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PL-19-1227BUILDING PERMIT APPLICATION ❑ BUILDING PLUMBING JOB ADDRESS: ❑ ELECTRIC Miami Shores Village RECEIVE© Building Department 0129It 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 &BIC 0 Master Permit No.'14-1 ~� Sub Permit No. F7(— OS - Ici - ( ❑ ROOFING EREVISIQ�) EXTENSION RENEWAL ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION 7 SHOP CONTRACTOR DRAWINGS Folio/Parcel#: 112.1 ) cc) b qC) 351 r. the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):AILCQUA wl!, 2.6 L Phone#: Q05)o S t -V iQ j Address: 2 -ft NE 10q 5},-�* City: cOc State: t Zip: 3 3 6 Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: W0 ✓0 CAA S -Pt H-��•�. Phone#: 305 4115-1100-} Address: 130 C tnur, —To City: !V4 -A w:c State: JCL Zip: 3,31--t4 Qualifier Name:oh-e "-&• boa/T State Certification or Registration #: DESIGNER: Architect/Engineer: Address: hone#: Certificate of Competency #: hone#: City: State: Value of Work for this Permit: $ d d o .4, 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Z Repair/Replace Description of Work: r—&V%N rte• • O•M _ .. - ., Zip: ❑ Demolition SP eciffco/oriof color'thru'tile': _ 5 Submittal Fee Permit Fee $ CCF $ CO/CC $ Scanning Fee $` " ` ' "' RadonFee $ DBPR $ Notary $ Technology Fee Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ' �� 30 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." 4 Notice to Applicant: As a condition to the issuance of a building permit with an estimated.valtie 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 s'ub'ject to attachment. Also, a certified copy of the recorded notice of commencement mustbe pofted at the job site for the first inspection which occurss en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be apprived and 0 rei pection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 ( f , by o is personally known to me or who has produced k,—WZ., U�As identification aAd who did take an oath. , NOTARY PU Sign: Signature The foregoing instrument wal acknowledged before me this 3 ,day of'p -e►� 20 p� 1 by w� o t e uo _ , who is personally known to me or who has produced ec-op nau Vtn04ww as identification and who di take n oath. NOTARY PUBLIC: / 1 Sign:_ MY COMMISSION # GG 238273 Seal: •' Seal: Pp EXPIRES: September 3; 2022 •''.;SOP F��' Bonded Thru Notary Public Underwriters ;; !� X,'i;: JACQUELINE GONZALEZ MY COMMISSION 0 GG092580 ****�*****r�*r****s**s*r*rr******s**:****s*s****s***�r***s•s******* s� ,Drsss��?I�i��Q,�(�2A*** **s*�** APPROVED BY 1--/-3/40Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)