DEMO-16-619Miami 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
RECEIVF
MSR 08 2016
AA IAA.
FBC 20 NS--
BUILDING Master Permit NoD If\4Q(-G-10(
PERMIT APPLICATIONCANCELLEDREVISub Permit No.
BUILDING ❑ELECTRIC ❑ROOFING ❑ EXTENSION
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
JOB ADDRESS: 3 //aj
❑ RENEWAL
❑ SHOP
DRAWINGS
City:
Folio/Parcel#:
Occupancy Type:
Miami Shores County:
Miami Dade
//z/3x 5'r/3jZI
Load:
OWNER: Name (Fee Simple Titleholder):
Address:
Is the Building Historically
Construction Type: Flood Z
Zip: J/(O/
ted: Yes NO (/
FE: FFE:
./a6"
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City: ��////./41/ 5),71
Tenant/Lessee Name:
Email: /7'& ray/7 1'
State:
Phon:..�6
CONTRACTOR: Company Name: Z,S
Address:
City:
Phone#:
Phone#:
zip: 31/G/
State: Zip:
Qualifier Name:
Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
GO
Value of Work for this Permit: $ 4520 Square/Linear Footage of Work: ('$ 'CO
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: /2e rigpe 471g//%1/- /%th //J / it cf.df(
( /1541, �/7 ff/2f#
Specify color of �colorrhru tile:
COw
Submittal Fee $ CJ�' Permit Fee $ CCF $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CO/CC $
DBPR $ Notary $ • 03
(Revised02/24/2014)
Double Fee $
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City j State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
k.
laa
Application is hereby made to obtain a permit to do the work and instal dt on gas i dicate 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
OWNER or AGENT CONTRACTOR
Theforegoinginstr ment was acknowledged before me this The foregoing instrument was acknowledged before me this
60 day of �,v �OA , 20 t r0 , by day of , 20 , by
110P -Q) 6`J Iet- Sji (G6( ho is personally known t , who is personally known to
me or who has produced ft-`-pTLI1.(.! Vis me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY P = LIC: NOTARY PUBLIC:
Sign:
Print:
Seal:
******************
APPROVED BY
(Revised02/24/2014)
� l pure, Notary Public State of Florida
j. ?° Sindia Alvarez
.a c o My Commission FF 156750
'°1e o�' Expires 09/03/2018
Sign:
Print:
Seal:
********************************************************
Plans Examiner
Zoning
Structural Review Clerk
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