RC-16-2386Miami 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
✓UILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL OPUBLIC WORKS
JOB ADDRESS: 4 44
7-1-,-7-
11M 0 2 2017
BY
FBC 20 14
Master Permit Not E\) 1 --4' ` 11
Sub Permit No. - 23? G
REVISION ❑ EXTENSION
❑ CHANGE OF
CONTRACTOR
. q G-17-2-T
❑ CANCELLATION
RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33(5S'
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 44A --0 '--)
Address: 5^31 „tt, cf0t, 3
r —
City: Y"4 LC(14 1/j S State: ''f7(
Phone#:
Zip:
173)3
Tenant/Lessee N me: Phone#:
Email: 5e �� E> ('L 1 I C�vr'1
CONTRACTOR: Company Name:. ,A L MO-I-IZACTO K
Address: 1240 Nut 1� 5T
City: f` riPMI
00 C? Phone#: 'l$(O r* cjg3 �J
State: 1L Zip: 33175
Qualifier Name: _ A - fa -Jet- - OAL cSO Phone#: r]grp '71$ cicia5
State Certification or Registration #: 661 C 1525,f (2. Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 1¢O () .170
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
Square/Linear Footage of Work:
ri New
❑ Repair/Replace ❑ Demolition
• Specify"co/or of color thrurtile:
f 3 4Y2'1a .p° `�� .�fl
Submittal, Fee $ '�� OM A Permit Fee $
Scanning Fee Ste- i t'a'A •T,.,- Radon Fee $
as ;:a1A 1
CCF $'',0"; Rr: ,"Y< , CO/CC
DBPR $' r 7'1 i;. ;,,,: n M NMa ( •k•-
Technology•? _.
Fee $ Training/Education Fee $
Structural Reviews $ • CC)
Double Fee $
Bond
TOTAL FEE NOW DUE $ 6 4" W
(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."
r
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. absence.of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. ,,
Signatu
The foregoing instrument was acknowledged before me this
OCO day of . 20 I , b
�U, 1 '�7 by
, who is personally known to
OWNERbr AGENT
Signature
+ r nxUG-1
me or who has produce ► 211 (,tC,. as
identification and wh
NOTARY PU
Sign:
Print:
Seal:
"1t11j�"' YINET CAMPBELL
=otter n�¢��t
* * * * * * * * * * * * .� �%'�` �naia�Y�P>ua;>scl >� staia�a�I Friltta�e
ni My Comm. Expires Oct 30, 2018
;' F`d' Commission # FF 173J�9
OF f�
APPROVED Y """"
In the
III' ,s
CO CTOR
•1 L... ii .L 1': )
The foregoing instrument was acknowledged before me this
day of AF 1 .F , 20 in , by
A who is personally known to
me or who has produced Rd 7-4C. as
identification an. did take an oath.
NOTARY PU:
Sign:
Print:
Seal:
rC
*********s********
plim4Plans Examiner
`\\\�11111,
o��ar Po'e'a,,� YINET CAMPBELL
�a 1 4p i - S ate of Florida
iif ," My Comm. Expires*Octgiri'i%
1r � Commission # FF 173169
r lI111 '''
oning
Structural Review Clerk
(Revised02/24/2014)