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EL-16-1965BUILDING PERMIT APPLICATION BUILDING ELECTRIC PLUMBING MECHANICAL JOB ADDRESS: Miami Shores Village u 4 ;^s Building Department IBY:_ p10050N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 S FBC 2011 Master Permit No. Sub Permit No. 01 ROOFING REVISION EXTENSION VNEWAL '-O(d PUBLIC WORKS [:]CHANGE OF F__]CANCELLATION SHOP CONTRACTOR DRAWINGS j- rtnq164eloap S City: Miami Shores _ County: Miami Dade Zip: Folio/Parcel#: //' 32o6 -d13-" (021'0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type:: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): nM r• [/ h Phone#: 3W9P-W Address: 2710 City: A-11,7, /to«S State: Zip: 33/3d Tenant/Lessee Name: %,/ Phone#: Email: e,Oj/ CONTRACTOR: Company Name: Phone#: Address: aped 50) City: ilL r• S L Zip: Qualifier Name: Phone#: ('s 3,,y -21W) e, — --- -- --- , State Certification or Registration # , y Certificate of Competency #: DESIGNER: Architect/Engineer: 1 Phone#: 4, ., Address: _City: State: Zip: Value of Work for this Permit: $, 01i'O. G Square/Linear Footage of Work:• Type of Work: EM Addition © Alteration New Repair/Replace Demolition Description of Work: e&,) GD20 , //176- IPI - Specify color of color tt hru tile: t Submittal Fee $ • W Permit Fee $ A 8,19-oa CCF $ CO/CC $ 13ScanningFee $ ' W Radon Fee $ 2 V DBP(RR $ r Notary $ roTechnologyFee $ - l Training/Education Fee $ l Gy Double Fee $ Structural Reviews $ P Bond $ TOTAL FEE NOW DUE $ c1'5'-'4-2_0 Revised02/24/2014) v 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 to attachment. Also, a certified copy of the recorded notice of commen ement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In a absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. , _ J Signature Signature. OW or AGENT The foregoing instrument was acknowledged before me this c; 2 day of //d 20/(,P by z//4,I pS7-AC J , who is sonally kno pito me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY Revised02/24/2014) CONTRACTOR The foregoing instrument was acknowledged before me this cPL day of uu' 120 /!a by 0 3( • Vlc/moi who' ersonallyknato me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 0/7.-A K/r-; as Seal: y. SONIA GUERRASONIAGUERRA MY COMMISSION # FF971657 MY COMMISSION # FF971557 EXPIRES March 15, 2020 EXPIRES March 15, 2020 8**=****** **** **** J 45z"'P= Z L7&A 1 Plans Examiner Zoning Structural Review Clerk Miami Shores Village Building Department AUG 9 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 FBC 20 BUILDING PERMIT APP (CATION BUILDING ELECTRIC ROOFING Master Permit No. Sub Permit No.T—L I L f REVISION EXTENSION RENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOBADDRESS: . -J a Occupancy Type: Load: OWNER: Name e( Address:3( Feee Simple Titleholder): N_ City k =r s,Jbll*lfilding Historically Designated: Yes NO n Type: Flood Zone: BFE: FFE: State: Tenant/Lessee Name: Phone#: Email: CONTF Addre! City:CfrG1'-1 State: Zip: Qualifier Name: -J'491re Phone#: State CertificatioL nor Registrati n MD Ce T tency #: DESIGNER: Arch itect/Engineer: KIM Phone#: Uri% Address: City: State: Zip: ofLValue Work for. this Permit: 7/ l$ lyw Square/Linear Footage of Work: Type o f Work.1 DdAddition [:1. Alteration New Repair/Replace Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE z 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 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 comme cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. / Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of C/ 201.5 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signatu CONTRACTOR The foregoing instrument was acknowledged before me this 4- day of d 20 /5 by Gt tiLGJ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: _.,.,.,,. / ( D121.6 (Qvc/1'i Print: Seal: ; ' SONIA GUERRA Seal: MY COMMISSION 8 915177348 EXPIRES March 08. 2018 a**ss#ss* _-- *assnssss*:::ass APPROVED BY !Y/jer- /s— Plans Examiner Structural Review Revised02/24/2014) SONIA GUERRA MY COMMISSION # EE177348 EXPIRES March 08, 2018 sasassasas Zoning Clerk