MC-18-3411Miami Shores Village
Building Department
NO 0 8�2018
Miami Shores, Florida 33138
`..� 10050 N.E.2nd Avenue,
Tel: (305) 795-2204 Fax: (305) 756-8972 V.
INSPECTION LINE PHONE NUMBER: (305) 762-4949 --
FBC 20
BUILDING Master Permit No. (Z.,
PERMIT APPLICATION Sub Permit No. �c� e - -_�411
F-JBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL
❑ PLUMBING �g MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
p CONTRACTOR DRAWINGS
JOB ADDRESS: n
City: Miami Shores County Miami Dade Zip: 5 3 i 3
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: ,.h BFE: FFE:
OWNER: Name (Fee Simple Titleholder): (IT I �� VW T. Tr roy l-le Phone#:
Address: 'B-10 1�E 2 - l
City: I`''V6 4 t sAp«6 State: Zip:
Tenant/Lessee Name: Phone#%—
Email: �.� lll/t_Q- .��i�✓I�PL`C�.IYI�i��• ��Iyl
CONTRACTOR: Company Name: 0& 60YljJ &A((\ I,R C_ k-' Phone#: -796 'z%c7G1
Address:
City: i (A
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
State:
Zip: '41D_o
hone#: ' ag�— ci_60�
2_ j _Certificate of Competency #:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition LZSI Alteration ❑+ New ❑ Repair/�Repllace ❑ Demolition
Description of Work: A�c N (yj V 0EXIAtL(�t�� I i �Iyl 1.s
Specify color of color thru tile:
Submittal Fee $� Permit Fee $ i CCF $ CO/CC $
Scanning Fee $
Technology Fee $
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if'applicable)
Mortgage Lender's Address
City
Zip
State 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 suc posted notice, the
inspection will not be approved and a reinspe ion fee will be charged.
c
Signature ignature_
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing
acknowledged before me'this
day of N� � � 20 ( P , by _ day of WOVeMb-C.\ , 20 1' by
who is personally known to
tJo �� iC1�Y`I�, , who is personally known to
me or who has produced -L U t2 U ct Ns me or who has produced as
identificat' n and who did take an oath.
identification and who did take an oath.
NOTARY U IC:
NOTARY PUBLIC:
Sign:
Sign: td,LL
Print:
Print:
Seal:
.: *_ MY COMMISSION # GG 238273 �
SINDIA ALVAREZM."31
iro'
��•%
Seal:
MY COMMISSION t FF 195571
May 15, 2019
EXPIRES: September 3, 2022EXPIRES:
"'
1 P. c 4r Bonded Thru No Public Underwriters j
11
Bonded Thru Budget Notary Seftes
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1
APPROVED BY Plans Examiner
Zoning
Structural Review Clerk
1RPviC dn9/74/9n1Ai