REV-18-421 Miami Shores Village RECEIVED
Building Department FEB 16 1018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(30S)762-4949
FBC 261q
BUILDING Master Permit No. -kms —\'Ne-N-t.
PERMIT APPLICATION Sub Permit NoJI' P N° I,1�—QZ l
BUILDING F_� ELECTRIC Ej ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE C►F ❑ CANCELLATION Ej SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: \02.1 D
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: \\ — 32—05-024—Q21ffIs the Building Historically Designated:Yes IVO ✓
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
f
OWNER: Name(Fee Simple Titleholder): ' "-� 1� -�Ql�`��6 Phone#:(,.:k O'S(oo\b
Address: 60CD ►.�� S'�pA -Q '
City: State: _V7_L_ Zip:
Tenant/Lessee Name: Phone#:
Email: t_k6G.cp"
CONTRACTOR:Company Name:"SCO �Ig!�Phone#: (_4Y55A, St:4�
Address:
city: State: #A-- Zip:
Qualifier Name: V � Phone#: CGISfi-��fre3dS�$6
State Certification or Registration#: C—(2G-- \5203 Q Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ `Zt'E:5� Square/LinearrFF,000tage of Work:
Type of Work: ❑ Addition El Alteration ElU New Repair/Replace ❑ Demolition
Description of Work: i.�\�`�r iZ+�D1..\ S^ _ ZZ'�\ ���►•�\�►-�1-
Specify color Of color thi,* tile.;
f+.'' 1+�� i)4�;5'LPermit Fee°Yr :o� . ..a'•. s -'1,i.. n+.A:4t:. i r5:.
Submittal Fee$" ' $ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ ` Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Compariy's Address
City� State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
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 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."
a
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
L
0 ER or AGENT CONT ACTOR
e
The foregoing instru nt was acknowledged before me this The foregoing instrument was acknowledged before me this
�
5V<A day of 1Z+' 20 %8 by \StH day of 20 08 by
161�/�'f� \1_1.dil��k JQ.who is personally known to QqWL1�] V'�A who is personally known to
me or who has produced I—V 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::
Sign: Sign:
Print: Print: �►,� '��
Seal: '`�4� ''= Commission if FF958686 Seal: ` Ricardo Dominguez
Commission I FF958686
Expires:Fegruary 8,2020 Expires:February 8,2020
NI% aa Bonded thna'Aaron Notary
,' 100 Bonded tMru Aaron Notary
APPROVED BY / Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)