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PL-14-2084Miami Shores Village 7SEP CEIVF Building Department 2�14 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 /0 BUILDING Master Permit No& % / /W!0- PERMIT APPLICATION Sub Permit No. FLI LA - Mgyl BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DRENEWAL R?LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Imo` G ( CONTRACTOR DRAWINGS iCi9 ADDRE 5 7 City: Miami Shores County: Miami Dade Zip: 3 3 C 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OW R N me (Fee Simple Titleholder): —JC.- Q0\S l'•"OfN6 w4hone#: T66 Address: 2-3 CI N12— 1(=) %4 V— IS+ City: M l Py-1` ^k CS�tO RE-S State: Ti, Zip: �3 Tenant/Lessee Name: �t Phone#: Email: CONTRACTOR Com any Name: (� KJ�1 rJ l�cP gof(�f (yPhone#:0� o S6s��3 Address: City: ryl\ State: � � Zip: Qualifier Name: ©Z S Phone#: State Certification or Registration M. 6—v `"1 �O 'cate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: slue of Work for this Permit-$ cZ4()V Square/Linear Footage of Work: * l '3 Type'of Work: ❑ Addition t� Alteration ❑New ❑ Repair/Replace ❑ Demolition jDescription of.Wor . Stl- 40 1A ,- Specify color of color thru tile: Submittal Fee $ � .6 Permit Fee $ 22S, Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ c TOTAL FEE NOW DUE $ J 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. t "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." i. a 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. . • _ • 6fe�Signature DOWNER or.AGENT Signature&�_o t—CONTRAC--TOR The fore ping instrume t was acknowledged before m this The foregoing instrument was ackno ledged befor7eIs J� day of �✓- 20 by t-Pday of wt�� 20 by ` ll who is personally who is personally known to me or who has produced �� 2e°or ho has produced as identification and who di5t�� n oaOlda Pereda idV on and who did take an oa- ..?OBE; Gilda Pereda ° <1 'COMMISSION#EE144691 -? •`:COMMISSION#EE144691 NOTARY PUBLIC: NOTARY�PUBLIC. �i: EXPIRES: DEC.07,2015 -...•°'.'EXPIRES: DEC.07,2015 I oFF.� WWW.AARONNOTARYcom..°;,;;�� www.AARONNOTARY.com Sign: Sign: Print: Print: Seal: Seal: *«.**********************■****************.******************s***r*********************sus*************•**** APPROVED BY�g Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)