REV-17-1878ReN111- 6"1lS
Vb 6— -14-- d--)1/2/1
Miami Shores Village
Building Department
0 N.E.2nd Avenue, Miami Shores, Florida 33138
5-2204 Fax: (305) 756-8972
BER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
JUL 211011
vat
FBC 2019
Master Permit No.( --c ) `C—' )) -7� R,-cj ^'1
Sub Permit No. 12
REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
9 I ) CONTRACTOR DRAWINGS
JOB ADDRESS: ) q o iV rao�% shore_ rPt ;��
City: Miami Shores /County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: �, " Flood Zone: BFE: �f' FFE: ( j
OWNER: Name (Fee Simple Titleholder): ] .Li_q 1—v./u vD ) Phone#: -V`1 C9 9-41
1
Address: Q'9Z of--4i-P 1 � / J 2 ,sT)6 .
City: Kt c1rvvi Gj1/1-u.(%-e.- S State: �/(_ Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: CAVA u—eucA
Address: l 1 S t� 'q51)k)
City: \•0 r I State: -3 Q-\\ Zip:3 I S
Qualifier Name: RCA 4,13 Ch%ONU&41 Phone#: (3V—zit,— G t 9 -3
State Certification or Registration #: OW ) 51, K Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address: City:
Vdacie br —
Phone#: '7111":71 ki-43'C 7j
Phone#:
State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
WI
❑ New
❑ Repair/Re•lace n Demolition
Specify b'lor of,color'thru
Submittal ee
r
Scanning) Fee$
Technology Fee $
•
tile: W
• --
Permit Fee $
iO3J *3*IO*3V
Radon Fee
Structural Reviews $
(Revised02/24/2014)
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE$ A , CA
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.
Signatu ja44
Th
OWNER or AGENT
ing instrument was acknowledged before me this
day of , 20 1 " y , by
Signatu
CONTRACTOR
The foreng instru ent as acknowledged before me this
, 20 , by
�J�
, who is personallyiknownkn{to •� `b ° Juhoo is personally known to
me or who has produced ." --3,n Pant—as oras me or who has produced —Mil/
identification and who did . .n oath.
NOTARY
Sign:
Print:
Seal:
*******
*
APPROVED BY
(Revised02/24/2014)
identification and who did take oath.
NOTARY P BLIC:
`�
Sign:
�_
Print:
Seal:
******************
Plans Examiner
Structural Review
VERONICA LEON
' c' Notary State of Florida
,u;• arc 'p'SS,0(}.+M,CGur 033187
ot:// My 1".42021
V************'*****
Zoning
Clerk