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REV-18-573B ILDINI ILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ PLUMBING ❑ MECHANICAL 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 tlR/❑PUBLIC WORKS ❑ CHA C CONTRACTOR RECEIVED MAR 0 6 2018 FBC 201L\ Master Permit No. Sub Permit No. �e.\1 ❑ ROOFING ®iR V SION ❑ EXTENSION ❑RENEWAL JOB ADDRESS: IJ O E '1 4 ST City: Miami Shores County: NCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: 3 (3 s? Folio/Parcel#: - 3 a3 6 - o t 3 ^ a., ct 1,© Is the Building Historically Designated: Yes NO Occupancy Type:1Ze.s Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): STe. r C ()L 1 6-to Address: S N E q L1 • S BFE: Phone#: FFE: City: M I M S e ct i s A:t1JCEjjED .3 13 E Tenant/Lessee Name: Phone#.Zip: Email: CONTRACTOR: Company Name: L C e (de.5 Co N S RUB i p N V Phone#: 340 5 4 - 3$ 9 y Address: 18' 1 8 t w 11 et uo c> y City: H % A \ e_. (\'\ State: V \ Zip: 3.3 e t 5 Qualifier Name: N A N C. ‘-1 C c \ -} e S Phone#: 3 o 5- L l-.% -. 8q 21 State Certification or Registration #: C C C 13 3 6 2. 4 to Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 31000 Square/Linear Footage of Work: al, l, FS (o Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: r'1 e. \ S ti O t•a F c5 fZ F • 'al a et -To ) N\dI E Sc 1Vv 5INT\ c, oo� Specify colors of col35- or,thru tile: • ".r (... Submittal Fee $ Permit -Fee $ Scanning Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (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 F r R. . City State Zip 4 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 nth t*a (Separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIRCONDITINERS;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." O Notice to Applicant: As a condition to the issuance of a building perms n estimated value exceeding $2500, the applicant must promise in g d faith that a copy of the notice of comm s l,construct>tin lien law brochure will be delivered to the person whose prope y is subject to attachment. • Iso, a certifie'1e';.' W'the recorded e of commencement must be posted at the job site for thefirst'i i section which occurs sev: 7 days aftt , din %emit is issued. In the absence ofsuch posted notice, the () Y>� 9P inspection with ';t pproved and a reinsection fee will be charged. Signature OWNER or AGENT' The foregoing instrument was acknowledged before me this c2 day of IA A ae-ti , 20 (X , by STePAN a Cottiu /11 , who is personally known to me or who has produced F / fl / as identification and who did take an oath. NOTARY PUBLIC: Sign:L' Print: AH fj e 2 C6)fz_ LA Seal: ystY P/�_ AMBER CORDOBA 'K* MY COMMISSION # GG 063399 OF Fog? EXPIRES: January23, 2021 ******************************************************** Signatu CONTRACTOR The -foregoing instrument was acknowledged before me this c, day of P//RGGi ,20 I$ ,by NA/VC y C f! 1'e8 , who is personally known to , me or who has produced F / 7 C • as identification and who did take an oath. I NOTARY PUBLIC: Sign: Print: APPROVED BY Seal: •s�F+ AMBER CORDOBA a MY COMMISSION # GG 063399 >4oF foe EXPIRES: January 23, 2021 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)