DEMO-16-154 Miami Shores Villager r ,
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Building Department
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A 2 !0 01610050 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)/
BUILDING Master Permit No15'
PERMIT
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
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! ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shore33\1
``s County: _ Miami Dade Zip: ✓� t9-
Foli6/Parcel#: ��' oC�`�Jlst' ��� - 09ZC) -is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ___Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): —KA_ Q_Aw� 1QN\VAO Phone#: 3Q6 -LcR -3 MAC
Address: VD-7 &44bJA-
City: State: ? Zip: 3 `
Tenant/Lessee Name: _ iPhone#:
Email: ?
Ag10,
CONTRACTOR:Company Name: 9� `� C)V C— ''f—Phon a�D- QA(D �J
Address: ^ '8>540
City: State:_. Zip: 53���J
Qualifier Name: �. _Phone#: _
State Certification or Registration M � e- dr"1 � _ Certificate of Competency#:
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DESIGNER:Architect/Engineer: �__ Phone#:
Address: —/ _ __City: State: Zip:
Value
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Value of Work for this Permit:$ �� 1�7• _Square/Linear Footage of Work:
Type of Work: ❑ Addition ,, ❑ Alteration ❑ New F__j Repair/Replace Demolition ��
Description of Work:�- 'lam � o�-- —�\e�. �� c ��_ �1 Vi"b
Specify color of color thru tile:
Submittal Fee$,.�J� 1 Permit Fee$ _ _ 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)
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..... h
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.
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Sign Signatur
OWNER or A ENT CONTRA R
The foregoing instrument was ackn ledged before /me this The foregoing instrument was acknowledged before me this
day of Q/A n d 0r 120 � 1P by ��day of 4r 20 G by,
I o ,who i ersonally know to �C`� n /"�4r- im_?_ w o i personally known o
me or who has produced p as me or who has 1 — as
identification and who did take an oath. identification and who did' a t
NOTARY PUBLIC: NOTARY PUB IC:
Sign: Sign:
Print: HA-r •1 Print: HAr12Ar;'�",o
Seal: Seal:
:►'" MARGARITA M RODRIGUEZ :ih: MARGARITA M RODRIGUEZ
MV COMMISSION S FF224715 MY COMMISSION>e FF224715
il 27.2019
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,'fill 4A•0'S3 FtriA.�NMa•�Sr.'vicetar .:.DC::'i^,.D".3 FtrMl.iNnia'�5�^rrn..t.nr
APPROVED BY Plans Examiner Zoning
' Structural Review Clerk
(Revised02/24/2014)