DS-16-2173 r
Miami Shores Village RFCETVED
�t•v �o�b Building Department AUG 0 2016
�\�\ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 ! 'v
INSPECTION LINE PHONE NUMBER:(305)762-4949
R- FBC 2014 s
BUILDING Master Permit No. k! S �P --a Ce>
PERMIT APPLICATION Sub Permit No.
'BUILDING . ❑ ELECTRIC ❑ ROOFING ❑ REVISION E EXTENSION ❑RENEWAL
F—JPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF• ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 16317 Al
City: Miami Shores County: 'Miami Dade
Folio/Parcel#: //_2�3 G-01'3'-03 Y-0 m Is the Building Historically Designated:Yes N0
1 Occupancy Type:.. Load: �A x Construction Type: Flood Zone: BFE:' FFE:'
OWNER: Name(Fee Simple Titleholder): L&—'S g,410 Phones
I Address: ltV3/7 .,y ez, 4-vG
City: /1//.9r-i Ir S`i o2GS State: A& 00A Zi 3�3
p:
Tenant/Lessee Name: XXIM
Phone#:
Email:
n —
CONTRACTOR:Company Name: �)- C)rj'6*fF✓C1(l) PhoneA3'
Address: / E
City:. ij State: Zip:
33 19T
_r
Qualifier Name: Phone#: .� U /R ��
State Certification or Registration#: C-G Certificate of Competency#:
e.
DESIGNER:Architect/Engineer: Phone#:
Address: City: Stat/e:_Zip-.,
Value of Work for.this-Permit:. �95� Square/Linear Footage of Work•" �. `� ,
r Type.of1Wgrk._0,Addition., ❑ Alteration ❑ New ❑;Repairr/Replace ❑ Demolition
a Description of Work:�yp 'd A(�� NO&W/4-`•(, ; Q ,a ,,y. �<- ' .•:f:'
,'I. .• tro"-Yt rT'S t \1 •r #''
Specify color of color thru tile:
Submittal Fee$ '� Permit Fee$ w CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary}$.
Technology Fee$ Training/Education Fee$ t Double Fee•.$"
Structural Reviews$ # Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
i
i
t
Bonding Company's Name(if applicable)
Bonding Company's Address
City I State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender'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 standardsof 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."
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 comrqeVcernent and construction lien law brochure will be delivered to the person
—---whose-property-is subject-to attachment.-Also,-o certifi y- f-the-recorded-notice of-commencement-must-be-posted-at-the-job-site—for the first inspection which occurs seven (7) days a ( bdldingtpermit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be cWged. r ,
rja
Signature ignature
OWNER or AGE CONTRACTOR
The foregoing instrument was acknowledged before me this The fore ing instrument was acknowledged before me this
,
jjl7 da of / `M�ic'I 20�/G by 7 day ofC1i 20 f4 by
who is personally known to ho is personally known to
Cir who has produced as z�-ar who has produced as
identification and who did take an oath. identification and who did take an oath.
S + y
NOTARY PUBLIC: NOTARY PUBLIC:
BANDYAS1010 °Ks+Fp% SANDYAROCHO i
Sig y, MY COMMISSION#FF 9423R -
Pri�nt:
= MY COMMISSION t FF 942688
e
12018i4/1/a Bonded Thru Notary N'Nic UnderS� ~' lt��.R••'', Bonded Thru Notary Public Underwriters
Seal: Seal:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)