Unknown (2)01
Miami Shores Village RECEIVED
Building Department 4
20050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Faux: {305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING ,Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING 0 ELECTRIC ROOFING ❑ REVISION p EXTENSION ❑RENEWAL
[❑ PLUMBING ❑ MECHANICAL C)PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION 0 SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I 1Aw k Lip
Miami ShQrr5 ramnZ.Miami Dad ZI
Folio/Parcel6: I `� } s {� i _ I the Building Historically Designated: Yes NO
Occupancy Type: Coad: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder); atvi hnrte#
Address
ZIP=
City: 1 State: .
b \ 6-
Tenant/Lessee Name: 1IN y Phoine##.--"3
Email. Cet
CONTRACTOR: Company Mame;
Address:
City: state: f .0 �1 i • State:
Zip; 73 R / D A
Qualifier Name; P &(A A /.z _..� Phone#• -T A z7 l ,
State Certification or Registration #: C Cn C`./��? 7..1_2x_ Certificate of Com eters p cY#: S r
DESIGNER: Architect/Engineer; Phone#;
Address:
City.State: • Zip,
Value of Work for the Pernsit: S_ 4uare/tinear t n+artage of Wow. _•�ii2�A.'IL.S
Type of Work: ❑ Addition ❑ Aiteration . ❑ New
Description of Work:
Specify calor of calor thru tiler At Vis
Subrruttal Fee S.._._ Permit Fee $
❑ Demolition
CCF $ CO/CC $
Scanning Fee $ Radon. Fee $ DEPR S Notary $
Technology Fee $ TrainindEducation Fee $, Double Fee $
Structural Reviews S,
IRe+dwed02j24t2014►
Bond
TOTAL FEE NOW DUE S
Bonding Company's Mame (f applicable)
Bonding company's Address
city State
Mortgage Lender's Name (if appkable)
*'_%. / es.
Lip
mortgage Lender's Address
City
State _ Zip
in a permit to do the work and installations as indicated. I certify that no work or installation has
Application is hereby made to obta
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all lays regulating
construction In this jurisdiction. 1 understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..
OWNER'S AFFIDAVIT: l 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 WITKYOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to AppOwnt: As o aaandditioe to the issuance of a building permit with an estimated value exceeding $2500, the oppiicant must
promise in good faith tfart o copy of the notice of comrneecement and constructian lien law brochure will be delivered to the Person
whose property is subject to attarchment:. Aho, a ceR'#W copy of the recorded notke of commeOwmerrt must be posted at the job s/tr
for the first inspection
which acc urs seven (7) days after the building pern* is issued. in the absence of with posted notice, the
Inspection will not be approved and a reinspectjon wN be charged,
Signature Signature %��
OWNER or AGENT CONTRACTOR
The fore�ln; instrument ISacknowledged gore me t 3
day of2 ) by
w naliy known to
me or who has produced til (� �Qw,rS as
identifk ation and who slid takie an oath.
NOTARY PUBLIC' . ^
Print:
Seal:
MAHARAI K. GONZALEZ
EXPIRES: November 2, 2020
Bonded Thru Notary Public Underwriters
The foregoing instrument was acknowledged before me this
__L3_ day of ��� • 20 L jR_� by
/� o " /'Q D CAwho is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBEIC:
Ste` +Y Notary ►uolic • State of Florida
Print: Com 0
r My Comm, Expires May 20, 2021
Seal:
Bonded throu;h National Notary Assn.
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APPROVED BY Plans Examiner
structural Review
(sW0ZJ24j2o14)
Zoning
Clerk