RC-17-2426I ok 4(2,09
ati-kor-
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 11
INSPECTION LINE PHONE NUMBER: (305) 762-4949 t`'1
FBC 20 lq
BUILDING Master Permit No — ZC0
PERMIT APPLICATION Sub Permit No.
p‘JILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
RECEIVED
c0024117
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / 2 6 If ` ,L 57
City: Miami Shores
County:
Miami Dade Zip:
Folio/Parcel#: l — �� ads- c& E'Qs the Building Historically Designated: ,s NO
Occupancy Type:
Load: Construction Type: Flood Zone: 86E;� FFE:
OWNER: Name (Fee Simple Titleholder):/a, v a < ( c�Lsc 2. Phone#: 34:�� f t .2-2 Z. eY
Address: / N 177 1 d_L 571 it,,,,
: ; 344tff_.
City: / F = 540, r-' . S State: r/
Tenant/LesseeLeName: `•
Phon\
Email: ` >` ('t 1,� \ n �1 `(�_ c rv'.C(\�\ }j��/ vt s . t'iS1il S I Vt�C�T 1 "CsYVL-
CONTRACTOR: Company Name: ,(
p Y C�Qv? S l 1' l.>'c,<<ls� C_� <' '� • Phone#: •4..
OR 4 & f t S ` J,,,
Address: ` ` Q� %LSz. � `U( �` � Zo �w .�
City: t� 1 _l 1(,a Y�(1� State: li .�,. Zip: 3 3 I e
n 11
Qualifier Name: �V al vct 1Q S • CrJ! ! 7 ' ,ra
f'vr a� Phone#: �S ' � -1- 9 �.P� te
State Certification or Registration #: C. r)C 0 S 0 Certificate of pAcy #:
DESIGNER: Architect/Engineer: 1� S �1// -s- , `P _ e#:. 3cS - Ar - 1 624.9
Address:`� �! 1
�\ �..� 1+ �. it,,
City: �l l� . ' State: C- I Zip: 3 3 11�- I
Value of Work for this Permit: $ if 0 0 0 0 I '' ,.il3 re/Linear Footage of Work: Z�c/6 n �7 7
Type of Work: ❑ Addition ❑ Alteration ❑ New. ❑, Repair/Replace •• ❑ Demolition
Description of Woik:
—To r-eP \O Cc t2JC t 2 - 2 I o) S •
Specify color of color thru:tile:
Submittal Fee .'$ 3 d0 (D Permit Fee $
CO/CC $ -
Scanning Fee $ Radon Fee $ 3 �J ' (,3 DBPR $ c' f 00 Notary $ 47-D k t'AT>
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 3 eG • 50
3/ 3C D. C CF$ 2& GO
i)V
(Revised02/24/2014)
Bonding Company's Name (if applicable)
t
Bonding Company's Address
r 4..,»
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 p/operty 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 pection fee will be charged.
Signature
OWNER o1GENT
.1
Theforegoinginstrument was acknowledged before me this
7 l day of 20 , by
������.pe sr onally known to
me or who has produced •�,Ly�Nas
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
•
APPROVED BY
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
31 day of
CLOUD( 0
J
me or who has produced
, 20 , by
, his perms s ally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
) t,
Print:
Seal:
Plans Examiner
ERA
Structural Review
2 i
•o:2 S �P1 �•1��
as
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Zoning
Clerk
(Revised02/24/2014)