RC-16-1964Miami Shores Village T!—,,—+--
Building Department JUL 14 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B"1':_
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20-,
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING F-] ELECTRIC ROOFING REVISION [:] EXTENSION E AENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:.3313P
Folio/Parcel#: //- 3,20(0-01-44249 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: /// Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): 4, r • v/ 1*4 Phone#: 61&) 3/ 105W
Address: /Q/! 6,7%e reu g
City: / a-'! e -s State: f- i Zip: 3.3130
Tenant/Lessee Name: / Phone#:
Email: PAOSAM--70ifty C01W _ . fir
CONTRACTOR: Company Name: 1e
Address: -231 6c% /
City: l6tirli QGiL'd/
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit:
Type of Work: i] Addition
Description of Work:
Alteration
v
V bo
Phone 1 7
tet: zip: 33/37 /
cG2
A
Phone#:3/0/
1S
j-31P3 o
Criificate of Competency #:
bo
City: State: Zip:
O -Square/Linear Footage of Work: z 60.06) .S >C%
New Repair/Replace Demolition
O/f1l LCGi
Specify color of color thru tile: '''
jj / TT
Submittal Fee $ Permit Fee $ ) 2-9 -3 'CF $ (,• M? CO/CC $ W
Scanning Fee $ 3 Radon Fee $ • 3 DBPR $ Hq • 3 ( Notary $
Technology Fee $ P.Q. C)) Training/Education Fee $ 22 • 00 Double Fee $ C i
Structural Reviews $ Bond $ izo I
TOTAL FEE NOW DUE $i 90
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
Zi
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work o—r rr%lallation 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 iss d/ In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
u
Signature Signature
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
2 day/off .7v 20141 by
who is p onally kno n to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Poe
Print: Q
The foregoing instrument was acknowledged before me this
4-2 day of q57;1& 20 149 by
aZ r
wh is personal) own to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: /I/GI U2/rlt
Seal:
SONIA GUERRA Seal:
1W.''sg;; SONIA GUERRA
MY COMMISSION # FF971557
EXPIRES March 15, 2020
MY COMMISSION # FF971557
EXPIRES March 15.2020
3B6•I****WNW*
APPROVED BY V Plans Examiner
Com
Zoning
Structural Review Clerk
Revised02/24/2014)