REV-16-3079 {
Miami Shores Village
Buildin rtment NOV 09 &-3 ~
10050 Ave i i ho es, Florida 33138 ,
Te 0 7 -2 756-8972
I L O MBE • 305)'762-4949
FBC 20M
BUILDING ,:• Master Permit No. L-U
PERMIT AP L NN Sub Permit No. V ((p — 3c)
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 369 nE qj St
City: Miami Shores County: Miami Dade Zip: 313�i
Folio/Parcel#: 1132 C)G 01 ?L S 33 O Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: II-. Flood Zone: BFE: FIFE:r.¢"`h
OWNER: Name(Fee Simple Titleholder): 1�', r &,nqw-, Phone#:
Address: 369 ()E 1-4 S
City: I){011-� State: Zip: 3tajuJ
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:-. L.;L,,,;. l'we'aQ. Phone#: (gSq 24 -`I o{!j
Address: "Llnoc r1 W ,.
City: , `State: I L& Zip: 31141
Qualifier Name: 2 0 cel Phone#:Ca9,r,� - S 1
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#: .
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 3o, 0 r re P�a CQ.,.ell t l
A cs� l P S 6
Specify color f color thru tile: - � �`p ` c\v
Submittal Fee$ Permit 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 Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
i r p
Mortgage Lender's Address R
City 1 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,
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 YOURrPROPERTY. 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 py f the n ice of commencement and construction lien law brochure will be delivered to the person
whose property is subjec t atta ment. AI 0, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection�whic o curs sev (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap ove a r inspection fee will be charged.
Signature Signatur
OWNER or AGENT ® O R TOR
The foregoing instrument was acknowledged befor oin instrument was acknowledged before me this
g g g rJit g g
l da of Iy 20 y b da of U.DJ 20 `�o b
Y Y Y Y
c Shy °,�nA�4�; who is personally known to 6� ,who is personally known to
me or who has produced `�� �1i�1 P� as me or who has produced -^ as
identification and wh id take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: �?:Pi'•, OSCARSERGIOCUEVAO print: "•Y°r'` OSCAR SERGIOCD
sr4 •,
2017~ *: " ION#EEr
Seal: t - EXPIRES:March 9, y,
%' oQn' Bonded Thru Notary Public Underwriters Seal:
EXPIRES:March 9,Bonded Thru Notary Pubiic U
APPROV BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)