REV-19-480❑ Alteration
❑ New
❑ Repair/Replace
ED
Miami Shores Village RECEIV
f- 3 g
Building Department
artment M R 05 2019
�
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 I}
BUILDING Master Permit No. /I �c-' - I
PERMIT APPLICATION Sub Permit No. IZ�J-63- L480
XBUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
- A 1 o n I CONTRACTOR DRAWINGS
JOBADDRESS:ag/y 1 c 1 `1 � ee-4
QKL Miami Shores County: Miami Dade Zip: 3 -3 3�
Folio/Parcel#: I i �a D s O09 D ( q Is the Building Historically Designated: Yes NO _ ,
Occupancy Type: Load: Construction Type: 'L� IFlo'od Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): p� ?(-00P-y4% t�-� Phone#: 9)q- /y-0&1 1 I
Address:: I P,9(o �JI q G sS P e+ 1
City: P i a 1-,-� sSa ryes State: aU2� QL C� Zip:
Tenant/Lessee Name:
Email:
Phon
,CUICQ
CONTRACTOR: Company Name: ► Qi-�� CJ��II111Q �15n� Phone#:
Address:
City:
Qualifier Name:
State Certification or Registration #:
Y- 1 br ► G Zip: E3 1 to
L2-;� Phone#: 9-g���l/o
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ — b - Square/Linear Footage of Work:
Type of Work: ❑ Addition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ �� d J) CCF $_
Scanning Fee $ 24 . e3 Radon Fee $ DBPR $
Technology Fee $
Structural Reviews $
Training/Education Fee $
_ Zip:
❑ Demolition
CO/CC $
Notary $ S • p
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I ��
(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
r,
Zi
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 inspec ion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not a approved and a reinspect'Lov fee will be charged.
Signature _ Signature
OWNER or AGENT CONTRACT
The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this
day of P1 20 i� by ��day of r,- 3— 1 20 �� by
06NOP, CWS-IkNa I who is personally known to ���`�2 U--��
cu( ,h ersonally known to
me or who has produced: 1CI k-uNoLas me or who has produced as
identiftaption and who did take an oath.
NOTAUBLIC:
Sign:
Print:
Seal: ��e.''• SINDIAALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
°F nded Thru Notary Public Undenvrltei
*********************
APPROVED BY
identification and who did take an oath.
NOTARY PUBLIC:
Print:
EMILIAMMS
My COMMISSM I GG 174378
� 10 ��_
****************************************************
3/ .
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)