Loading...
REV-18-3128Miami Shores Village Building Department ° o��a 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 S -'_�I 180- 3 os.6 FBC 20 I J BUILDING Master Permit No.i/° S--/-7-4271 PERMIT APPLICATION Sub Permit NoTZ-0 C5 -31 ❑ ILDING F-1ELECTRIC❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 5-4lJ/C3 Phone#: Address: 1�116 m57 /y3 ,$T City: State: '�/ .e%O� Zip: 3-Y/jz� Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �L�/SSS L�,✓�/r�/S�� -Z;e, Phone#: Address: City:'461el..-4.4b©G/>2/ State: %�0�/4� Zip/: -'?-3k: %zf//� Qualifier Name •<1 �z'--& �0�/l�/J Phone#: ! 4 State Certification or Registration #: I Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $!'�9%9d Square/Linear Footage of Work: Type of Work: j ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: L U ay t-46 JZ�N) (S b I V Specify color of color thru tile: Submittal Fee $ Permit Fee $,= Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ , CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 4 3, Q Bonding Company's Name (if applicable) Bonding Company's Address City 411 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 brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs 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. ) Signatu Signature NER or AGENT CONTRACTOR Thlefpregoi g instrumelnt was acknowledged before me this The foregoing instrument was acknowledged before me this 1 day of O/JZ� bJ20 by day of 20 � by who is personally known to ;!Q�FS�v�/rl�,.� , who is personally known to _ _ mg or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY BLIC: NOTARY Sign: Sign: Print: Print: I Seal: �� �LIZETTE LLORET Seal. ;State of Florida -Notary Public _ = Commission # GG 118087 +,F OoP My Commission Expires F f� sss#irk*#*i � s+�sl:hakkss**s*1�sialr��i�i�lii*ss* s**sss***1e1�sr*i*'�. APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review PqY YV i LIZETTE LLORET s° °`:State of Florida -Notary Publi _„ Commission # GG 118087 OFfLbp' My Commission Expires 11.11" June 22. 2021 Zoning Clerk