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REV-16-2896
BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC ❑PLUMBING ❑ 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 RECEIVED CT 2 5 2016 ST� FBC 20(`1' Master Permit No. RC`l 55 /6/4( Sub Permit No.— (& 2eQ.G �EVISION ❑ EXTENSION ❑ RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: I2 O / Nye- cmT S1 t( b City: Miami Shores County: Miami Dade Zip: 3 3 / 3 0 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): De Ak6 %2(0 iJ R.AS Phone#: 26 -5 (2 ^ 17y Address: (2-0 ( NE T"`-(-- Siy €T i City: IN1 l A ' t State: Zip: 331 3d Tenant/Lessee Name: �TbC LD L-s) (4.s Phone#: 7f.b S l Z - q 7? Email: L L- G 2 ( 6, Mt-A-i L . Co M CONTRACTOR: Company Name: 6),a. /cT 12v .77e ,4/ 1C9 Address: /6,716�l-0 (I) Sogc/ 3 20 City: r74(JC&r State: L Zip: Qualifier Name: vf0�a5i GOTE1212 Phone#: ( ) State Certification or Registration #: C. CC /S-(8 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Type of Work: ^—a" Description of Work: ©'_ Phone#: Square/Linear Footage of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace '5c 15 /'V G £X ( /)o 9 To 14/1 s 4Th 200a! Woof S 7--P-2 f&C Z r -14 /V ❑ Demolition Specify color of color thru tile: 3 S Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ g • Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ 80 Bond $ (Revised02/24/2014) D v TOTAL FEE NOW DUE $ Zq 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 su ' posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 1 S�'r�^l. g �� WNER or AGENT `—�I' OR at The foregoing instrument was acknowledged before me this The foregoing instrume' as acknowledged before me this Z.- day of 0C3313E`ie— , 20 CCz. by day of G of 8E.2- , 20 (G , by M.- (i J G'-1.0 el S , who is personally known to leSE is j(S GOTTEes personally known to me or who has produced 1)121 Vim .L./1..r-N .. me or who has produced F-.L J f _ 1 f identification and who did take an oath. Signature identification and who did take an oath. NOTARY PUBLIC( NOTARY PUBL Sign: Print: s,I4cAA Seal: skg:f °L't Notary Public State of Florida Sindia Alvarez 4 My Commission FF 156750 S '4'of or Expires 09/03/2018 Sign: Print: Seal: ******************************************************************** APPROVED BY (Revised02/24/2014) Plans Examiner �6041Y Nt Notary Publi' Slate o Flofld'r. e. Sindia Aivare2 I. e * oft.° Xp e50 * 9/ ' i*'**CV41*********** Zoning Structural Review Clerk