REV-17-323Miami 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
BUILDING ❑ ELECTRIC ❑ ROOFING �EVISION
❑ PLUMBING MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF
p; CONTRACTOR
JOB ADDRESS: / 0 / ,V G 5 57
Master Permit No.
Sub Permit No.
City: Miami Shores County: Miami Dade
CE JJED
FEB 082017
FBC 20 14 5t'h
Pity I1- 3 23
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
Zip: 33/ 3b
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
BFE: FFE:
OWNER: Name (FeeSimpleTitleholder): MPS "15 A.4 e Phone#: ( 36S) 8G7 "4/6q5-
Address: /�/qe N& and ,4
City: LI t'z n i 51V68-6-"3 State:
Tenant/Lessee Name:
Email:
Pe-- zip: 3'� 131'
Phone#:
State Certification or Registration #: CA C 181 6 5 37
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $ 100 Square/Linear Footage of Work:
Type of Work: ❑ Addition1-1Alteration❑ New ElRepair/Re/p-lace ❑ Demolition
Hate) Description of Work: Atir" t l''K e as par A e v day 04)1) /32 yfrtakie
o bZQe4, ,c2-x03 T-e:11 e�
CONTRACTOR: Company Name: aa s Yee Qdig hlQ2/ t4 vite co'- . a,1�'
,�/ � Phone#: ��3 9g-6
Address: ' L� sal NUJ 33 ' ,4'•
City: LR1i! State: 1- Zip: 33 1Y2.
Qualifier Name: Rider de 14 ,Jcd'e2 Phone#: 6 4) 1' .3 -/367
Certificate of Competency #:
Phone#:
City: State: Zip:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 0 CCF $ ' (00 CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Z Notary $
Technology Fee $ + Training/Education Fee $ . Z'd Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ I 1 L-I .
Co t0
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 f such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
NER or AGENT
The foregoing instrument was acknowledged before me this
en
8 day of F`'"w� ",20 L')- ,by
a Lye .u///z-)12 , who is personally known to
me or who has produced 6.7/1 �[•t/2,-' as
identification and who did take an oath.
NOTARY PUBNNC:
Sign:
Print: Cli(%j-VlC) CI 11"�
Y
RICARDO IRIARTE
.
PUB"•'"
MY COMMISSION #FF088736
";•,,, ,00-: EXPIRES February 2. 2018
"(4071368-0153w" • F.o... I ItI,. I Iicef.. I , 1*******t;n2aminer
** *. *****
APPROVED BY "� N
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
O 8 day ofFe/JY6t?y , 20 1 , by
d"
6e, who is person/ally known to
me or who has produced &der' de C4. 'wilts
identification and who did take an oath.
NOTARY PUJQIC:
Sigrf:
Print:
Seal:
ialg
RICARDOIRIARTE
• MY COMMISSION #FF088736
cf,,di EXPIRES Febru;:,ry 2. 2018
#> Mieb44 1 ***Feipy4lr>!Alplgl!! .044M***
Structural Review
**************
Zoning
Clerk
(Revised02/24/2014)