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EL-19-1445Miami Shores Village Building Department . 4t- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 •�FBC 20 BUILDING Master Permit No. 1 c 0 ��j,5 '14— PERMIT APPLICATION Sub Permit WEL Gb" l(q-1 Ll q�p ❑BUILDING P ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP rr CONTRACTOR DRAWINGS JOBADDRESS: 4�� L r 04'x4) 5 `' M Folio/Parcel#: I� 2 _ t� (o i� 1 �c Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Q O i, hq (2 (/IPho e#: -3 2-S 73 i7 CAI L —•Addresss- C�-icy'`D ,—State:, Tenant/Lessee Name: t \ Phone#: Email: U CX c-t I Cm f� ram, \ Q-4 9 a van CONTRACTOR: Company Name: 9�abv561rr c X %ry Qyf%6Q Phone#: Address: f~)ROO % tt---- 1100 O 1 City: &%' YV !M Stater Zip: / Qualifier Name:6ogi Phone#:�©S State Certification or Registration #: LC 1'2, On Certificate of Competency #: DESIGNER: Architect/Engineer: Address: one#: City: State Value of Work for this Permit: $ N512 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace Description of Work: / K r El Zip: Specify color of color thru tile: Submittal Fee $ Permit Fee $} /✓�a� O CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ ' Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ j i TOTAL FEE NOW DUE $ I (o ' 1 O rte (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 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. Signatu or AGENT The foregoing instrument was acknowledged before �m, a this day of �+�^� �. 20 1 by ����(� 0? o is�p sonaally known to me or who has produced_D2*J�.9- LkUNS--as identification and who did take an oath. The foregoing instrument was acknowledged before me this day of JUrN?� 20 /fl by who !s personally known to me or who has produced — '1 2- LA_C.�--N as identification and who did take an oath. NOTA LUB: LNOTARY B IC: Sign: Print: t MY COMMISSION # GG ?.38273 rPSeal: �; ��* SINDIA AILVAREEXPIRES: September 3, 2022 ;: MY COMMISSIO73 Bonded Thru Notary Flblic UrOerxri!ersa:. o` EXPIRES: Sep2/dF��e' Bonded 7hru Notaryters ****************************************************************** ************************* APPROVED B�S'�T4.� l� Plans Examiner Zoning Structural Review I Clerk (Revised02/24/2014)