RC-17-76 (2) \� Miami Shores Village LIAN
,12 ' 017
V
Building Department --1 _
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 i(A
BUILDING Master Permit No. t2_C- 1, — +(0
PE MIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
t A CONTRACTOR DRAWINGS
JOB ADDRESS: `1 l t\, S
City: Miami Shores County: Miami Dade zip: 33 13
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: 11 nnConstruction Type: Flood Zone: . BF�E:: FIFE:
3 OWNER: Name(FeeSimpleTitleholder): ft"7 Y�+U 1-o Ca 611, 1 )(,, Phone#:�l�Ct a sa-owo3
Address:
{ y Zip: ✓�
Cit �( Q✓�*1 �� !� State:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: [4(9 vv\Ln uj AiA Phone#: C gO a) _106 1)
Address: k
City: State: Zip:
a VnVVM==
Qualifier Name: Phone#: !`-�--•-- �
State Certification or Registration#: Certificate of Competency#: " a
DESIGNER:Architect/Engineer: Phone#:
Address: City: x State: Zip:
1 (j:
Value of Work for this Permit: ( ZS� ~J Ods_
$ Square/linear Footage of Work: f � -.; -• �� �
Type of Work: LTJ Addition ❑ Alteration ❑ New ❑ /Re laceRe air
p p E] Demolition
Y
ffnn ��pp
DescriptiioonofWork:
' C.� U�J1Q +� . ._.A_ JLCaCe 7 0...&_AL_.t0 cel
e1 .
�Si t {.. .. , .., t+.Vit' ,♦ .`kii i ft .f ` p .gg
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ . CO/CC$
C �
Scanning Fee$ I ^ ` Radon Fee$ J S DBPR$ S S Notary$ .�
Technology Fee$ 10, -40 Training/Education Fee$ re: Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ /
(Revised02/24/2014)
Bonding Company's Name(if'applicable)
Bonding Company's Address.r _
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address {
,City. 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. 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.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before mz"miti instrument was acknowledged before me this
31111
day of Gr1 20 14 ' by '�i cof 20 by
N �
�( N ro .Wtt I kqho is personally known to ,who is personally known to
ZN
p 8 A rS r who has produced C��.j(J (�� -(0
C7me or who has produced as
a do
Y N 4 ie tification and who did take an oath. identification and who did take an oath.
wz
ARY PUB NOTARY PUBLIC:
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� J
.aeo ig - ign:
?;A,'H.APW K.GONZALEZ
_ __CO
!AlV,- SiON#GG044802 Print:
:o," EXPIREi."lovember 2,2020
' #'lea ,pdi Via` Oonded'r~+u Public underwriters eal:
**************************** ******************************************************************************
APPROVED BY `V Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014) ,