REV-18-3269JOB ADDRESS:
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
BUILDING
PERMIT APPLICATION
0BUILDING 0 ELECTRIC 0 ROOFING
R`:CEEVEJ
OCT 252018
CkkTh
FBC20CA
Master Permit No. Ds S 'j4 (Q
-1
Sub Permit No. 4_1/ le- gZiCO°1
REVISION 0 EXTENSION 0 RENEWAL
PLUMBING 0 MECHANICAL EIPUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
2452 GCefuN1) C0rl1C0Cit?.SG
0 CANCELLATION 0 SHOP
DRAWINGS
City: 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): Nl�fx- (4 A
Phone#: 5=6 R?S 11ScD
Address:
t 1L 'tS72- 1a) CC�O'mar&,3 1�
City: IM� ( SA-C (Jt� S State: PL_- Zip: `2;15* 146
T }Eessee-fd2rne: Phone#:
Email: J'Cbt►P--�BQ osJUf1sat('. COVE
CONTRACTOR: Company Name: (PA Itioxe J-C Phorie#: -3`,5 2)52_4 &
1/..t7
Address: jC2 Z /OP b
City: JIC%/LQ
Qualifier Name: 'c f14
State Certification or Registration #: f
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
Stake:
y..
!19S
tt
Zip: Cr �,, " �!J
Phone#:,3 7C1 9
Certificate of Competency #: CC -OS S mO
Phone#:
City: State: Zip:
Square/Linear Footage of Work: / 2 5f
Type of Work:'= ❑ -Addition" -,0 ,Alteration! n New
Descriptioh of Work:`,.l'
❑ Repair/Replace n Demolition
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
q.
▪ RrdS: :, , :tsF�`i:e'.rl�- ; -X 3
Permit Fee $ CCF $ • v_.� $ .:.;ZZZ,1,.„-�;-
CO/CC
Radon Fee $ DBPR $ + - =Notary $
• x
Training/Education Fee $ . Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
r
Bonding Company's Address
City t--w State Zip
Mortgage Lender's Name (if applicable)
E
Mortgage Lender's Address
City f' �3 , �`� State Zip
s t•4a: Y 1i
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."
t • . y . •,
Notice to Applicant: As a condition to the issuance of a building permit withan estimated.valiie exceeding'$2500, the applicant must
promise in good faith,that a copy of the notice of commencement and construction lien law brochure, wil
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse
inspection will reinspection fee will be charged.
Signature
WNER or AGENT
The foregqing instrument wa's��accknowledged before me this
__ day of CC -Cr-i- , 20 I A , by
1h , who is` per�R now
kn to
me or who has produced
identification and who did take an oath.
_i
NOTARY PUBLIC:
Sign:
Print
Sea
Signature
be delivered,to the person
ust be pasted atthe job site
of such posted notice, the
CONTRACTOR
The foregoing instrument was acknowledged before m this
fo
L.J l day of l_df , 20 by
antra .basitt,Q0 is rperssoonaaily known to
as me or who has produced 1 iC.2. e as
identification and who did take an oath.
NOTARY PUBLIC:
V`��.._..--Yk.
yIYIAN YON
MY COMMISSION i FP 909724
EXPIRES: September 30, 2019
Banded Thre Notary Pubic Undenaters
*************************
APPROVED BY
.05111W
Print:
Seal:
,P ou''•., MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
11
Bonded Thru Notary Public Underwriters
,
**************************************
Plans Examiner
********************************
/6*/V
Zoning
Structural Review Clerk
(Revised02/24/2014)
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