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REV-17-1462Miami 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 Square/Linear Footage,of Work: BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: /uw 2/t4S7' City: Miami Shores ` County: Folio/Parcel#: //_ 3j0[-- Q 33 -- /150 Value of Work for this Permit:.$ FBC 2011 Master Permit No.-VAM n--�� I ) Sub Permit No. LtV l - REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR Miami Dade Zip: �� Is the BuildingldngHistorically Designated: Yes Occupancy Type: �!%CJ Load: Construction 'Type: ` i�/C�� Flood Zone: OWNER: Name (Fee Simple Titleholder): rv/`�� V e✓ Address: City: BFE: �-6 Phone#: DRAWINGS / ?/.5746 State: T �/ Tenant/Lessee Name: Phone#: Email: 0� PM HO CONTRACTOR: Company Name: ell£90 - / Phone#: �? Address: `0 x SW „24 City: MMin f �} State: / ��- Qualifier Name: 37)cSe �S) / Zip: N0� FFE:rrri /��^ /�r }� p-/� Phone#: State Certification or Registration #: l,C,�l� OL (0 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: 3cc-0c� Zip:(p. 7J ?9 2770 r ' i.1 a• 1 Lv .. , r .. p Type of Work: ' 0 '�Ad'dition ❑.4Alterattion / New ❑J Repair/Replace "' n' Demolition /��, Description of Work: 'Y'r '�f • V"/—(16' /t WOOD 0 0 iM. �.. '."'"`— s 02 PIG Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CCF $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ DBPR $ (Revised02/24/2014) Bonding Company's'Name (if applicable) Bonding Company's Address City State Zip Mortgagetender's Name (if applicable) Mortgage Lender's Address 61,t l; ' State Zip ":r Ap4piication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has om nenced 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, T URNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC 91k, O, WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all N'amilicable laws regulating construction and zoning. "Mt..ING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RE = IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TOZ TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y1INOTICE OF COMMENCEMENT." o Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must pis in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person es property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for e first inspection which occurs seven (7) days after the building permit is issued. In the ab j ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature All) 7 OWNER or AGENT The foregoing instrument was acknowledged before me this �3O day of ,7/4Y ,20 /7 , by A/'/%/4 510 , who is personally known to me or who has produced DR4 t' td C�iR as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Yordanka Wingfield NOTARY PUBLIC STATE OF FLORIDA Com n# GG026296 ire* s ©/31/202 6(//GFJ NOTARY PUBLIC: �� `` Sign: i� III%Ii� %��' •^�:�lr.� Print: ( 61 L! Seal: Signature The forego! CONTRACTOR inst ment was acknowledged before me this 31 day of )14 44/ doge- `os7 , 20 /7 , by , who is personally known to me or who has produced Gp?$•d"qa1-(✓ems/ as identification and who did take an oath. Yordanka Wingfield NOTARY PUBLIC STATE OF FLORIDA Consti# 00026296 Expires 8/31/202 M ****************************************************************** 4. ********sss*********** ****s***ss** APPROVED BY Plans Examiner Structural Review ** Zoning Clerk (Revised02/24/2014)