EL-19-492Miami Shores Village
.0AR fl (29
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
FBC 20
BUILDING Master Permit No. 0' C
PERMIT APPLICATION Sub Permit No.��— �v
❑BUILDING ELECTRIC ❑ ROOFING EVISION ❑ EXTENSION ❑RENEWAL _
❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS [:]CHANGE OF [:]CANCELLATION ❑ SHOP q q 2
CONTRACTOR DRAWINGS
JOB ADDRESS: 13 a- ( NE I O 3 rah J yee_t
City: Miami Shores County: Miami Dade Zia: 3 3 (�
Folio/Parcel#: 113-3L-0 S-Q 3 O 7 I D-C) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): SC-&tt r A &,- u Phone#:
Address: 13 .3LI nlE, f O 3 "� SVr-e et
city: M f a.rn i 54iU,r//� n
eSState: (Z Zip: 3 913 T
Tenant/Lessee Name: Iv I P \ ^^ Phone#: 01 A -
Email: awlGl Sl kyu(Yl aln t_G, !�i rnauj - cpyn
CONTRACTOR: Company Name: C YULt A. SA VU_S Phone#:
Address,: � -& `l S .3 ' &W 35- �
City: 4bMecTec,_.di r, State: Zip: 3303-,X
Qualifier Name: _ 011j / Phone#: ,(%9k Pi2t- 2/�
State Certification or Registrations #:�, �30) Is 4 q Certificate of Competency #:
DESIGNER: Arch itect/E,V n�giineer: b-eY_i,,,�.CI 1 � `/(,�. e, �) Q � s , �-L-�- Phone#: 61 5 ^�,1 ` 261 ' �-
Address: Z3 I' Ali bu 21` 0a/e- City: )—a j Ef hak State: Fr_ Zip: 3 3
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑JJRepair/Replace El Demolition
Description of Work: No WO r K ( o-C. U" 'e_ c n l he� . C.01,.b&T 7(,L
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/ Education Fee $ Double Fee $
Structural Reviews $
Bond $
TOTAL FEE NOW DUE $ Z • S�
(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
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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
C
— day of C- QY 1 20 I q , by
TY 1J� �) lJ► ��// i personally known to
me or who has produced r—' `) (& )3 was
identification and who did take an oath.
BLIC:
Signature W4�1�
CONTRACTOR
The foregoing instrument was acknowledged before me this
M1— 2— day of 0Y'� 20 lg by
47s>u�a 0 Q�cYU who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
7SeaJT
Sign:ILKA EDERLIN GUZMAN
print:EXIRMIS 10 Seal: 'BondedThruNotaryPIREb�February 21, 2021
********************* ************************************************
APPROVED BY Plans Examiner
Structural Review
as
*******************************
Zoning
Clerk
(Revised02/24/2014)