REV-18-3688 (2)Miami Shores Village g
::-. ,,.dRECE{VEC-
Bullding" Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
- Tel: (305) 795-2204 Fax: (305) 756-8972-
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 2. O1-::f :..
BUILDING Master Permit No: _. 2-c - ? l e - z 7 / '
PERMIT APPLICATION Sub Permit No.�
❑BUILDING , UOELECTRIC '` "' ❑'ROOFING , ❑ REVISION1 EXTENSION ❑RENEWAL'
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCE'LLATION ❑ SHOP t
CONTRACTOR , DRAWINGS
JOB ADDRESS:
21fN6 -A
'City:,` :lUlCountV",4 - - V s Miami Dade Zip:-,, , 33-138 •"
Folio%Parcel#:` a % z -•a 4t , _jY s Is:the Building Historically Designated: Yes k i,. `�" NO` M
:Occupancy Type 2; 07 1 Load: "At 1 �. Construction Type ` ` `Flood Zone a�3�� BFE t''' FFE:-
OWNER: Name (Fee Simple Titleholder): Phone#:
Address:
City, . State: Zip:
Tenant/Lessee Name:"' Phone#:
Email:
CONTRACTOR: Company Name: �9'S�� a� �'°!" ✓mow S �y,� Phone#:
Address: q7
�>Y6-z57o-983�
City: State: r�
Qualifier Name: Phone#: )-Y.( — Lro " :9 SY4C
State Certification or Registration #: E/Z- 13 v / 4,7zg' Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: ;�; State: Zip:
Value of Work for this Permit: %S4 ` ° `. ` l � '(I ' 0 $ Square�Linear.Footage of Wprk: . ,
Type of Work: ❑ Addition ❑ Alteration ❑,cNew q `' '�' Repair%`Repl te
% D/e/ e, ❑ Demolition
Description of Work: �2 ed 3 °� ( 3 e^ .m. �"�' `�'
Specify color of color thru the:
Submittal Fee $ . . . � • Permit Fee $ < ,14A d�540, r CCF $ CO/CC $ ,
Scanning Fee $ Radon Fee $ DBPR $ Notary $•
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $•
i
(Revised02/24/2014)
Bond $ TOTAL FEE NOW DUE $ 4 ✓?,
- oU
Bonding Company's Name (if applicable)
Bonding Company's Address'
cityState: F.' a . s , , r:,, sti ,�, <. •� i . , +,. zip
p
Mortgage lender's Name (if applicable) jt1 "iAui 14 z,,.t
Mortgage Lender's Address
City ,rn 44. ,State., n Zip '-war. qnp
Application is -hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has
commenced y 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.....
14 <•''IIr 'ii: i•
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.
0 P QC A F-CJt
"WARNING TO OWNER: YOUR FAILURE"TO RECORD X NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING ' WICE-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 rioiice of commencement.must be posted at the job site
for the first inspection which occur, 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.
41
Signature Signature'
WNER or AGENT "" CONTRACTOR---.-
The foregoing instrume was acknowledged before me this The for going instrument was acknowledged before me this
day of - 'r- '��" 20 �,�-by �' �- - day of G� -204yn
by
�' , •`�lpersonall° ... _ y pertGw o is r anto
me or who has -produced -----as' me or who has, produced - _ as
Stiff . _?
identification and who did take an"oath-N�N!lINN1l//�
NOTARY PUBLIC: '" - _,,•�•'•• p��i
Sign/ •
Print:+-/`�1 !- P
Seal- ST
identification and who did take an oath.'
-I °J NOTARY PUB C:-
- - Print: - \ - -
Seal: - -
--- MAHARAI K. GONZALEZ' �[ 0�
November 2, 2020 __ I l . _ .
.._... ,... ._, _ .._._... _ _ _ _......_ _� _ ,._.rNpIMMlIt�•-- _ . _ _ - r - _. _ ._ _, � ''�' 3 ..1ti,� t 'lt:� • 4.;�'�,O .-1'.,, � tR =' ��
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APPROVED BY-10/)-6i�m _ L O1PZ Plans EXaminer _ Zoning
c i "cri _ , Ri,f 'f Tie
- - Structural Review ' Clerk
(Revised02/24/2014) _ _ r