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RF-16-3121r BUILDING PERMIT APPLICATION Miami Shores Village [—B CFrvED Building Department Nov 15 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20H51"I Master Permit No. irir 1l —Ci j 12 1 Sub Permit No. ❑BUILDING ❑ ELECTRIC %J ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12.30 N C I DZ `'d S i - 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): V*t-'-b g.+ Wb*L-Fr>t-t4 Phone#:�J Address: I Z3t> 141' 10 'Z't d S4 - City: A4 1-4-t 540.aG-5 State: Ex Zip: Tenant/Lessee Name: Email hone#: CONTRACTOR: Company Name: Z"B 5 Phone#: Address: fit NE 04- 5.�' City: ?A State: �L Qualifier Name: -; W,qc- Phone#: State Certification or Registration #: CCC t 3 Z ZS',J Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: 305' s' z?- 8 3 0'3 Zip: 33 13 Z Address: n City: State: Zip: Value of Work for this Permit: $ d- i �U Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: R2— ">e—"" ecnn f J- -0 2ietFLAN<-1r— P -f ►S Specify color of color thru tile: Att ,00 Submittal Fee $ Permit Fee $ L 5 Q CCF $ , a CO/CC $ �S Scanning Fee $ Radon Fee $ 3 DBPR $ �S Notary $ Technology Fee $•(.4C) Training/Education Fee $ SOD Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Z 49 , `S© Bonding Company's Name (if applicable) 01A - Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State 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. Signature1111 Signature ` 0 WAGENT CONTRACTOR The foregoing instrument was acknowledged befo a me this The foregoing instrument was acknowledged before me this AS day of 20 by S day of A)av--.b t , 20 by "W'-- who is personally known to aft k »,� _ who is ersonally know to me or who has produced as me or who has produced _ as identification and who did take an NOTARY PUBLIC: Print:'9 Seal: ��ii,,•(yan; c identification and who did take an oath. NOTARY PUBLIC: Sign: Print g t— S Seal: APPROVED BY I� Plans Examiner Structural Review (Revised02/24/2014) ERIC PM9 MY COMMIIsm" 0 FF963"4 EXPIRES Fowu" 23.2020 Zoning Clerk