CC-16-3315 Miami Shores Village F r
DEC 0 7 2016
`� Building Department
` ��� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: —
��\ Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
6C F 1
BC 20A
BUILDING Master Permit NoIAV' -
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION - ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑'.SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores �j(� County: Miami Dade Zip:
Folio/Parcel#: 11 2 06- O 13 y7 -/0 Is the Building Historically Designated:Yes NO_X
Occupancy Type: Cz;f1/11, Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): % M-7LXA44 K of' fL Phone#:
Address: 2.15— Ale-5-1
City: )(41141-11 State: �' Zip:
Tenant/Lessee Name: Phone#:
Email: 7
CONTRACTOR:Company Name: $-A .Tn 2 7-A-A C'7�Phone#:7 Fw'--
Address:
City: 5 ON.--447Y IS L£S*Bf,1-c1l state: Zip: 33 l
Qualifier Name: t�' Phone#:
State Certification or Registration#:C 6C 17 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 2-000 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: L/1 1C!5;0 2 ?'�'f�of A 4-1 L/A/6'
Specify color of color thru tile:
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 Lenders 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 subjec a attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which cc s seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a prov and)`reinspection fee will be charged.
Signature Signature
rAGENT CONTRACTOR
The forre�going instruOAR
cknowledged before me this The foregoing instrument w ackn wledged before me this
30 day of 20 1 by �day of ' 20 11, J by
'J"OL/ d is perspnaUX known to a who is per ally 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 PUBLIC: NOTARY PUBLIC:
Sig ') Sign: '
Print: �/� � S v Print: L S
°`••••.°�% PAUL LOISEAU
Seal: Sea * MY COMMISSION#FF 103507
MARIA T.GROSSO EXPIRES:March 18,2018
* MY COMMISSIONy#FF 231886 �J�-cF Fl�`O' Bonded Thru Budget Notary Services
:IS"*EOndllnN 2019
u **********************************************************************
"41"F OF F-
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)