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REV-18-710c\acAl BUILDING 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 MAR 2! 2018 FBC 20n Master Permit No. RCIOIb2€CitZ''�, Sub Permit No. eiCV 1Z— 11.0 BUILDING 0 ELECTRIC ROOFING a REVISION 0 EXTENSION El RENEWAL PLUMBING MECHANICAL El PUBLIC WORKS EI CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOBADDRESS: eci U.P LOct Si" City: Miami Shores County: Miami Dade Zip: 3 3 ( (2 1 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ,) Address: e \ 1,,,c lock s-�- City: y...\; SkAere...S State: F \ Tenant/Lessee Name: Phone#: Email: Phone#:' O -- 2E 'to.SSci zip: 331G CONTRACTOR: Company Name: Q014/2_ /\ COn J (1#,ran '3J titer' Phone#: 3Q$'.--aLItt—C1lat Address: 1 o' rn Pe&teh € Dr City: M\At State: F\ Qualifier Name: kOt S State Certification or. Registration #: add. /•j 3 1 31 4- Certificate of Competency It DESIGNER: Architect/Engineer: Phone#: Address: 6 City: Value of Work for this Permit: $ Square/Linear Footage of Work: 4 k- 0 Zip: 33161 (� j Phone#: WS- a��.�9, `l State: Zip: Type of Work: ❑ Addition ® Alteration n New I I Repair/Replace Demolition Description of Work: Rtuisor1 Por *kc u jvr al 'FoundoA con e.4.1\- 6Aaruy S On , k.ckY\ Y10 Yl-e & W 0 " k . Specify color of color thru tile: !, Submittal Fee $ Permit Fee $ ~ o • CO CCF $ CO/CC $ Scanning Fee $ _.Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Bond $ Structural Reviews $�(0) 03 (Revised02/24/2014) TOTAL FEE NOW DUE $ ►39, 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 20tlti day of MArCh , 20 le) , by 6' 04 y1/4).;-j ("Glt'c L , who is personally known to me or who has produced 0v iv-Q f t IC_'trio 1 as identification and who did take an oath. NOTARY PU Sign: Print: Seal: Arty , YAN i PRIETO ,a, :;;, MY COMMISSION # FF 214031 "�; ITIr : �. �.-. , ` EXPIRES: March 25, 2019 *044 d 7 n Mary Public UndenariwrS CONTRACTOR The foregoing instrument was acknowledged before me this ©day of KCA.Y^0h , 20 l , by �V1 S \/]]/• , who is personally known to me or who hasproduced pergov..41.41. ir'oW h as identification and who did take an oath. o Dawn Marie Leighton NOTARY PUBLI i NOTARY PUBLIC o STi FLORIDA • G110341 4 Sign: W �� 1 Print: Icti► U >► M• �.etgr `OR' Seal: `J ************** ************************************************************** APPROVED BY (Revised02/24/2014) Plans Examiner Zoning Structural Review Clerk