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DS-16-2606 liami Shores Villag ,, ID Building Department sip 31 zoo 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax: (305)756-8972 —' INSPECTION LINE PHONE NUMBER:(305)762-4949 5 FBC 201q BUILDING Master Permit No. L .Z.00 0 v� PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC C ❑-ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL- ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10B ADDRESS: 3 coo ( rJ3 ST City: r Miami Shores County: Miami Dade Zip: 3313$ Folio/Parcel#: '( 3 2v&O Is the Building Historically Designated:Yes i NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Phone#: :3:17_S2_ lob�`► . . Address: 3(oU, City: �'`�'4 t S S State: TL Zip: Tenant/Lessee Name: 10+' Phone#: Email: CONTRACTOR:Company Name: Phone#: Address: 1 l0°1� ASIS n.E� �C�►� 4U City: YL I WA, I Stat zip: S,00 i. Qualifier Name: M1LL4 41C1. ' Phone#: f State Certification or Registration#: CCfC, 115N 3_'(o Certificate of Competency#: _ DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$, y�5ao Square/Linear Footage of Work: 5&O Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace s ❑ Demolition Description of Work: u✓ ©ti1VIL k�4. 4– Lel 2�c,1+,dvE �cxlSh . c z7,�jS�1i1 (WNi�:� "1YJ Y ti t ��1/�s}�E "b (),G'I(,01A)a 4 f Specify color of color thru'tile Submittal Fee$ d Permit Fee$ CCF$ �'� CO/CCµ$ +� Scanning Fee$ : `o, Radon Fee$ DBPR$ rNotary$ Technology Fee$ 4 Training/Education Fee$ Double Fee$ 0 Structural Reviews$ Bond$ r�d TOTAL FEE NOW DUE$ (Revised02/24/2014) r'tf f •. Bonding Company's Name(if applicable) Bonding Company's Address City - State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City s 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 bf 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 tie 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. K "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 appioved and a reinspection fee will be charged. ]::�: Signature •r Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this oing instrument was acknowledged before me this (a day of \t 20 ib by 16 day of AtA46T 20 IJ6 by r!'►IW � who i5 ersonally own to t "� —' who is p rsonally kn n 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. 3 ' NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 'rtGn rti G h�,o hui C (tQ�. Print: � Print: •� "%,\ GIACOMO CHIOVARO Seal: Seal: " ` t )' rnYCOMMISSION#FFii;• My COMMISSION #FF160979 ,a EXPIRES 30ptember 17. _c (40 ;J , . ;'Fancf�: LAPIRES September 17,2018 J af157 1407)398-6153 FloridallotaryService.com, �.. 'FlArideNoteryServictr:.�:; ' APPROVED BY /Y Plans Examiner CU Zoning Structural Review Clerk (Revised02/24/2014) ,