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REV-17-2468(As\\''' y.� 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 RECEIVED V11 FBC 20ILI Master Permit No. Q.C. 1 C ~ 3(S2$ Sub Permit No. �� R C U(DS El BUILDING ❑ ELECTRIC ❑ ROOFING EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 2-C1 {N C ge� ^� 71,� r� r Citv: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: t *d ti= c City: Puyvo Qr \ L- C_ Phone#: S tom= State: fL Tenant/Lessee Name: Phone#: Email: Zip: 1 vg CONTRACTOR: Company Name: Aire a.Y-i c,Z 2 > k 1 Phone#: j 6 \ C7(t `sS-3\ Address: ){ o k Air City: J cLr.�` tj2� State: �L zip: "n t t3 Qualifier Name: LTPhone#:� s j'�S 3 \ State Certification or Registration #: �ir C 1'So Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip •Value oflWorkforthis Permit:f$ Hry Mtn ,� siGA,`;,'<�;1 TypeiofWork ` Addition: Descriptio ofWork:"°'?"(Wo eJ�o CAI eration .ri, Square/Linear Footageof Work.T ❑ New [�)epair/Replace:;I;:;e";❑ Deinolit�on �,kle}fi.t{ t- peierf""_nf�c KrCIR Specify color of color thru tile: Submittal Fee $ Scanning Fee $ )S - CO Technology Fee $ Permit Fee $ 9S' GO CCF $ CO/CC $ Radon Fee $ Training/Education Fee $ Structural Reviews $ 53, DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE$ I�O'Cr-) Bonding Company's Name (if applicable) V U\ ') i. i ;Jr Bonding Company's Address City • ! State Zip Mortgage Lender's Name (if applicable) 6 Mortgage Lender's Address � F• 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. ,l "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''alue 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 ro ert is to attachment. Also, a certified 6 P P Y subjectcopy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) ys after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reins ec qr fee will be charged. r Signature OWNER or AGENT The foregoing instrumen wa (': ,. �,r 1c' day of 0 acknowledged before me this tr ,20 �'\ .by l c. , who is personally known to me or who has produced as identifica io NOTARY PU •'il MY COMMIS - EXPIRES Fe 40/) 3'8 o' b3 Sign: Print: Seal: G TORRISI SION # FFg64004 briery 23,, 2020 ON�4BDMI�o�CWn J r Signature The foregoing instrum t day of O ( • me or who has produced CONTRACTOR ec t as acknowledged before me this 6C T' , 20 j- , by identification an. w NOTARY PUBLIC: 6 1 Sign: Print: Seal: , who is personally known to ************ass*******************>t(***************ass****************** APPROVED BY Plans Examiner Structural Review as TIN 0 TORRISI MY COMMISSION # FF964004 EXPIttati February 23. 2020 1' i✓ i?)r v7/j/ r ************************************ Zoning Clerk (Revised02/24/2014) •k • L.D 4•- 4 -1-14.10.6.4 peas-. • loot!, • _ _ - - GRAM 14.41,1 Prirlent-- 400 .4003.fo Iarl PAIPC . • .9 s. 41••41.4114. 01,11,0•1•0. • • • • I • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • u...4..- e, • • • • I' • .)1P • • • _ . • • 0--0.--1 A — -- . 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