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REV-16-2743 Miami Shores Village 0CT 1 1 2016 Building Department By: i 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 �T+r INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No. C C 3od PERMIT APPLICATION Sub Permit No-FE:V'[L-W-:4- 3�. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑EXTENSION ❑RENEWAL '" PLUMB_ING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF E]CANCELLATION ❑ SHOP J" CONTRACTOR DRAWINGS JOB ADDRESS: //j001 N t✓ A)rj D NYC - r/v e: At-s OyAo / 4vl S'n.eFs ,�L. 33/6/ City: Miami Shores County: Miami Dade Zip: p Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: //Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder) ✓mAy UN/VeAt /ry Phone#:: Address: t o NE �rqQ Ayc Ml A&I City: State: Zip: Tenant/Lessee Name;- - .4'O Phone#: Email: j . EDv CONTRACTOR:Company Name: �T� 06 11 EDk Igo 5Q �f(�, Phone#: c�� 0�7 " [ 7 6,3 Addre j51 Lfa N� (l er) ��(;;ez-i `�f City: ^^ rti State: 1�(o t r Zip: O L qualifier Name: t-t Phone#: NQS' (17 O -,37 3 �/ State Certification or Registration#: 0 EC•Q--S 17 U I Certificate of Competency#: DESIGNER:Architect/Engineer:_-g*t vasa 6LL.Y Phone#: (561 78 �57 Address: 2 � Vi0ySTA- A'OMchWA�- ,S'j/�'700 City: W&Pkv 4State: zip: 33311 Value of Work for this Permit:$ 0. Of) Square/Linear Footage of Work: S F- Type of Work: ❑ Addition Alteration ❑ New _ ❑ Repair/Replace ❑ Demolition Description of Work: E,C/M�N'� J d'OV OF- Auu film F,. �p t-k— A— �E ArjWb"S QF- 141iN r, 4evA-77vav of CAPI N 6 AIU6 /1 a VhL O F �t�iL 00,N rAiAjS ATOP' A Ai th L f nJ lK' Specify color of color thru tile: i Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ _ Bond$ TOTAL FEE NOW DUE$ O: (ReVIsed02/24/2014) � E r 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 per""mit and'that all workwill 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..... I 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 The foregoing instrument was acknowledged before me this The foregoing instren wa/�acknowledged before me this day of ©MO.-6Q- .20 1� by day of P�6C /_ by 54� N Q1' who is personally known to_ ! o is personally known me.or who has produ'ced as me or who Pias produced as identification and who did take an oath. , identification and who did take an oath. NOTARY PUBLIC: NOTAR Sign: � Sign: U (.ePrint: nY Seal. ♦i° tvotary Public Stab of Florida" +°s•p''�,8�'c •VERNARDA TEAL Seal: Jeffry J Yeo * My COMMISSION iI FF 146575 �c j My CornmiWw FF 16e4e1 EXPIRES:Juty 30,2018 M Expirafall/1?/2010 Nj"TEOFRI� BondedThruBudgetNotaryServioas APPROVED.BY o7il�� lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) t