REV-18-279BUILDING
PERMIT APPLICATION
BUILDING 0 ELECTRIC
PLUMBING 0 MECHANICAL
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
▪ ROOFING
REc "--
FEBO520k8
BY:
FBC 2014'1r\
Master Permit No. g C P '2-3 1
Sub Permit No. ` z - 1 9
1ff REVISION 0EXTENSION 0 RENEWAL
CHANGE OF
/ G% CONTRACTOR
JOB ADDRESS: 7 3/ /(/ B S T /1 S %—
City: Miami Shores
▪ PUBLIC WORKS
County: Miami Dade
❑ CANCELLATION 0 SHOP
DRAWINGS
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type:
Flood Zone:
NO
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /.-Z-7L/T0AI/ f / U- 2.0 a/a Phone#: 3US- 7c16'-�y�6
Address: X // `� T' Sly j
City: ,g1fe.4-y/L4 �/¢X�%� State: r i Zip: 33/6 ,
Tenant/Lessee Name: Phone#:
Email: 4-b /CC/Li ?tJ ) (0 141
CONTRACTOR: Company Name: 2>/Z: / ( /j7.se //7C Phone#:
Address: r;& r S� C�� �dPi
City:l.J€ T /� State: /� \ Zip: 33
Qualifier Name: i'-///9/� /71../¢ ( Phone#: -.P5-6-4401/9
State Certification or Registration #: /96-. /%,°'‘.3,5— Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 34 42
*gy
Square/Linear Footage of Work: 3.5.
Type of Work: ❑ AdditionitAlteration ❑ New
Description of Work: c.4//S f%/7pioG/44e
Zip:
❑ Re air/Replace ❑Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ ` _ _ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
•
Bonding Company's Name (if applicable)
ti t: t! j '
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 cibuilding 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 Ot 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. , k, 4 i ti
Signature
.' -,
The foregoing instrume. was acknowledged before me this
_.ice ,,,
da of CO 20 13 ` , by
MG U r ; CV F--dn , wh. is personally known to
%VQ v (1 Ckeus'e
me or who has produced
identification and who did take an oath.
NOTARY PIIBLI
Sign:
Print:
Seal:
a
4`44% YANADI RIET0
.; �•� •.- MY COMMISSION # FF214031
""r. EXPIRES: March 25, 2019
Bade ThruittariPM rrde d,te
APPROVED BY
•
(RevisedO2/24/2014)
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Signatur
The foregoing instru
bi.hv `day ofn"
as me or who has produced
identificati. - . nd who d'
t I,
NOTARY
Sign:
Print:
Seal:
BLI
CONTRACTOR _
t was acknowledged before me this"''
11��,,, (� 20 1 l"') , by
Y 5- r , wtlo is personally known to
-Thrt uI?v l iCtr Y as
a
take an oaah
uG
r7
•• "Y?yV; YANRIETO
;'. MY COMMISSION # FF214031
a_._�� : o EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
*************
//i'pIans Examiner Zoning
Structural Review r Clerk