PL-17-2573 (2)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
REC]ET VED
CT30 017
_
FBC 20 ILI
Master Permit No.TFP! - 2:3 2
Sub Permit No. ?LA-4- - 25 �3
El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 15 CJ IVE 107
City: Miami Shores County: Miami Dade
Zip: 331101
Folio/Parcel#:11. 2436' OV 1 •OQy(J Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Er/111m grerlf vni- 4, 3e e kojok.off Phone#:'72(o• -233-1 •
Address: 160 NE. in 51rc ‹.--1--
City: 'Jam % .ShoreState: -L Zip: 3-)(01
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: , C Pk) V - IVAl VLC..O.) 1 VI 2 Phone#:
" Address: 3ta BpJIce,nJN (k{ lour 0
City: [O(L11 (A)C,�C / State: r-L Zip: 3oi'
Qualifier Name: : V� ear lc5 I-Q c '•\ Phone#: ` - ? )O U01 Z
State Certification or Registration #: Ore j ((a'o 9.3- 7 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1, /029,470 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration
n New
Description of Work: 1V fV , /0,-/6/14G Po.e puda,�ooG-
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile: -�
Submittal Fee $ 03 ' Permit Fee $ .,[ •W CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ [�
TOTAL FEE NOW DUE $ (; • ('J-_✓
(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
The foregoing i
d
E rrl i 11 le,r .id w , who is personally known to
me or who has produced OL o r, c; 1( as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
ON RACT
Signature
OWNER or AGENT
ent was acknowledged before me this The foregoing instrument was r
.ckno ledged before me this
20 11 , by 2-8 day of c OO l9&\ - , 20 t , by
who is personally known to
R
NOTARY PUBLIC):
Sin: �` /��; Sign:
Print: Sll.�a1)a, V.- (,t,t_2 Print:
k��►Y. eP,�% ��s. uyapa T. Vasquez
Seal: 4. Commission 0 rr an 41 Seal:
Expires: December 9, 2019
eetV Bonded thru Aaron Notary
APPROVED BY
Plans Examiner
Structural Review
JORRS 1W55Z%&U
MY COMMSION 0PP11904$
EXPIRES M y 4.701E
(407)39e403 IlloridallourySaivicemat
Zoning
Clerk
(Revised02/24/2014)