DEMO-16-156 Miami Shores Village J N 20 ops
Building Department BY:-
-7-
10050
Y 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 T
INSPECTION LINE PHONE NUMBER:(305)762-4949 `_.
FBC 20
BUILDING Master Permit No.
m6
PERMIT APPLICATION Sub Permit No. 6 6
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1�� you TIS
City: Miami Shores County: Miami Dade Zip:
3310`
Folio/Parcel#:'e®` - a2.O�J� ' M57 - OZZO Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
f
OWNER:Name(Fee Simple Titleholder): Phone#: -m4
Address:
� �I VD-7
City: ' ki Wk \ 9102CL,J State: t'C._ Zip: `�.;F&Q
Tenant/Lessee Name: Phone#:
Email: nn
CONTRACTOR:Company Name: *2 Qjck' -'Phone#: _'3 -2+�� 5\7
Address: (_ogb(�) aAj W a
City: ���'�� State: Zip: z ?\(42ej `
`Qualifier Name: 05w X-5 ` -Sk#: 'a 73 17
State Certification or Registration#: '�V \440 2-� Certificate of Comp
DESIGNER:Architect/Engineer: 1Q Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ C D Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work: 1 4
0�5 ®
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$ i
Structural Reviews$ _ Bond$_
TOTAL FEE NOW DUE$
(Revised02/24/2014)
a
a
4 '
t+ r
+ a
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 1
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
t 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.
Signa _ Signature_
OWNER rAGENT CONTRACTOR
The foregoing Inst ment was a nowledged before me this The foregoing instrument was,acknowledged before me this
(Q day of �J—,q n J 9-f 20 by ___LS�'day of_ �/�n 4 rte_ 20 by
C1--/1A q,rJ& who is ersonally known o �Sl[�J ���►�? ,who ispersonally known o
me or who has produced _as me or vih f __ as
identification and who did take an oath. identification an ka o
NOTARY PUB IC: NOTARY PUBLIC:
Sign: Sign:
Print: t-'A1' r` M 2 Print: A /L(• J(o.��i o E�
Seal: Seal: —�-
MARGARITA M FltlaFilQU(xX ;:N'•"4., MARGARITA M RODRIGUEZ
Ii FF224715 M
•: MY COMMISSION p FF224715 s! } MY COMMISSION
EXPIRES Apr1127.2019 ; ''4;;•„d!° EXPIRES AIxi127.2019
********** w*a,aft'�#**********�**�***�*:►***x:, *a:*�*�:*a***:�***,x**r.•*>y,*:�*a�;#�.�3`*****F#r,�1%'�!`, K'tri�#**** ********
” I
APPROVED BY _ Plans Examiner _Zoning
Structural Review Clerk
(Revised02/24/2014)
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