REV-18-2971m
Miami Shores Village 7SE1 IVED
9 20 8d
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
FBC 20
BUILDING Master Permit No. e pp -9 - le- u6
PERMIT APPLICATION Sub Permit No. V-31 1) 0 3 -2=9-9-1
BUILDING ELECTRIC ROOFING [X REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLICWORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Z t0 %e It ST
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): \'n
Address
hone#:
City: 1- ` 4,el,-\ `Q,,'VQ'C State: TZ— Zip: n3
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: 1!2 &.1 W YNY' ''JV--',.
City: 2
I
G„T V1 State: T_L_ Zip: 53313
Qualifier Name: _ J 1 (\_QrnS Phone#:
State Certification or Registration #: (1, Pel 1 Li S 99 X12 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address:
Value of Work for this Permit: $
Type of Work: Addition Alteration
Description of Work: " sr oyl
City: State
Square/Linear Footage of work:
N}ew Repair/Replace
Specify color of color thru tile:
Submittal Fee $ M Permit Fee $ • CCF $_
Scanning fee $
M Radon fee $ DBPR $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Training/Education Fee $
Zip:
Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ . cl-,:)
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 o 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 issued. In the 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
ft)
A ,
20 by
V1C211,C who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY
Sign:_
Print:
Signature 00-11i a=====,
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20—, by
OL&t.D who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC: A /
Sign:_
Print:
Seal:
yk Notary Public State of Florida Notary Public State of Florida
Adriana Rojas Pierrend Seal: Adriana Rojas Pierrend
p•My Commission GG 183868 , < My Commission GG 183868
d; Expires 02/07/2022o, Expires 02/07/2022
s*ssss**s***sss*sssss*s*******ssss****s********ss*ssssss*ss*ssssssssss*****s********ss*s*ss***********sss**
APPROVED BY --- %G–" Plans Examiner
Structural Review
Revlsed02/24/2014)
Zoning
Clerk