REV-16-2005 b
Miami Shores Village JUL 1 s 2016
Building Department a
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
i INSPECTION LINE PHONE NUMBER:(305)762-4949 Sr
FBC 20
BUILDING Master Permit No. �C '' II— L -16D--t
PERMIT APPLICATION ' Sub Permit No. 1��
❑BUILDING LECTRIC ❑ ROOFING E"REVISION ❑ EXTENSION [::]RENEWAL
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❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP}
CONTRACTOR DRAWINGS
JOB ADDRESS: qEa N E `%b AJ-112—
City:
W'12—City: _ Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ` 5 Is the Building Historically\Designated:Yes NO
Occupancy Type; t(j aW_, _Construction Type: Flood Zone: BFE: �,bQ FFE:
OWNER:Name(Fee Simple Titleholder): YYyP 1�� Phone#: 61 I—0 [2-7g�3
Address: 1:4 1bi c-lk N �3+IV-, PAJ t
City: T-kM I ( State: Zip: 3 3 3�
Tenant/Lessee Name: 1V f-C Phone#:
Email: —7C,
CONTRACTOR:Company Name: umy1Kk F-1t C C- Cnm Phone#: la lo—I
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Address: —1-7`1:1-s NW U S'I' SWtC 9
City: M(ani T.)'aLh State: E Zip: 231 (D(,p
Qualifier Name: S`r A YI A Phone#:
State Certification or Registration#: F—C Certificate of Competency#:
DESIGNER:Architect/Engineer: °,l Phone#:,•-)
i Address: JV5 1�>2+ r— Cc�y� City: tAlam(, tate:-)a4 Zip:—331 S
Value of Work for this Permit: Square/Linear Footage of Work: /
" Type of Work: ❑ Additionn� ❑ Alteration LlNewElRepair/Replace;, El Demolition
Discription of Work: Veo1 " Yip_U-3 D.
Specify color of color thru tile:
Submittal Fee$_ 0 Permit Fee$ f/AQ CCF$ `CO/CC$
Scanning Fee$ Radon Fee$ 6 DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$ I
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Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �
(Revised02/24/2014)
1
t �
I
� I
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,
i
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.
s
"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
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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
a
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 subje o ttachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspec ' n is occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no be a rove and a reinspection fee will be charged.
Signature Signature 41/""7
i
ER or AGENT CONTRACTOR
The foregoing i meet was acknowledged before me this The foregoi ' strument was acknowledged before me this
day of 20 `(O by day of ��``� 20 L( by
a l • ..
who is personally known to 11�ie�Z4s personallyknown to
me or who has produced Rl. UCC_ produced , ���•
as me or who has as
identification and who did take an oath. identification and who did take an oath.
NOTA P IC: NOTARY PUBLIC:
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v
Sign: Sign:
Print: Print:
Seal 't ••� MY COMAM88tON#RF933000 ;'• ••
Seal: MY COMMI83tON#FF935000
EXPIRES November 09,2019 EXPIRE-NoVember 09.2019
14071 99 0.53 W^' ��O�►S80 O+p /biArWuq 9wvN u.wm
*�***�**s*>«�****♦****�***********�**�***��*•*►s*�*s*►*****�*s***»s`sssssst�r**s*s**����**�***�**�**«��*r�*���
6
APPROVED BY 6_'; & Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)