REV-17-2485 Miami Shores Village RECEIVED
Building Department OCT 181017
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'h
FBC 20,
BUILDING Master Permit No. V-,(— t-j^ i02�
PERMIT APPLICATION Sub Permit No.9�-N 1-9 - ZQ35
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
Mi PLUMBING F-1MECHANICAL ❑PUBLIC WORKS F-] CHANGE OF ❑ CANCELLATION ❑ Si HOP
7— 1 CONTRACTOR DRAWINGS
JOB ADDRESS: ��� /N- :5 / 7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: f f 3�4 6 013 2570 Is the Building Historically Designated:Yes NO _
Occupancy Type: Load: Construction Type: / ]Flood Zone: BFE: ��y- IFFE:
OWNER:Name(Fee Simple Titleholder): �✓ / / Phone#: -37 T( 6y �J?�
Address: & / C C
City: State: /— �- Zip: 3 3/30,/
Tenant/Lessee Name: Phone#:
Email: 4 i
CONTRACTOR:Company Name^_ .�i1W r Phone#:
Address: U D 1�_ �� 1) S97— ? 1
City: ` State: Zip: J 3
Qualifier Name: n S hone#: G�/_y 1 Q-
State Certification or Registration#: ,31 Certificate of Competency#:
DESIGNER:Architecctt/Ejngineer:A//, / / C' T� 4 Phone#f
Address: 53 < / /y A �jp2 C, City: 'State: FL Zip: -33D6 3
Value of Work for this Permit:$ /9 V Square/Linear Footage of Work: LoC/ S'
Type of Work: ElAddition ❑ Alteration ❑ New ❑ Re air/Re lace
p p ❑ Demolition
Description of Work: 12 � 1 ti
MI
,,....r._ ,...�.es�*.G.�`: '�•a++Jc.^�' ,,M3 .a trsfi: �fi;9u'?§ �t,i �R!j�'_.�'F
igAvSiQ)l r[�^,`C:v S, �y lv (f .1 ]
Specify color of color thru tile. t
T 1J.:+
Submittal Fee)$ _ 4 Permit Fee$ CCF$ I-'2— •- `��""CO/CC$+ �
Scanning Fee$c3•i Radon Fee$ .2• CJ DBPR$-2. 2S Notary$
Technology Fee$ ( Training/Education Fee$ d ' Double Fee$ XJ
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
i
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
F .
Mortgage Lender's Address
City + - z ,_� r 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. 1-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. 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
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 1 Signature
OWNER or AGENT 't.• t (CONTRACTOR ,
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
1. day of -b"Cff&jt,( .20 L bCl'�� .20 1� by
� y �: day 'f -�U
IVB -DOLUS6 ,who is personally known to �C�I �V�� ���5 who i personally k w to
me or who has produced as me or who has produced as
identification an who did take an oath. identification an who did take an oath.
NO ARY PUBLI NOTARY PUBLIC:
S n: Sign:
Print: .••`a�':' MARGARITAPrint: (( �il�C(��1/I
r NWgry PIr011C;Salat W1 Florida j
Seal: •: Seal: ,,•,; �P ANALUISAPARRILLA
. = My Comm.EXON08 Apr 1"201% o
_. NotaryPublic-StateofFlorida
CWmmlaslon N FF 108835 '' (•: `• Commission N GG 090452
"'"!•" 8"40d ThW11a1 Nsil0lW Wary'Assn ? � My Comm.Expires Apr 21;2021
•.,,OF Fl�,,•
d�`��:hfPVl9�8�'sl['Al41We�,Rsrr** *********
APPROVED BY G� T Plans Examiner Zoning
i• Structural Review Clerk
(RevisedO2/24/2014)