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REV-17-1529 I A �-�A. Miami Shores Village 7BY: CR, gp Buildin De artment 0'8 2017 o 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 i FBC 2014 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ky 1 -7— 152 ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL 1 ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP n CONTRACTOR DRAWINGS JOB ADDRESS: ( 2,0 (\3t-- k© ` City: Miami Shores Count : Miami Dade Zip: Folio/Parcel#: %W32-05-093 -00`3c7 th i cally Designated:Yes NO V r b Occupancy Type: Load: Construction Type: ne: BFE: FFE: 1 ' .0 WNER:Name(Fee Simple Titleholder): " '\��� Phone#:8 -'ZOS- Wo- 2:4474- Address: t 2 rALS�- r City: M\e'.i S 1`e< State: EC- Zip: Tenant%Lessee Name: Phone#: k' Email: - o F CONTRACTOR:Company Name: �"cc__'Q. Phone#: qCu kb3 2-1-AAI Address: City: State: Zip:�73 Qualifier Name: Phone#:O('Zk State Certification or Registration#: « 139K4 v'�' Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: ' Address: City: State: Zip: cr , Value of Work for this Permit:$ 9'Gk"t=7 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: '6�S\CO '-\ ')S(o n 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$ Structural Reviews$ Bond$ ,TOTAL FEE NOW DUE$ (Revised 02/24/2014) 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 f 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 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 r✓ Signature " "' OWNER rAGENT CON RACTOR The foregoig instrument was acknowledged b Wregoing instrument was acknowledged before me this ��lL day of -1, —.2 day of I a_ 20 �� by Zo dn who is personally known to who is rsonally kn n to { me or who has produced. 'qA— 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: 4 I � j Sign: Sign: Print: 11 hONNIII-LK PrintOp k : Seal: '"r°` ' JENNIFER D COLE Seal- MY COMMISSION#GG049278 �`• MY COMMISSION#GG049276 EXPIRES November 21,2020 EXPIRES November 21,2020 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i