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FW-17-1650BUILDING PERMIT APPLICATION 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 Master Permit No. PEZ.LJV,ra Sub Permit No. t-l.) (R- - t (95(3 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION t RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP c ,` CONTRACTOR DRAWINGS JOB ADDRESS: 2J ( fJC qB S City: Miami Shores County: Miami Dade Zip: j i 38 Folio/Parcel#: \ 132- Oce, 0 ( 3(L4 ( 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: _ Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C)ft:Dec- Address: ZS ( IBC 9 8 Sr City: V\ ‘. 1/1cDc- 2 S State: c_ Phone#: SG ( -c,:(_ 3533 Zip: Tenant/Lessee Name: Phone#: Email: 33 (38 CONTRACTOR: Company Name: V (e . -? i c e Address: -42 c7 S . S r-. �f ?as .ACceS-5 Phone#: �� ��o��(- 3533 City: 0-1\' 2c+ , '17e.2Gk State: {�I Zip: �i 33 1 Qualifier Name: LA.4-' T.,.� 1, ?e Zf 'Z, , .� Phone#: 3)5 -4 (1O/ State Certification or Registration #: C ( < (S—LS 0 'Y+ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition r-c 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: w`Y ' J { 3 [fi r"� ='ham Cad f ! s q.a. .5 VO;Zi": '.:At 1:;d' Specifycolor.:of color'thru tile:'' } 'tw.' t:h AZS•,..:rAY.•.�*A,G ..r�',.�.rJ:y,T �, i �—� Submittal Fee $ d...... Permit Fee $ rc%> :CS v! t.nr':rl CCF $ - CO/CC $ Scanning Fee $ - r� Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ GE ((0 ` TOTAL FEE NOW DUE $ (� W (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 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 OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 02. day of .-rc14./1 , 20 18 , by Cr2.- day of +___r-CSel , 20 ct Q,e rc , who is personally known to Ce e-e 13z1-.? who is personally known to me or who has produced as me or who has produced as identification and who didtakean oath. NOTARY PUBLIC: Signature Sign: Print:• Seal: ..�ini// MY COMMISSION # FF964004 ;o; am EXPIRES February 23. 2020 140/:398-0a3 HactallotarySeNicecam ******************************** * * * '*****,J*****************'********************************************** CONTRACTOR identification and who did take an oath. NOTARY PUBLIC: 18 , by TIN ti TORRISI Seal: MY COMMISSION # FF964004 EXPIRES February 23.2020 MalallotoryBenke.aar APPROVED BY v Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1 :t/z 6/ to) 0.4. i0 0 owe p o.o d dstd cz.. L 070 hV Si DE 77.1E 'vac, sE ONE S-re:DA2.5., - _ Fences- GoadlitatuV'EVtalrid horizont pl t.pporting members •of a fence shall face t i terior of the _plot on which the fence is locat nd the finished side shall face the adjoining lot or any abutting right-of-way. ' G. CP A/ C.1 • . z; A.:at*: . f=4,-,s//2/, 641. ( '"0)) .3 • E , eLd -pss Ds .._7) Miami Shores Village se) 7"W ,.srAPPROVED 2 0.50' s r-HA0AONNGDEPT 171-0 TPSTI-m OCT 1 .1 20i3 L BLDG DEPT BY 'SUBJECT TO COMPLIANCE WITH ALL FEDERAL B .............. 4.-3C "ITV :'.1,-_14,4--P-41\11•4•4=4.ti6lit.o.I101\11 e� �e C� � �4/Ge-p� /ft OD D r eel `i-v 4f Ua k f 4_ of 9cde i6 if HQ./, (1ipic EkosI 1 Yij