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REV-17-2647 (2)Miami Shores Village NO'4 06 2V Building Department Cal 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBI 201'4 BUILDING Master Permit No. ZL\11-7 - 4—&-3 i PERMIT APPLICATION Sub Permit No. I E V e 'Z�`"�_4 ❑BUILDING 0,51ELECTRIC ❑ ROOFING 0 REVISION EXTENSION RENEWAL ❑PLUMBING [:]MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Pq ' City: 11Miami Shores P C County: Miami Dade Zip: 3 � 1 S V Folio/Parcel#: 1 I - 3 ) U _2 J + U ( V U Is the Building Historically Designated: Yes NO Occupancy Type: Load: C Construction Type: Flood Zone: BFE: FFE: �/ j OWNER: Name (Fee Simple Titleholder): `� 1 �� CCL;YY IC{ I%1 ( Phone#: �C.> l 3J Address: t C)- (y wI q 6 "4/1 City: -((Cxym' !Stwrf `Z State: Zip—:��y`�1�C] V Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: 3-J �+��Q'ti�C, @F DOR>- t LIC Phone#: Z!!�S" S - /.6� Address: ':7290 NcO lIU7 �t AVS -F Zo�, City: Ata:_�_ State: :FL Zip: 33'1)-8 . Qualifier Name: E 12— J,y►2.6� Phone#: g _wp5' _; rD - /6 Z-0 State Certification or Registration #: 130148,61 Certificate of Competency #: �� 6.S' DESIGNER: Architect/Engineer: Phone#: City: State: Zip: Value of Work for this Permit: $ © Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: v/' ,,. �' t� �•- /�±6 >.. o 'A'--f} 4,:- Specify color of color thru tile: Permit Fee $ �L Inv CCF Submittal Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ DBPR $ CO/CC $ _ Notary $ Double Fee $ _ Bond $ _ _...---....._.." -18 o4 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. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: 1 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 a eeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law broc re will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencerknt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued the ab nce o uch posted notice, the inspection will not be approved and a rein pection fee will be charged. Signature Signature \/ WNER or AGENT C CTDR The foregoing instrument �w s acknowledged before me this day of ��J! VV 20\� by who is personally known to me or who has roduc�`-O — ©`" as c p Lsv identificatii/o��n and who did take an oath. NOTARY 6�{dkIC: Sign: "%- Print: PD ,,- —�� U Seal: r Ruth J' `---� My C,..lssion E*M • Mwch 12, 2021 sssssss APPROVED BY The foregoing instru ent a ckrgwledge'd before me this day of Z 20 1-7 by � 'ki) 1) , who is personally =own to OM or who has produced as identification and ,.:LPG;, ROMMEL L. UICATEGUI PUBLIC: :° ` Notary Public - State of Florida Commillion #r FF 969514 My Comm. EXPINa Mar 9, 2020 Bonded threuah 11I1firinal Nntw. Ice.. sing .sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Plans Examiner Zoning Structural Review Clerk