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MC-17-2657 (2)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 Rev n- z9 Z8 FBC 201T BUILDING Master Permit No. GC— 2—/7-3�6 PERMIT APPLICATION Sub Permit No. NC —/ / — / 7 - ❑BUILDING ❑ELECTRIC ❑ROOFING REVISION ❑ EXTENSION ❑ RENEWAL ❑ PLUMBING �MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 13 7 N,E 2_4()E. City: Miami Shores County: Miami Dade Zip: 33 /.3g— Folio/Parcel#: // 3 2 0:, " ©/ 3 — 3 01) ° Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): j Y S LL C Phone#: G Address: 157 % 4) .0_ 2 /YE City: 01 jam r - / J' State: Zip: 3 3/3' Tenant/Lessee Name: cUt 7's/q/e C �+ o b ' k 1) W'/SPhone#: 2. `tel - Z 2 -Li Email: CONTRACTOR: Company Name: -3 V 4 V R. cPrl/l CeS Phone#: '7r'1 'Ss I/ dl —gl / Address: 11570 SI ice. S"til S— C-/34/ City: bQi//t State: /5?.1• Zip: 333-S Qualifier Name: E f varein 6e//2ao Phone#: )5-1/- 5 C/ -B1 / I State Certification or Registration #: CMC0 5-7 011 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Pee 1M CO A) jS 110 ,Qeio Specify color of color thru tile: Submittal Fee $ Permit Fee $ . CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Bond $ �j TOTAL FEE NOW DUE $ v• () 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 no ce .i commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is 'su • '0 In the absence of such posted notice, the inspection will not be app ov . ► nd ► reinspection fee will be charged. Signature 7 / OWNER or AGENT The foregoing instrument was acknowledged before me this /3 day of 1..e hi la? r , 20 / 7 , by , who is personally known to ,.meor who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �� [O✓rl�Q �j� Seal: ************ 4444114;:,... EUZABETH ELORRIAGA :• MY COMMISSION # FF953536 e.,• EXPIRES January 25.2020 e oar Signature R The foregoing instru -nt wa\a owledged before me this 3 day of !i a=i� 20 / 7' , by / bar o Del -AU p , who is personally known to me or who has produced (t,5a y16 -241-4Z-/56-6 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Y -'"T2 L11/J`- - ELIZABETH ELORIIAOA •••1 MY COMMISSION # FF953536 ,, EXPIRES January 25.2020 (40/, 3 -0.53 FladaNMayswvicecon' ************************************************************** APPROVED BY Plans Examiner (Revised02/24/2014) Structural Review Zoning Clerk