DS-17-1577 (2)Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
I - -- A Ia v r
JUN 14 2017
An"AA-n- - -
S4-,
FBC 20-k
BUILDING Master Permit No.
PERMIT APPLICATIONCARELLED Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING— ❑ REVISION ❑ EXTENSION L�JITENEWAL
❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1-4-0 ` K\ l`, A T h 4\,J ,
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Ll - 32-C)C. -Cp l -4- -02_4u Is the Building Historically Designated: Yes —N O _�
Occupancy Type: Rte► AI86&cl: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): (b Z�nr G LLC Phone#: to 337
�-'{ �C�6
Address:
City: �'
Tenant/Lessee Name:
Email
1
State: tel . Zip: 5`51-24
Phone#:
CONTRACTOR: Company Name: A 12i4e 0_ca� 1(U&Ico Phone#: ,iso(- - _s gg8F--54
Address: ls( N Vv V All 13
City: AtFt-t-k1 XL State: Zip:��Jl
Qualifier Name -,1 X1.1, tiCZ I i �
Phone#:
16 -
State Certification or Registration #:K-- (5;,C— +5 lCertificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $ () Square/Linear Footage of Work: (`Kr C I=-
Type
=Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Re air/Re lace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $,
Scanning Fee $
Permit Fee $ tW- 00 CCF $,
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $,
(Revised02/24/2014)
DBPR $
CO/CC $
Notary
Double Fee $ .
Bond $
TOTAL FEE NOW DUE $ &--)S - (e0
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 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 o attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap ved and a reinspection fee will be charged.
Signature,
Signature Na vqm�
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
I LI day of U 20 L� by "n1, day of ` l� p �p 20 �� by
r S ( S r�4ho is personally known to t/� rT,) 2wis`p�rssoonally knownto
me or w o has produced 1(Q -U 7D-Sci-LI LP-ge or who has produced -I QZ J-ooq-SCI-620's ry
identification and who did take an oath.V I I identification and who did take an oath
NOTARY PUBLIC: NOTARY PUBLIC:
Print:
Seal:
MAHARAI K. GONZALEZ Print:
MY COMMISSION
ExpIRES: November 2, 2020 Seal:
Bonded Thru Notary Public Underwriters
MYCO
GONZA%fisSp N
CEEXPIR:NovebGGBonded ZESer 044602
Bonded
- 02
0
ers
**************************************************
APPROVED BY `� Plans Examiner
Structural Review
(Revised02/24/2014)
Zoning
Clerk