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REV-17-2589Miami Shores Village Building Department RECEIVED 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 'T "7 INSPECTION LINE PHONE NUMBER: (305) 762-4949 5 FB0201`4 BUILDING Master Permit No. Y PERMIT APPLICATION Sub Permit No. W ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL Op LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Al K) CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:T� �1 �z�� - 0 [0 U Is the Building Historically Designated: Yes NO Occupancy Type: _ Load: _ Construction Type: Flood Zone: BFE: _ FFE: OWNER: Name (Fee Simple Titleholder): ✓I IC C1 —U✓rtiG ✓► Phone#: Address: i z-C-1 A)L,,-J q 6 5 City: A6 k o^ I State: L Zip: // 1 S-1y d� Tenant/Lessee Name: Phone#: Email: 0i 4'''1 c jC _ W /W CONTRACTOR: Company Name:1( U �� t l ► phone#: -O)2 Address:, ( w -4- 2 T City: Qualifier Name: State Certification or Registra DESIGNER: Architect/Engineer: Certificate of Competency #: hone#: Address: City: State: Value of Work for this Permit: $ 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF DBPR $ Zip: ❑ Demolition CO/CC $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) 'Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature O R or AGENT The foregoing instrument was acknowledged before me this day ofp )L+- , 20i {�� , by �-1°.`� �1 1 ��Y�^;'3@s'pePor al; known to me or who has produced z as identification and who did take an oath. Signature MW �--6 A",-� CONTRA R The foregoing instrument //was / acknowledged before me this day of PC to 20 by J who is personally known to me or who a`tn as identification and who diet takelan oath. NOTARY PUBLIC: NOTARY PURL rnAHARaIIc.GrIJ2ALEZ ,/k n. *" :qY CGNI AIS°'.ON i GG 044602 EXPIRES Hove ,bet 2, 2U20 $j ~ :FOP F4� ' 3cnd -.i Ti.: Nrlary ?ublic underw iters Print: t: f' �— Seal: Seal:. MY COMMISSION #FF1 98880 �ri►� EXPIRES: FEB 1$, 2019 as Bonded through 1st State Insurance APPROVED BY '� Plans Examiner _Zoning Structural Review Clerk (Revised02/24/2014)