REV-17-27634 .4
BUILDING
PERMIT APPLICATION
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) 7624949
Master Permit No.
jR-CF:1—‘
NOV 1 2017
13Y:i 41(4I
FBC 20)4 Sth
)6 -2605
Sub Permit No. Pie v 17 mbs
BUILDING 0 ELECTRIC FA ROOFING El REVISION 0 EXTENSION 0 RENEWAL
PLUMBING fl MECHANICAL 'PUBLIC WORKS CHANGE OF E CANCELLATION Ei SHOP
CONTRACTOR
cio nE q62:.
JOB ADDRESS:
City' Miami Shores County Miami Dade
Folio/Parcelfl:
Occupancy Type:
DRAWINGS
Ca
z,, )
the Building Historically Designated: Yes NO
Load: Construction Type- Rood Zone: BFE: FEE:
OWNER: Name (Fee-iple Titleholder)- _\)erso 45771 e". LC C
Address: C1-111 surie .(2
FL
City: .4711 (
Tenant/Lessee Name
Erna 1:
CONTRACTOR: Compny Name:
Address: 1 Is 20
KA, -
City- Ivi \ 0•6411\ \
Phone:
cL.- 6&
or
.)p
Zip:
Phonetk
40/1Phone0: 5,55 -2k 3 I 34
State.
Qualifier Namek.krZ;t>0 k -YE -R> Phonetf;
State Certification or Registration a: . 2J 3S-- Certhicate of Corrioetency fl•
z,p G
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: 5
Type of Work: Ei Addition fxc Alteration
Description of Work: haiIC
4)Lwe
City
Square/Linear Footage of Work:
Phon ea:
State: Zip;
ri..] Nev.
epair/Replace
fL,11 Demolition
[A Cl dia(r4
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
(Rev4vaz/24/2014)
',-
Permit Fee $ CCF $ CO/CC $ _
Radon Fee S DBPR $ Notary
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1•
r
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if app'icable)
Mortgage Lender's Address
City
Zip
Zip
Application is hereby made to obtain a permitto do the work and installations as indicated, I certify that nu work or instaiiaton has
commenced prior to the issuance of a permit and ,t„r; all work will be performed to meet the standards of alt faw regulating
construction in this jurisdiction. I understand that ::cparate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC...,
OWNER'S AFFIDAVIT: i certify that alt the forrl,o'ng information is accurate and that all work will be done in corrspliance with all
and 'ef ,
applicable laws regulating constructio
"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 ,52500, the applicant roust
promise in good faith that o copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, n certified copy of the recorded notice of commencement must be posted or the job site
for the first inspection which occurs seven (7) does often the building permit is issued. In the observe of such posted notice, the
inspection will not be approved and o reins 'ctirar 'e i!1 be charged,.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before
n1e Il i
day of S -e 7 e. 0 L day of .5.ir0
Asa. C S—P t <� rsc� r,C 1
who
isi b ' ,Y(1i-no vn to i� f QbC) e+
me or who has produced L1*-{.�.F--'' L,1 NSA e car s, o has produced
identification and who did take an oath,
NOTARY PU IC:
22
el
Signature
The foregoing instrument was acknowledged befo
Sign:
Print:
Seal:
f>.A jyytir r r .
° ,0., Notary
Sindia Alvarez
lic to of Fiona
S
el My Commission FF 156750
Expires 0910312' 18
APPROVED BY
ho
his
by
entifiation
NOTAR
Sign
Print:
Seal:
y Public • State of
ion X FF 97
omm. Expires Apr 3, 2t/20
.....,....._ Plans Exarneer
Zoning
Clerk