EL-14-1977 Miami Shores Village ;L14
VEDLBuilding Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 10"
BUILDING Master Permit No,m Z2/ - 11-S[]
'PERMIT APPLICATION Sub Permit No.EZ ZY,e77---F
❑BUILDING XELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
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❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: 33 i 3g
Folio/Parcel#: -3206 - OA-00 4-0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): phone#:-Ieb- 25 2 Zee ?j
Address: L
City: Iyl \yam S\-i Q)Y2 State: `- Zip: 331 3
Tenant/Lessee Name: Phone#:
Email: Com' L /� G S G Mme,L � C U
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CONTRACTOR:Company Name: � C- C Phone#: 7d U
Address: ✓ c,�
City: c.- State: Zip:
Qualifier Name: v� Phone#: Zq S QCU 4�
State Certification or Re 'stration#: C'D�� lb
Certificate of Competency#:
DESIGNER:Architect/Engineer: r!I' \-A SG'1"S Glt1 Phone#: SOS 23-,27ZSe�
Address: q-1100 µ. V-L%C1A0/.NCL aL"4 SCLC..* City: (� �A`� State:f L Zip: �(5�
Value of Work for this Permit:$ (D is ,�! Square/Linear Footage of Work: qa>\ SF7
Type of Work:—)�,<Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: GA`t
Specify color of color thru tile:
Submittal Fee$ </")l•/�90 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ ` G
TOTAL FEE NOW DUE$ ` 1✓• l
(Revised02/24/2014)
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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,
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 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.
ell
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Signature�X Signature
OWNER or AGENT CONTRAC R
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of S'en k&(" 20 /5 by q" day of !S",,6— 20 11A by
�Y4 r
rr
D r d t yli/ who is personally known to ��l 1 l �is personally known to
me or ho as produced lZR-- t^Z l4:)otb6S"76->90 me or who has produced t L-= (cZ.S- wo-3Z-LnO-D as
ident fication and who did take an oath. identification and who did take an oath.
NOT RY U IC: NOTARY PUBLIC:
Sign: A Sigp: �X�.1j.
Print: nt::1,4Li MAKE,n—
AJ
Seal: KUR MSWU�(IE + Seal: LAURA MAYER
Notary public,State of Florida •NOTARY PUSUC
Comm�lonA FF 81175 STATE OF FLORIDA
My comm.expires Oct. 8, 2017 x
. 1o,y Expires 1/22/2018
APPROVED BY �7� // fel Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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