EL-17-2988 C�
Miami Shores Village DEc
Building 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 S1'h
FBC 2014
BUILDING Master Permit No..
PERMIT APPLICATION Sub Permit No.1 L n- 298
❑BUILDING [r,71 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
f n/ c L CONTRACTOR DRAWINGS
JOB ADDRESS: 13rd /V t- 1 U5 J7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // _A�?O "'�-S3y �fl Is the Building Historically Designated:Yes NO
aF -Occupancy Type: Load: Construction Type: Flood Zone:(��,/�p BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Z V/_5___' Ale- 1i�� Phone#:
Address: °� A/�7-7 14)-S
City: n1 e2 dj/ 5J14 1 State: PI!, Zip:
C
Tenant/Lessee Name: Phone#,36 S' '911
Email: MWS -3
CONTRACTOR:Company Name: U /IL Iy \, e� . �GL. Phone#: &S'3 b'j)"I O(S
Address: _1_) S1� C b�h� �}••q.l` \p r4GAj.4[\1
City:Vh;"rt-lk%16 t State: jq1
`Qualifier Name: tDMkAV%_ 1��fi� �� Phone#: '-T�6-2.`'cG-9 SC)"3
State Certification or Registration M.E-!__r oo O 20S14 Certif• ate of Competency
DESIGNER:Architect/Engineer: e6t Cl r?�jPhon #:
� , f � �
Address Ua fJ�/
jr 5 t !�7
y: )QWL State Zip: G?
Value of Work for this Permit:$ i Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ IAlteration
-�— ;❑ New l❑ Repair/Replace ❑ Demolition
Description of Work: \X � LfJ�-�
i —
Specify color of color thru tile:
Submittal Fee$ QI Permit Fee$ /rJ °' 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)
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;Qb riding permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of c %theb
gnd construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certifiedr t
d notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days afteis issued. In the absence of such posted notice, the
inspection will not be approved and a reinsp ion fee will be charged.
Signature Signature
XNERLknowledged
CONTRACTOR
The foregoing instrument was before me this The foregoing instrument was acknowledged before rm�e this
day of ,, /� 20 by o�tJ day of ,20 j ! by
t
f, /�"� IJ ;who is personally known to � - V (LLQ�2— who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PU C l
NOTA
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} Seal: ®r, ,... .. Seal: JSERG*D.CALDERA
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APPROVED `� A+'��c �� Plans Examiner Zoning
• rn��
Structural Review Clerk
(Revised02/24/2014)