DS-18-2151Miami 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) 762-494911
FBC 2014
BUILDING Master Permit Not3 I & -2A S I
PERMIT APPLICATION Sub Permit No.
i0
BUILDING
❑ ELECTRIC ❑ ROOFING
❑ REVISION ❑ EXTENSION iRENEWAL
El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
12 63 NE 92.1461 dt ,
City: Miami Shores County: Miami Dade Zip: 33 138
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE:7FFE:
OWNER: Name (Fee Simple Titleholder): h1 ..T A� SAC j{ECb Phone#: Cw �-) 233 - 3606
Address: 1263 II,)t R2 A St
City: 1''(n.3N. 5Iue r44
State: Tit) t 1.att. Zip: 33 438
Tenant/Lessee Name: I Phone#:
Email:, h'lafl'MISka C% 'f -tW*. Ct)W.
I
CONTRACTOR: Company Name: / O VtIA tCA ' IRAs 1.I fit' Phone#:
Address: �0 v, t q'g st ,
City: tOlwt
d 7 Zip: 3 130
Qualifier Name:
('o5-) 333 - 316q
State:
EL.DI `?NODS': T-E1'0LI Phone#: (3c)r 333- 3(69.
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:. Phone#:
Address: s• _. p •,.. City: State: Zip:
a
Value of Work for this Permit: $ t (,c • 14 Square/Linear Footage of Work: 2) i 0
Type of Work: ❑ Addition ❑ Alteration , ❑ ❑ Repair/Replace ❑ Demolition
Description of Work: • _ i � C J ?OON w b t,titik 414.0J (Ake e.q
.4
Specify color,of coi(;r:i,,,th.lruj:cint:ioie.:)1'( }At
+J_ J4 s'Yl FI
Submittal Fee $�� '" " I
--Permit:Fee $; .
Scanning Fee $
Technology Fee $ Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ R.O J
CCF $ • CO/CC $
Notary $
Structural Reviews $
Radon Fee $ DBPR $ -.
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State Zip
Mortgage Lender's Name (if applicable)
- R 4
Mortgage Lender's Address
City a j 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 tote 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. , j; , +,g 3) ';
"WARNING3TOOWNER: 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."
.1,
Notice to Applicant: As a condition to the issuance of a building permit with an estimated Value exceeding $2500, tfie 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,
ommencemen't 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 such posted notice, the
inspection will not be appr ed and a reinspec;'on fee will be charged. I . r ' ,
1, Signature
OWNER or AGENT
'r ! . ,` .r �.
The foorregoing,instrument.was acknowledged before me this The fo
� day of AO60 ,20 ) byl'a ,.`�
/vN+V L rJCl r11S-1�Jc S
tt co ,who is personally known to
me or who has produced -FLO- re-7, 56'S "bj / 0 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
tot
iG_v-
Seals «aa►......c+�, CARLOS J ZELAYA
Notary Public - State of Florida
N iu • Commission # GG 031309
%'FComm. Ex Tres Sep 18j2020
******Rl********** ******* ***
ir
60*
APPROVED BY
si•., 1
Rol PAOS
.. .�:,
CONTRACTOR ,
oing.instrurnen was acknowledged before me this
day of 5 �5.. , 20 1' O by
Y
tLO
, who is personally known to
me or who has oduced Dc ,.'u s 1,1Zc nle.-.
co 32 - Zb) -(.Ic - 09 z -o
identification and who did take an oath.
NOTARY PUBLIC:
r
Sign:
Print:
Seal:
*********************
/ //Plans Examiner
RAPHAELA ST. AUr
_ Notary Public - State of Florida
• • ; Commission # GG 051820
'• My
,« Comm. Expires Nov 30, 2020
%'...'+
as
* *******************
Zoning
Structural Review Clerk
(Revised02/24/2014)