PL-14-1316Miami Shores Village
BuildingDepartment _
.,., p AUG 01 2014
� M
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
NSPECTION LINE PHONE NUMBER: 305 762-4949 BY
FBC WO
BUILDING Master Permit No&
PERMIT APPLICATION Sub Permit No.p/
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
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CONTRACTOR DRAWINGS
JOB ADDRESS: 00
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: � 1 Is the Building Historically Designated: Yes NO -
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):�^'� H�%/1� Phone#:
Address: /60/ Xf
City: M",(,'4�i' S0�0 State: Zip: 13?l
Tenant/Lessee Name: Phone#: 7/L�7%/,2,2?J
Email: l�li4l�Vr7 �.2 le�v `cIJ 1% C�
v f
35
CONTRACTOR: Company Na e: / Phone#: , Address: / t/
N45 ��/ ��
City: State: Zip:
Qualifier Name: 6 .G Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: 69 .'-eS -T—C PPhone#: �65— S O8, 0/0/
Address �� /`� l (7 3 s City: l��iG State: ( Zip:
Value of Work for this Permit: $ o6iL Square/Linear Footage of Work: '��
Type of Work: ❑ Add- ion ❑ Alteration ❑ New F1 Repair/Replace ❑ Demolition
Description of Work: .5 �w'/K Dluy' iZxc' rPludvC o?rD r'yyti 1kr4p'�
Specify color oo�or
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
Training/Education Fee $
CCF $ CO/CC $
DBPR $
13
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ C6y .00
Bonding Company's Name (if applicable) • ' ` *'r
Bonding Company,s Address A
F �
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 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 sevent(7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinsp c 'on fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrumentwasacknowledged before me this The foregoing instrumen was acknowledged before) Jme this
day of �y 20 by day of U S� , 20 ' "t by
/ //q2&/4Ln who is personally known to who is personally known to
me or who has produced457,3�s'/.Y23 .�0��� as me or who has pr duced k DA Tlrj'v-iuS UU��' �
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PU IC:
Sig Sign:
nnt: Print: F In se C S
�.oP`�"� f+loi" Publio
Seal: 00 Py Notary Public State of Florida Seal: , %% f�8 of F10rWS
Joanna M Feliciano : ° °
My Commission FF 082753 �Qo� comm800
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A-i ExPires oi/12l2018
CpfflflWofl No. EE 1W79
APPROVED BY c�8- S' �`� Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk