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PL-18-3410Miami Shores Village 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING T ED N 0 8 2018 BY: FBC 20 Master Permit No. Yam©x:> Sub Permit NOTA _ ❑ REVISION ❑ EXTENSION DRENEWAL PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 06 ` A10 4/ 0I 'f//W6r City: Miami Shores �b County: Miami Dade Zip: 9811E Folio/Parcel#: #_ S 2'06 •V� %Z� o Is the Building Historically Designated: Yes NO Occupancy Type: Load: 4 Construction Type: V6 Flood Zone: o— BFE: FIFE: OWNER: Name (Fee Simple Titleholder): MOP �d/� WA Am Phone#: � -CaC 2L Address: "o) y 0101 sp�*iFI- ttt City: Mew ob#mq State: Zip: Tenant/Lessee Name: Ph Email CONTRACTOR: Company Name: Ai' C iqua'oI <)6 $C9C la.r Phone#: 7GJ_-796 Address: 3 ?57d X­/ c cJ -E,-T City: We L-•O C� State: F-n_ Zip: -� 0-5-Y Qualifier Name: 1?Sa 2'0 6�Z�rOc— Phone#: State Certification or Registration #: (2 J lL/2,16 O % Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ 111�00 Phone#: City: State Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration 1. El New ❑ Repair/Replace ❑ Demolition Description of Work: ( ut—'SIAL4- X)C-a) C-goto rsYI.tIJks�6C1- Specify colorr``fo--%f collorthru tile: Submittal Fee . M Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) • 1. 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 h posted notice, the inspection will not be approved a d a reinspection fee will be charged. / Signature I IL Signature OWNER or AGENT �' COrACTOR The foregoing instrument was acknowledged before me this The foregoing instrumentt was acknowledged before me this �.� day of .SE,6r. , 20 I by 57 day of 20 /"�"20 l % by ZO�'%S who is personally known to � d4//+ vrq.-. , who is personally known to me or who has produced as me or who roduced as taenta,catp,Uon and who did take an oath. identification and who did take an oath. s BLIC: NOTARY PUBLIC: Sign: N [ •�-u-� /��� K Print: Print: Seal: ;:��yr"a� , JU ASALA Seal: , Notary Public - State of Florica MEILYSAIMEE RODRIGUEZ iti `a Commission NGG242596i' ;i: MY COMMISSION # GG 255464 My Comm. Expires Nov 21, 2022 + o�p', EXPIRES: September 5, 2022 ****** APPROVED BY _ /� (3�/� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)