MC-15-2157Value_of_Work-for this Permit:
Type of Work-- ® Addition M
City: State: Zip:
Square/Linear Footage of Work: Q
W RJ,epair/ReLplace Demolition
Descriptiowof Work: I& jZlild zV111 W U i i (/^' 7 ! n ' ("VrA rj- ( VI
Specify color`of color` t iriu'tile•
s rin.. rt+ 9'li.+N r .••t` • -
k'-
Submittal Fee.$ _ Permit Fee $, CCF $ CO/,CC $
r..
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
Revised02/24/2014)
Miami Shores Village CF,IVE`l
AUG 2 4 2015
Building Department BY•—
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
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 Nol" 0 —, 2-
F-JBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
ECHANICALPLUMBINGXMI PUBLICWORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
rJOBADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)- Phone#:
Address: jvt-%
City: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: /"W'dw 4hgt Sh-t-phone#:
Address: 4W -Y
City: N` l /lrM 2 122
State: Zip: 33 l 7
Qualifier Name: S • vrn Phone#: 4
State Certification or Registration #: J9 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Value_of_Work-for this Permit:
Type of Work-- ® Addition M
City: State: Zip:
Square/Linear Footage of Work: Q
W RJ,epair/ReLplace Demolition
Descriptiowof Work: I& jZlild zV111 W U i i (/^' 7 ! n ' ("VrA rj- ( VI
Specify color`of color` t iriu'tile•
s rin.. rt+ 9'li.+N r .••t` • -
k'-
Submittal Fee.$ _ Permit Fee $, CCF $ CO/,CC $
r..
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 Len' er'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. '"%C v M.s ?ti
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 ApplicaZ •'A, s a condition to thM4i6nce of a-;builbing permit -0#h on,esth7vt gJvaluV_exceeding1$ab'90,gtN-Ac'pplicant must
promise in good faith that a copy of the notice of commencement!6nd construction' lienjaw brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice ofx%
Aqnce
cement must be
osv7 '
at tPe job site
for the first inspection which occurs seven (7) days after the building permit is iss i of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
w ;
4-1ve, Signatur acture
OWNER or AGENT t. CONTRACTO
The foregoing instrument was acknowledged before me this The f6regoing instFurnent was cknowled ped before me this
day of ff!/Gl 20 /5— by ..'7-)-,
clawof r. kv4 20 !S— by
rl 572 wh .is personally known o
i
s personally known t
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Arl, Sign:_
Print: U%I/1 Print:
Seal: ;,,p "ka SOMA GUERRA Seal:
i MY COMMISSION 0 EE177346
EXPIRES Mardi 08, 2016
APPROVED BY
Revised02/24/2014)
4 Examiner
Structural Review
17,A
SOMA GUERRA
MY COMMISSION # EE177346
EXPIRES March 08. 2016
Zoning
Clerk