Loading...
REV-17-718Miami Shores Village RECEIVED MAR 16 1017 Building Department LAL 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 05 795-2204 Fax: (305) 756-8972 I , SPECTION LINE PHONE ffUl CBFR:'MS) 762-4949 R. 17I BC 20 N BUILDING aster Permit No. G PERMIT APPLICATION Sub Permit NoVEy 11- 71 r BUILDING ❑ ELECTRIC ❑ ROOFING fo REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING 7 MECHANICAL [:]PUBLICWORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: r Z �� 9' d S / City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: r f z o 649 /3 z !�;'� O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: t_ 13 5 Flood Zone: ""7 BFE: FIFE: OWNER: Name (Fee Simple Titleholder): �� �i� V �� A L/ So` cAowS LG( Phone#: S� 3 C) Address: `Z 0 17/ % City: State: �r!i Zip: ; / 3 Tenant/Lessee Name: Email: one#: CONTRACTOR: Company Name: '�✓ �C_xn-- Phone#: 30 � -51� 6 3-1 I -A l Address: ` 1 c7P5� VI-'2CVei �. City: d"State: VL— Zip: 5 `3\33 Qualifier Name: �iL 1— t��/�� /S' G 00 9 ACh -+ Phone#: State Certification or Registration M Cis/li© 0' 3 ""1 3 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: .% , i �ID a Square/Linear Footage of Work: e#: State: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 'A t��i ���, �V ��T r1 J3111 1176,,,41 Specify color of co r thru tile: Submittal Fee $ Permit Fee $ 100 CCF $ ?,y CO/CC $ Scanning Fee $ C; (n Radon Fee $ 2 DBB�P11R $ 2 Notary $ Technology Fee $ ) (0 _ Training/Education Fee $ V .40 Double Fee $ Structural Reviews $ 80 Bond $ TOTAL FEE NOW DUE $ Z 7 _ 2 U (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 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 Signature 6jg�,o OWNER or AGENT CONTRACTOR The foregoing instrument was^ acknowledged before me this q� day of V 20 i by Vim) Ko V) Qa ( who is personally known to me or who has produced V-Cf' / ZVla 2 as identification and who did take an oath. NOTARY PUBLIC: Sign: " a- �qel ► I I (l BARBARA A. ESTEP MY COMMISSION # FF 073975 EXPIRES: March 29, 2018 The foregoing instrument _was acknowledged before me this day of YV &" , 20 V) by C 1 eyyy�t Qon za l ?, 2. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: • ram., APPROVED BY Ql I AZI I i Plans Examiner )7 Structural Review (Revised02/24/2014) BARBARA A ESTEP MY COMMISSION # FF 073975 EXPIRES: March 29, 2018 Zoning Clerk