WS-15-2708 (2)Miami Shores Village 7Y..
Building Department T 2 2 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 ----`__
INSPECTION LINE PHONE NUMBER: (305) 762-4949 �
IFBC 20 (`"f
BUILDING Master Permit No. W ✓ 1 —
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 6YE? &W47d CD/1G6tz1-"E
City: Miami Shores County: Miami Dade Zip: 33/32
Folio/Parcel#: Is the Building Historically Designated: Yes !/ NO
, Occupancy Type: Load: Construction Type: S Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Aa e5j M • 46 a SS -n2S Phone#: Jos- q691-166.?,
Address: r19 dm4d 67wj e_
City: Ail', i0tm i SAOI-e S State: P. zip: c.?3 3 fe
Tenant/Lessee Name: Phone#:
(Email: Vic, �iSead'�t.�Ji9uil�inesn/u�-io►�s. edw,
CONTRACTOR: Company Name:
Address: _430/ ww j ?
City: P&MA*,ny d3r�
Qualifier Name:
State Certification or Registration #:
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
-34V 8.240
: S3069
Address: City: State: Zip:
Value of Work for this Permit: $ & to - 5S1- Square Linear Footage of Work: o2 7.
Type of Work: ❑ Addition ❑ Alteration EDNew ?[� Repair/Replace 11Demolition
Description of Work: AdW Y�l . l lt) Lt>i &a SCL� i-_
Specify color of color thru tile:
Submittal Fee $ "50 Permit Fee $ - Q�j' CCF $
Scanning Fee $
Radon Fee $
DBPR $
CO/CC $
Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $ ° O l
Bonding Company's Name (if applicable) Nli+
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
N
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.
SignatureAOZ1�� .3� �/s�i•A -,T :moi Lil
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_3 day of QC�. , 20 IS— by day of 20/-S , by
itv A&S S who is personally known to .�1A who is personally known to
me or who has produced I> . L. as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:. 13c�
Print: . t,ge, M.
Seal:
APPROVED BY
(Revised02/24/2014)
ALICE M. BRYANT
Notary Public - State of Florida
My Comm. Expires Nov 3, 2015
„•� � � ***Ben�rtdeSl4hM �f �9#88B3t*
ttl'�J,✓.
identification and who did take an oath.
NOTARY PUBLIC:
Sign: (.Z ,�. Agg"t
Print: Aey— lilt . 13I V&, �
Seal:
ALICE M. BRYANT
"` Notary Public - State of Florida
%.',;off �op� Commission # EE 143603
Plans Examiner Zoning
Structural Review Clerk
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