FW-16-3280 (3)Address: 22_1 S w
Occupancy Type:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑
Oft
REVISION
FBC 20 (J-i
Master Permit No. f LA) l- " 6
i
Sub Permit No.f —�2_4v
—tC-32
❑ EXTENSION [(ENEWAL
❑PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS E OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: 2S 1 \ c `(g ST
DRAWINGS
City: Miami Shores County: Miami Dade Zip:
Follo/Parcel#: (- 32-067 - t i I.3 - H1 0 Is the Building Historically Designated: Yes NO
FFE:
Load: Construction Type:
Flood Zone:
BFE:
OWNER: Name (Fee Simple Titleholder): C /1 �7.€f ' IC Phone#: G -37.c-42 )
Address: .c+.44 I A r,e 2 C1 3 ( ud Sic 2 J2.
City: a4u.) / 4- 6
Tenant/Lessee Name:
Zip: Ji 00 -(
Phone#:
Email:
CONTRACTOR: Company Name: j !.J Z -41n GC-:7c ' . `I� Phone#: O G -2-27a 7-4-6
,J;;--
i 6c�
:
City, State:
Qualifier Name: Lott l O. O 2 c z_'1J 0
Phone#:
Zip:
State Certification or Registration #: CGC (S i I 0 4-O Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ -(9 _ — Square/Linear Footage of Work: /
Type of Work: ❑ Addition ,Alteration ❑ New *1 Repair/Replace ❑ Demolition
Description of Work: Re 0 2 t' r Q •-1 C Fcp,•- cam. CI'
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $ JOr
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 6 ( I`
ED v
(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
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 comme • a nt • t be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In - .;e o ch posted notice, the
inspection will not be approved and a reinspe n fee will be charged.
Signature
WNER or AG
The foregoing instrumentnwas ackn. (edged before me this
J day of u � , 20 \i— . by
�CJ no In who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
MY COMMISSION 9 FF964004
+;• EXPIRES February 23, 2020
•40/; 3lr8.Oi 3 ► • - � fvto.Odb
APPROVED BY
(Revised02/24/2014)
7-
Plans Examiner
Signature
The foregoing instrument was acknowledged before me this
l 4 day oft \yl , 20 t �-- , by
l0 2r-aj a , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Structural Review
:hA MARTIN G TORRISI
Ira MY COMMISSION # FF964004
•;.,; ;. EXPIRES
NFaesbrr�unarryyo2� 33..n2020
Agra.
un sys o,s3 eagg i rra ks* ir,R!!'ilsrtsssar*y, y s-**** ***
Zoning
Clerk
POWER OF ATTORNEY
The undersigned hereby authorizes Mr. Bruno 1-lalimi to act as my representative in
regard to the property located at 251 NE 986 Street, Miami Shores, Florida 33138.
David Pcyrec
Owner
Sworn to and signed before me. this Z1 day of
Miami, Florida USA
Maitre Jacques BERAT, Notalre Associe
d'une SCP. Titulaire d'un office notarlal
51, rue Bugeaud 69006 LYON
Certlfie veritable la slgeatora do
i
.2017
Notary Public, State of Florida.
7
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