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EL-17-2428Miami 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 El ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 1 ,)-(c, NIL 161 Citv: Miami Shores County: Folio/Parcel#: 1 - '_ /s5voZSt Occupancy Type: Load: Construction Type: RECEPVEO ©C 1 iltzw h FBC 20 Ny r^ Master Permit No.R �� - 2-L1 ZY✓ Sub Permit No.te ZU2$ ❑ REVISION ❑ EXTENSION ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR . Mia NC&'LLFfr: Is the Building Historically Designate gnateYes Flood Zone: ❑ RENEWAL ❑ SHOP DRAWINGS NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): /�U�Gt-lam l / / AP�IIX Al pi e2/ Phone#: Address: ,' (p i✓ 'D g �� ' 0 City: ( 0-X ",4J �:"1:Y.D.-n State: Tenant/Lessee Name: r� 1. Zip: 3s\3S Phone#: 4 Email: C ,\ cL iclh COif\kla ry 1 S t e.CSY€S ) P '\ 6V1 • C CONTRACTOR: Company Name: CPS Electric, Inc. Address: 1600 NW 28th Ave City: Miami Qualifier Name: Angel Romero State: FI .ca+w• Phone#: 305 6345570 • . State Certification or Registration #: EC13005401 DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ ZP 5D Type of Work: ❑ Addition ❑ Alteration Description of Work: Zip: 33125 Phone#: 305 6345570 Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: New % / / ��❑ l�o / /?. �o r-ep10 ❑ Repair/Replace 42- V3 Pi C.CJ t€ \ 1 — LeciQ ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ C� DBPR $ 2 ' 2g Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $\:9 3 •05 (Revised02/24/2014) 1 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 applkant must promise in good faith that a copy of the notice of commencement and construction lien low 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 whkh 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 reinspectlon fee titil Ocirgl ... ANG LLED ,172e.-6 6 Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this C) day of OL* , 2019- , by CACCAMCI,A 0 �`ntY' ),.91?'o e piy rsonali known to me or who has produced - fi it ()i as identification and who did take an oath. NOTARY PUBLIC: Si Print: Seal: MAHARAI K. GONZALEZ EXPIRES: November 2, 2020 ' ,p ;F Burwlud Thai NuGwy ruuA. u,n ,,..,,l,.rs NTRACTOR The foregoing instrument was/acknowledged before me this day of a6ef , 20 /7 , by AN,'W ,vV1 E' l2 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY 4 o '" D4:"- JEANNINE RAMIREZ Notary Public - State of Florida •c My Comm. Expires Feb 3, 2018 Commission # FF 089240 i!!!!!!#i!!!i i#! #!!###!lilt! i#iii##!!!## ii##!! # ##!!!i i i #!#i! i i #ii!!i4•ii!#*+1_##!#!6*#Jtit###*;i!!i#!#!!7R#! APPROVED BY 41111111or Sign: Print: Seal: a-.d—Gr l S'Plans Examiner Zoning (Revlsed02/24/2014) Structural Review Clerk