REV-16-2004 (2) a
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Miami Shores Village
f Building Department
t 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 T�
INSPECTION LINE PHONE NUMBER:(305)762-4949 C
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BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit N2My
UILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
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❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -M19 N 13—t" aVe
City: Miami Shores County: Miami Dade Zip:
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Folio/Parcel#: 1 J _� C) l) Is the Building Historically Designated:Yes` NO
Occupancy Type:1PeTktdk.Construction Type: Flood Zone: _BFE: `• FFE: 1
OWNER:Name(Fee Simple Titleholder): kJl VI o ( vim 40, Phone#:
Address:G R �- 1Q f'�
City: NMT a 'V\ State: Zip: 3,31
Tenant/Lessee Name: �' _ Phone#:
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i Email:
CONTRACTOR:Company Name: �__lin-�G �fi1(� �1Y 1 Phone#: �2� S &'j7a 'C'z;/4t
Address: L �VV L4*i S+-
' City:• 1• ,n'll State: I Zip: 33 (SS
Qualifier Name: JAGion SanGh,_ Phone#: -186 P O�
State Certification or Registration#: CSC 12_ D QaW3 Certificate of Competency#:
DESIGNER:Arch itect/Enginee
err: Phone#:
Address:�� �2 NL � }1�� City: 'MiGrnI State: Zip: 5313-7
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: C e_\ �` P.1 / 1 \ cnyl COf�fxt�-�a S lGcb
cAp S,ek4 z,, S -fat r5 v.j ystt C_ -r— r'_ e )
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ S W CCF$ CO/CC$
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Scanning Fee$ rr W Radon Fee$ DBPR$ Notary$ !!
Technology Fee$ Training/Education Fee$ Double Fee$ f
Structural Reviews$(ZU• � Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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Bonding Company's Name(if applicable)
Bonding Company's Address
I City State Zip
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Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
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City State Zip
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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.
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"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 o condition to the issuance of a building permit with an estimated value exceeding$2500, the appi licant 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 sub' attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspec on hi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no pro ed and a reinspection fee will be charged.
Signature Signature
INNER or AGENT CONTRACTOR
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The fotregoin strumme^n�t was acknowledged before me this The foregoing instrument was acknowledged before me this
4 da of -icV1 20 by day of 20 �by
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whopersonally,known to ,who is pdrsonally known to
me or who has produced •�r�flet�S W, C+ as me or who has produced �o `)Inlk re r'4s t% ,as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PLJBUQ
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Sign: Sign:
Print: Print: �I
�iI.AUDM P RAMIREZ Seal: MY COMMISSION M FF935000
Seal: :a MY COMMISSION'FF935000 EXPIRES November 09,2019
EXPIRES November 09,2019 *cri. .� igodgrrw;r 8wviso.am
a07! •� ?R1 ' .ami
APPROVED BY Plans Examiner Zoning,
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Structural Review Clerk
(Revised02/24/2014)
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RICK SCOTT;GOVERNOR KEN LAWSON, SECRETARY,
.�—sT-ATE,OF.FLORIDA. ``• Y` r �,,
-w DEPARTMENT QF_'BUSINESS AND PROFESSIONAL'•REGULATION
--{' -f- --CON_STRUCTIONrINDUSTRY:LICENSING-BOARDS\ "\N�x"\\,
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C-1260743�✓ .`-~".^ w ... "`� ,\•�`� S
Tfie'BIJILDtNG CONTRRC.T_QR '""''"'�: , ;r. ti....'. � �� •�
Named-belowlS CERTIFIED
U.nd6kIie-provisigns of Chapter 489'FS �
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€xpir'aCiori'dat6* AUG 3�,8"'�•----=
SANCHE N•RAFAE0
SL'�jTE;CONSTRU,C;TjbN�GROUP Etc,; R
7.l778,9W 4.7TH,ST,REET��B►-
MIAML�✓ FL 3315 ��.,��_. ,�
ISSUED: 06/15/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1606150000917
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