REV-18-2069\� Miami Shores Village
gDepartmentRECEIVED
Buildin
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 AUG 0 2 2018
Tel: (305) 795-2204 Fax: (305) 756-8972 ��, r% INSPECTION LINE PHONE NUMBER: (305) 762-4949 \
FBC 20«
BUILDING Master Permit No. b"QP — Lk — Ay--99''y
PERMIT APPLICATION Sub Permit No. RE } 11B_WUq
[--]BUILDING ❑ ELECTRIC ❑ ROOFING IXREVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF [::]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: E 611 61- lam ; �✓`��'�
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): Phone#:
Address:
City: (441114 + ��'��"� State: t' I Zip: 3-A� i3
Tenant/Lessee Name: Phone#:
Email: j jJ
CONTRACTOR: Company Name: ��7rtVt 1 `ec.,' it CZ 'S t S V111 Phone#:
Address:
City: State: 1 Zip:��� S
Qualifier Name: C�'i� CCT1� 2 e—.
Phone#:
State Certification or Registration #: C C O a-z-lfL Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: _ Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: - � � S Lc-�
Specify color of color thru tile: q
Submittal Fee $_ _ Permit Fee $ 70,10 d CCF $ CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
i
Structural Reviews,'$ Bond $
j\ 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. 1 certify that no work or installation has
commenced prior to the issuance of d 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--J Signature & ✓ R
OWNER or AGENT CONTRACTOR
The fforeegoi instrument was acknowledged before me this The foregoing instrum t was ackn1oowledged before me this
�5/ day of S 20 � by .L;th day of Tt Y 20 0; , by
who is personallxknown to I: OV�C1 who is perso ally known to
.! �2•ly�''
or who has produced '�pji1 as me o(RYP
as roduced YiJ Y lC Sias
identification and who did take an oath. idenand o did ke an o h.
NOTARY PUBLIC: NOTBLIC:
+ 131 MAHARA=ION#GG044602
Sig i I Sign:
EXPIRES: November2,2020
Print: fir PAmorhadIbm Notary PublicUnderwriters
Print:
Seal: - Seal:
.N6 YANADYPRIETO
; M1'COMMISSIaNt FF214031
a= EXPIRES: March 25, 2019
+ %, o t°• Bonded Thru Notary Public Underxrisrs
APPROVED BY 1I//�
Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)