DS-14-1908 Lc� ar 67
Miami Shores Village CEIVED
BuildingDepartment p SEP 0 2 014
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 t c>
BUILDING Master Permit No. — I
PERMIT APPLICATION sub Permit No.
,JWUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
t� CONTRACTOR DRAWINGS
JOB ADDRESS: sy'oa z
City: Miami Shores County: Miami Dade Zip: 3 1 3 y
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder)'�� i r Q ►S�� Phone#P,57) 7 7 _A4%—V/
Address:
City: 1,w%k Oct,�� State: Zip:
Tenant/Lessee Name:. Phone#:
Email:
CONTRACTOR:Company Name: C.;C.sli Gr>w,v Phone#: CC`s` X019"
Address: oc Vu
Al{•`
l �'� yft•
City: l A VA\ State: Zip:
Qualifier Name: \vim Phone#:
State-Certification.or Registration•#: Certificate of:Competenty
1 DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ''7>S-00 quare inear Footage of Work: '4-;ro
Ar
Type of Work: ❑ Addition f9-.Alteration ❑ Neewe ❑ Repair/Replace ❑ Demolition
Description of Work: -3-T&A✓%,P CVin � Prr� pdZo):.C't4-
.a+� s1h..,c.5- a�r-'�w,. -.l""+ �_, s,,,,, t• r: ,�� .fin
Specify color of color WU tile: „ t `' ;{
Submittal Fee$ �(� lit_ Permit Fee$.IJ w,\`�� CCF$ � CO/CC$ � y
Scanning Fee$ `I. \_�� Radon Fee$ DBPR$ Notary$
Technology Fee$ ^
��� Training/Education Fee$ l l �i _ } Double Fee$yam
Structural Reviews$ Bond$ f`yW rlJfl_��^
TOTAL FEE NOW DUE$
(Revised02/24/2014) _ /'� Ll r
4 1Q
T
Bonding Company's Name(if applicable)
Bonding'CompanVs Address _
City 7, State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City t 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 OFF 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 R
OWNER or AGENT -CONTRACTOR
The foreDoing instrument was knowledged before met J ing instrum nt was a riowledged before me this
day of 20` i by of 20 Ig by
who is personally known to r( ho is personally known to s
- 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:
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Sign: Sign:
Print: Print: t cJ
;6y•,, MARIA DESPUZ
Seal: ; ' `�- MY COMM1SS10DI FF 044099 Seal:
tr= N MARIA DE BRUZOS
EXPIRES:August�C,?017
.„MY COMMISSION 9 FF 044099
H d; Bonded Thru Notary Public Underwriters
EXPIRES:August 20,2017
Bonded Thru Mary Public_Underwriters
(rT
APPROVED BY Q L� Plans Examiner < Zoning
Structural Review Clerk
(Revised02/24/2014)