REV-18-3701g
Miami 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
RECEIVED
DEC 17 2018
a J
UA—) t:3
FBC 20
Master Permit No. 2 OR -3 _ i` & -&,3 q
Sub Permit No. _ZE \f 1& —2-:40
1
REVISION ❑ EXTENSION ❑RENEWAL
N216UMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOBADDRESS: 10115 GI 6mq la `, 'c7l. a
City: Miami Shores County: Miami Dade Zip:�3 �31�
(( a
Folio/Parcel#: 1" 32,019 0 19
—o lei l) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): l S(`.R N N it) IZ S L� Phone#h-s (');S O "3l D 4
Address::1 l(1 0 f4d ' IQrIJ ki�— SU I, 91 C)
City: 1AA`'l,,A-*.t i 6 re" State: EL Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Na"mee: b)A- _ PtvS 0lZ 17 • Phone#��D!�) 0S5 D
Address: �� 51I�I �(XJ wl -10 t-
City: �4 State: zip: 3?> )
Qualifier Name: akcya �-u �• RL4(vya� Phone 399)
State Certification or Registration #: 0, iF-(nnJ CN Z �j 41 S Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: City: State: Zip:
Value of Work for this Permit: $ "0 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration
❑ New
❑ Repair/Replace
❑ Demolition
/❑
p Description of Work: Se �' 6. 7i))L PJ YV
D M Skffk� o'x ,
Q611, t (Q/ e— Z"&Q1
4104:--1e 4 u t .
AimAi to pgi der a(
p4aSi-se— B"oeitt
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 4-3 - G(D
(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 ochur ' I be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded n ice of com a em nt m t be posted at the job site
for the first inspection which occurs seven (7) days after the building perm t is sued. In the sence o such p sted notice, the
inspection will not be a ov and a r ' ection fee will be charged.
OWNER or AGENT
The forgoing ins rument was acknowledged before
me this The foregoing ins ument was
/�'/�. -,J day of ( Q 20 75 by day of (U�
C�(�Jy P tb 8NGd8J' ' , who is personally known to itrlL�/SL'a Q
me or who has produced
as me or who has produced
before me this
20 by
who is personally known to
as
identification and who did take an oath.
identification and who did take q1P. Jessica Socarras
NOTARY PUBLIC
NOTARY PUBLIC:
NOTARY PUBLIC: c STATE OF FLORIDA
? Comm# GG019849
• ONCE
Sign:
*,�,456A
191 Expires 3/6/2021
Sign:
Print: 90a"' ItAs
Print
Nor Jessica Socarras
Seal NOTARY PUBLIC
Seal:
,z STATE OF FLORIDA
? Comm# GG079849
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APPROVED BY 9 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)