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WS-17-1307BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department MAY 112011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 q F C 0 Master Permit No. V-� S t _:k '' � Sub Permit No ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑MECHANICAL [—]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: jg& wz -20.4m • City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ��—�2©d 'T%' $0 Is the Building Historically Designated: Yes NO Occupancy Type: lZ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address:f� /�� zN'�a►/E' City A.///4/119, State: rl • Tenant/Lessee Name: /(-�1!/G?�P Phone#: J41,5-455- /SOcV Email: CONTRACTOR: Company Name:/ � ''s `ANG Phone#: Z2W'y4#6'& Address: 1�5U4o� City: State: O� Zip: J3/25 % Qualifier Name: �'�N VI"Arz- Phone#: State Certification or Registration M G D -7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repai ❑ Demolition Description of Work: '� Specify color of color thru tile: Submittal Fee $ Permit Fee $ Cn2o W CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE (Revised02/24/2014) 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 p of he notice of commencement and construction lien law brochure will be delivered to the person whose property is subject t c ent.rtified copy of the recorded notice of commencement must be posted at the job site for the first inspection i o urs s n (� days after the building permit is issued. in the absence of such posted notice, the inspection willnot be pr a and ins ction fee will be charged. tr Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of A!Zti.20 17- by 6.1i �!td!w7M/ A who is personally known to me or who has produced AV, P4- as identification and who did take an oath. CONTRACTOR The foregoing instrument was acknowledged before me this _ day of elvW- 20 1Z by Z:7,(d,it/ V1444F- , who is personally known to me or who has produced �'� 14:t- - as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print:Print:'L Seal: ************ APPROVED BY (RevisecIO2/24/2014) TERESA DEL PINO Seal: MY COMMISSION # FF 046586 EXPIRES: August 19, 2017 Bonded Thru Notary Public Underwrders TERESA DEL PINO MY COMMISSION It FF 046586 EXPIRES: August 19, 2017 Bonded Thru Notary Public Underwriters ************************************************************************* ►/3�� Plans Examiner Zoning Structural Review Clerk