I N SOLAR NATER • : PIXTURtS i I ELECTRICAL PERMITS & INSPECTIONS CONTRACTOR J72. & iC � T C. , * PHONE P RM*T NO �,i O':_ i DAT �" -i- P((5 A. DRQ ATION ADoITION P• !REPAIRS SPECIAL PERMITS PERMIT NO- I DATE FEE Tlp1PQRART SERVICE w RE- iNsPECT1 SY R • N. i RANOE CONN. $ • .4•,I: $ to _No` HRan! QP,04 IN k$ OA Yt SY RE =INSPECT w RE- iNsPECT1 SY ¢.a to _No` HRan! QP,04 N • : w •••• • • • • • • • • • • • • • • • • .• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• vs • ewiS -CERTIFICATE OF OCCUPANCY ONIr3 MIAMI SHORES VILLAGE, FLORIDA BUILDING DIVISION N? 1396 e. . Miami Shore:7. Village, Florida__ Owner, Agent or Tenant of Building • •:-• l• • 1. Lot..19 ' ' Block_ 17... Subdivision - - 1 r ..• •.. t Street Address Approved use by occupctncy-1,1-2.L.ILt t °riot: • - to- - • Remarks:_ This Certificate of Occupancy is issued to the above named — for building at above named location only upon the express provision that the applicant will abide by and comply with all conditions of Ordinances Nos 92. 93. 94 and 97, known as the Zoning. Electrioal, Plumbing and Building Ordinances of Miami Shores Village pertaining to the erection, construction, alteration or remodeling of buikiings or structures. - - 1/1,211P - • BUILDING DIVISION • • • • • • • • • • • • • • • • • • . . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0 • • 0 • • • • • • • • • • • • • • 0 • • • • • • • • • • • . • • • • • • •