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Building Department o jo
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (. X ,9
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �.�.�
FBC 201`l2�-I �1
BUILDING Master Permit Novo W—
PERMIT APPLI A Permit No. V-Ey)3 -P - i l 39
❑BUILDING ❑ EL Nu
SFIN' RE S ❑EXTENSION ❑RENEWAL
la
❑PLUMBING MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
u l CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: ,3 �2S
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1—r�� t' :l` lCiliGY1 Phone#: 312 -J(Q -319_]
Address:: !43 i NE 1 cn s+
P
City: { L `IQi —t shoryz2 State: FL Zip: 3313K
Tenant/Lessee Name:
Email
Phone#:
11 ,,
CONTRACTOR: Company Name: /'(i u�t �t,tl+vnn`r..rl CCM�Y�L�'7+--5 Phone#:
Address: 56"S (01/* ^.j A -v-,'-
City: -ou 13 State: f -L Zip: .72/y'-0Qualifier Name: J 01-4-- �• /-ink Phone#: -7 62 -A-/4
ro
State Certification or Registration #: Certificate of Competency #: 12H0000 2.3
DESIGNER: Architect/Engineer: Phone#:
Address:
City:
Value of Work for this Permit: $ ).'000.00 Square/Linear Footage of Work:
State: Zip:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: A.M�. WLbj-�I+. P • .11Qtx' - Ban
Specify color of color thru tile:
Submittal Fee $ Permit Fee $/n, « CCF $ 0' 040 CO/CC $
Scanning Fee $ � Radon Fee $y DBPR $ Notary $ co
Technology Fee $ 2' GO Training/Education Fee $n, ZO Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ I S
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 -V iITH 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.
Signature
OWNER or AGENT
Signature 2—'/ 7
CCkRACTOR
The foregoing instrument was acknowledged before me this The for oing instrume t was acknowledged before me this
day of/UCas��US ( 20 (� , by day of 20 by
who is personal) known to �OSQ who is personally known to
me or who has produced
identificatiordandi who did take an oath.
NO4PBLIC:Sig
Pri
Seal:
APPROVED BY
(Revised02/24/2014)
as me or who has produced
S►ND►A ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September's, 2022
identification and who did take an oath.
NOTARY P B IC:
Sign:
4
Print:
b.
leal: = = MY
o d' COMMISSIONGG11G
E)TIRES:: January
Ihm ►w
Structural Review
as
Zoning
Clerk