REV-17-2277 _ -C V D
Miami Shores Village s SEP 24:z017?11 � , Building Department ! ,.
` \\� \ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 `S"
FBC 20 It
BUILDING Master Permit No. PIC I"]-2Sct
PERMIT APPLICATION sub Permit No. PleV 1-7 -zz-) 7
❑BUILDING ❑ ELECTRIC ❑ ROOFING �EVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGEOF ❑ CANCELLATION ❑ SHOP
/�
CONTRACTOR DRAWINGS
JOB ADDRESS: (4 R 7 -e-1 N 6 4-11� A Ve, (Road
City: Miami Shores County: Miami Dade ZiD• 1 .272
Folio/Parcel#: ( (- 3 Z 0 4 V 0 I -1 ( Z $0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
• .y
i
OWNER:Name(Fee Simple Titleholder):_ MA I t Phone#: 32 05 -,lP ( ?z • 546 (o
Address: 010 `Z 0� N� Q-I i'� AV 2 ( o"A
City: M l A wt l 56V6 6 State: -1" Lny,AA, Zip: 2i 13 g
Tenant/Lessee Name: Phone#: 3 0� ,te
_
Email: WOLAV L L PA , C Ul v,
CONTRACTO :Company Name: ey--.4(0sx-M V")j Phone#: O
'
Addre s: I nV It L
City: U n1 State: Zip: ��✓�b
Qualifier Name: Phone#:,011��� - —f 1b-;405
State Certifica ' or Registration#: d �6 Certificate of Competency#:
�A 'ai s
DESIGN :Architec Engineer:` f of�f"� A- C.6^P6CE - - Phone#:
Address: City: t - State:11 Zip: 33
d-o
Value of Work for this Permit:$ oo Square/Linear Footage of Work: L�1
J
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition -
Description of Work:
�.� A4�zP,Cd:i;1^ r 1:. i�Y' �" o'cry
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$ 20 Bond$
G -
TOTAL FEE NOW DUE$
(Revised02/24/2014)
!' f
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 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. N
"WARNING ATO 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-on 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
'J
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The fo egoing instrumentwasacknowledged before me this
�
_ dayofSCp� 20 1 by day ofyr ^L 20� by
OTy I Y) IL ) �S)who is personally known to {�/�i� N�S�f'vYho is personally known to
M�
me or who has produced P n S� as me or who has produced if r tC z as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: r
SiSign: G/
••••.ecf MAHARAI K.GONZALEZ! ; ` ?o ••• FF 188027
Print: 'r MY COMM Print`. f "
;,e oP EXPIRES:November2;2020 c l iW
Seal: { „,, BondedThiuNotaryPubllcUndenvriters Seal: °r' ��° BonNdThtuBudpltNotatySelrkel
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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