DS-18-97 (2) a Miami Shores Village RECEIVED
Building Department JAN 12 2017
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2017
BUILDING Master Permit No. E L-I —jc,c,—
PC DMIT APPLICATION Sub Permit No. — 1- 1 q1
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/ /6 J / CONTRACTOR DRAWINGS
JOB ADDRESS:_ ! � /jr / �/ +
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:& (,�/,� r Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Cgs Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Phone#:
Address: r {J
or
City: State: F17-. Zip:
Tenant/Lessee ame: KYA Phone#:
Email: !�
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CONTRACTOR:Company Name: k j 'j L• �� / Phone#: dJ
Address: / ��� � ,, � ✓ _
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City: �l�'�l�N � State: /4/- Zip: ��)/� 7 p
t Qualifier Name: zl� / J/ Phone#: .; �Fbp �Q /?
State Certification or Registration#:��/� 13(� 3 3 11. Certificate of Competency#: (79r6 Q0' / X A
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
rr/
Value of Work for this Permit:$ J Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
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3v 7 1� i K Rr yr f f��"9i�rt7a`i tit {lr t
Specify color of,colodr thru
�T�.sCil�?A
Submittal Fee$ �gt ,19^t J. �y� j..�.ro• .3!Rh Rq F i!'�t�tc`nt .l?c44`n
Permit Fee$ W CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
I
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ &(2 ' 20
(Revised02/24/2014)
i
Bonding Company's Name(if applicable),
Bonding Company's Address
r
r City State Zip
Mortgage Lender's Name(if applicable)
r
Mortgage Lender's Address
I City j 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. h '
"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.,
he absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
' Signature J Signature {
NER or AGENT CONTRA OR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1� day of, 20 ► 7 by .day of 66'a h z 20 by
A�C J 3h2 Jl,who is personally known to r�U� �LSnr 01S
personally known to
—:
mfr who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
a
Sign: ,,/� Sign:
Print: rJII�� 1 tr`�C...)GLA Print:
Seal: a°';�•�°'� ALEJANORAWGWWU Seal: �`��•�:;�
• * MY COMMISSMON f FF 1430s �* COWSS"#FF qu
EXPIRES:.Mily 21,2018 . EXPIRES:
ifa�41� lanMdTMulul�tMgryMenkef yfFandr lm6dTAr�Bu JL*21,2y0�1„8�,
i`
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)