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DGT-14-379Miami Shores Village zj � ' B ing Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756,8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 12 PERMIT APPLICATION Permit Type: BUYUDING JOB ADDRESS: S7Z NE_ E_ 9 * FBC 20 Permit No. Master Permit No. C-17 ROOFING City: Miami Shores County: Mia Dude Zip: .3 Folio/Parcel#:�J(�L� �/ Is the Building Historically Designated: Yes NO I' _ Flood Zone: N D GDre--4y-) OWNER: Name (Fee Simple Titleholder): Y-1 Phone#:. ial9 - �70'7 Address: City: State: P Lr Zip. j S Tenant/Lessee Name: Phone* - ��rt, LO33 p q$� I LP Email: CONTRACTOR: Company Name: Address: i 7 7). S -, 4::; -, hs i2 _�'n S' L-1 eDD 02 0 City: M t G ryri ► State: 1— Zip: 3 3 C� Qualifier Name: Phone#: _SOS State Certification or Registration #: ccnci S 1519 1 q Certificate of Competency #: Contact Phone#: 3 CD . Cl Ej (p 6-2S Email Address: m1 nc -)xre 11 (::J G-1 O c-, c-71 -, r .r2 `, ICA, C,::y� DESIGNER: Architect/Engineer: Phone#:QWL1.�]_ S` Value of Work for this Permit: $ 95� . g [� Square/Linear Footage of Work: _ 4�V 5[i p_f Tyke of Work:, C] d icon ©Alteration ❑New ❑Repair/Replace.. ❑Demolition Description of Work: 'P i c. #' =t 1 cl Color thru tile: Submittal Fee $_, d C� Permit Fee $ Scanning Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) I"J 1 P Bonding Company's Address City State Mortgage Lender's Name (if applicable) �,z �A Mortgage Lender's Address City State Zip Application is ,hereby rrtade 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 COMNXNCEMENT." Notice to Applicant: As a condition to the issuance permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice men[ and construction lien law brochure will be delivered to the person whose property is subject to attachment. AIs copy of rhi ;,*corded notice of commencement must be posted at the job site for the first inspection which occurs seve s after the buitding'. permit is issued. In the absence of such posted notice, the inspection will i approved and a reinsp n fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this day of QD 2d '-4-, by Se(Nr (7fX Y--X01,1\ . who is personally known to me or who has produced L ID Z— • As identification and who did take an oath, NOTARY PUBLIC: Sign: Print: 94 Elf ARTO LA My Commission Expires: �` rotary public, State 6 Florida Commiasion#t EE 17448 My domh expires Feb. 7, 2016 APPROVED BY Signature I1 Contractor The foregoing instrument was acknowledged before me this 2-::) day of a , 201'A , by (YVA4 who i ersonall know io me or who has produced 'r as identification and who did take an oath. Plans Examiner Structural Review NOTARY PUBLIC: Si¢ . Print: 3run r ZM Commission E; 1y IS )20171 J. BLANCO = Notary Public - State of Florida My Comm. Expires Jul 8, 2017 Commission # FF 34395 IL Zoning Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) w. a� low.iA . +1 ` 1 ��. .� �. � - :_ +7� � ,r �r r '� ■ j � � ' ��r. � �..