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REV-17-230 Miami Shores Village RECEIVED Building Department AI 0 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master Permit No. 9 ');' 2J PERMIT APPLICATION Sub Permit No. k_V I II- ZQ ❑BUILDING 0 ELECTRIC ❑ ROOFING ' REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 OSS SCJ e �� � r City: Miami Shores County: Miami Dade Zia 3�r3d Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFFE: s OWNER: Name(Fee Simple Titleholder): ?AT21Gts, Q(2 X31 Nib j Phone#: ©5� 5`�6' so Eop Address: ) 0S S City: S-1/A P) 'S State: FL Zip:331391 Tenant/Lessee Name: Phone#: Email: ?A(2iG3 24(31A"e IVu/Ni4 CONTRACTOR:Company Name: O (.0 r\'ty Phone#: Address: City: State: Zip: Qualifier Name: r Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#:-- a I '4."} Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ' EJ Alteration F-1NewE:1Repair/Replace El Demolition Description of Work: CSV/SCS' ��+Q,�/ fp e DRitler"'JAY �Gte C e 1-0 3 -- Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee.$ 1 t Radon Fee$ DBPR$ 4 Notary$ Technology Fee$ '• -Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ // TOTAL FEE NOW DUE$ 43'7 , (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 t State Zip T r + 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 workfwill 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. , ?, r, Signature )9Signa re OWNER r AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoiXof t was acknowledged before me this fih day of 11 (ar1 20 1 1 by 20 by �C k-r C,L G • bi VNAl ho is personally known to who is personally known to me or who has produced 1 )rte �V`�1' l l � as me or who has produced as identification and who did take an oath. identification and who did take an oat . NOTARY PLIC: NOTARY PUBLIC: Sign: Sign: -- r Print: r Print: Seal: -- Seal: `;AMY P���i , :•• YANADYPRIETO C. . MY COMMISSION#FF 214031 EXPIRES:March 25,2019 of fid'` Bonded Thru Notry Public Underwriters APPROVED BY Plans Examiner ! Zoning Structural Review Clerk (Revised02/24/2014)