REV-18-3229Miami Shores Village ICRIV
C�
\�� Building Department I cfi 1 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY'
Tel: (305) 795-2204 Fax: (305) 756-8972
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INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 l.�t"G�
BUILDING Master Permit No.V Pt- 8-)i8-2283
PERMIT APPLICATION Sub Permit No. 4��
❑ BUILDING ❑ ELECTRIC ❑ ROOFING 'REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�/y CONTRACTOR DRAWINGS
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JOB ADDRESS: 8 �(lZS ' v C I W S�
City: Miami Shores County: Miami Dade Zip: 33) 3 $
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: r FFE: (�
OWNER: Name (Fee Simple Titleholder): AQ ka,m rn ffl h[j Aoun i Phone#: 1 �� 13 —35( 7
Address:G 1
nA
City: / `�` lancer / D�4S State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ' I ome- 64", WCa Phone#: %� ' 6Y3 Il
Address: l U G2 o (7 w y
1 if
qI
City: � " `� Cif', i State: Zip:
Qualifier Name: �����w G-OVT, Phone#: SC6 " 6 q/ —
State Certification or Registration #: 3 i 2; Certificate of Competency #: 600W 16 I %
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip: _
Value of Work for this Permit '"�" Square/Li ar Footage of ll8'�k:i°'"" *• j-.[a.�,
Type of Work: ❑ Addition ❑ Alteratio ❑ New ❑ Repair/Replace . ❑^Demo)
Description of Work: a +�
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 6• 0Q) CCF $_
Scanning Fee $ � ' 00 Radon Fee $ DBPR $
Technology Fee $
Structural Reviews $
Training/Education Fee $
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
Zip
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.
"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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not begpproved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
% 4� day of (2 , 20✓ / by
M06L.0M11-eC Ark; e h" j who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PU IC;ow-1 , TAMMY B VALDES
,.Fo1- -" Notary Public State of Florida
• •` Commission # GG 038648
,� o�: My Comm. Expires Oct 25, 2020
Sign: '•.'rE diWhonal Notary Assn.
Print:
The foregoing instrument was acknowledged before me this
day of (17�yr 20 1&4"' by
{6v,& -p G-»'L who is personally known to
as me or who has produced
identification and who did t ke n Dath.
NOTARY PUBLI "J'd� •.,, TAMMY 8 VALDES
�oR s. Notary Public - State of Honda
Commission # GG 038648
;ter o� My Comm. Expires Oct 25. 2020
Sign: %%govc.d;'•• edihrou h National Notary As,
Print: /I
�'� • v .0 `vim` L���7���� j%y
Seal: Seal: ' v
as
*s*s**ss**ss****ssss**s**s****************r*r****s**********s•ssss*ssssss*sssss::*s***rs*s*�r*rr*s****srssss
APPROVED BY <EEj� lGldd A Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
FVAA
I1A
1060 SW 27 AVE
MIAMI FL 33135
(305) 643-1511)
Fax (306) 643-1616
( r" --"
CT 19 26t�
TABLE � Z,Li (Z�)
PIPING DIAGRAM
CONTRACTOR LICENSE # 1616
CONTRACTOR SIGNA RE
Sworn to and subscribed before me
INS d day od2_
by
TAMMY B. VALDES
Notary Public -State of Florida
'
Commission # GG 038648
>"i `o•
My Co n(SEA$j s Oct 25. 2020
P, oil `,„°
Bonded through National Notary Assn.
r' c W �Jfi-V
a
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PLUMBING PLANS Date �� e lf
" gF roved � Date
Disapproved
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
IBLDG DEPT
I
` r Ilt.11 CT TO COMPLIANCE WITH ALL FEDERAL
!I
I A `( A' :" (;r )( IN I Y R, l_l-S AND REGIII ATIONS
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Its
1060 SW 27 AVE
MIAMI FL 33135
(305) 643-1511)
Fax (306) 643-1516
PIPING DIAGRAM
CONTRACTOR LICENSE # 1616
CONTRACTOR SIGNA RE
C
9L(,nTfl
PI'UMBING PLANS Date_
n,'
Approved
sannroved Date— —.
Sworn to and subscribed before me
this day � day of� , 2eN2� de'
Notary Public -State of Fig,
Commission k GG 038648
My Comm. Expires Oct 25, 2020
BondedISMI a)ional Notary,Assn.
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