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REV-18-3578Miami Shores Village 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 RF C�IV� DEL 03�� FBC 20 BUILDING Master Permit No. Cam-- 8 " (Oi3o PERMIT APPLICATION Sub Permit No. Z, — t ❑BUILDING ❑ ELECTRIC ❑ ROOFING 24EVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 0D kT HANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 iA ` - ACC O V 1 neL..- Phone#: Address: f5� O �It F— L L— City: R (0' k t Si-XO r zf S State: L Zip: F>,:5 �� 8 Tenant/Lessee Name: ��, Phone#: Email: 1( ��Z--� Q ��' � ✓� c..�,pp \z)0e c a3 ' CONTRACTOR: Company Name-:' (-1 a 4�`� t C �I RPot��t Address: l l —I 40 1 �(.C) r t ar, City: ( StateZip: s3 jg3�P Qualifier Name: F�l �QeZ Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: c7 CO Value of Work for this Permit: $ — Square/Linear Footage of Work: K Type of Work: Adydiitio�n ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: y 5t� © V\ Gf'OP!�! OF— W 0(2t_ Z V'-' ! C'A x r /- —A A l l _1 1_ Speciffto/or of color°i}hru tile:'' Submittal Fee $ •.-- —. Permit Fee $ CCF $ ,r �,, �' CO/CC Scanning Fee $ Radon Fee $ <DBPR $ _< — * rr^'w�•.� 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 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 exceedi 2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure ill a delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem nt rprust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the s e of such posted notice, the inspection will not be a proved and a reinspec ion fee will be charged. Signature LtLignature OWNER or AGENT CONTRACTOR The foregoing instrurnent was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ( Qj by day of 6V�— M2 20 `� by tJ (� ��¢�N who is personally known to �L-�3o A�� who is personally known to me or who has produced �� f {ZI (�C l`lSC as me or who has producedIL M oO�N SCas identification and who did take an oath. NOTARY PUB Sign: Print: Seal: SINDIA ALVAREZ MY COMMISSION # GG 238273 ******************* TW APPROVED BY identification and who did take an oath. NOTARY Sign: Print: t Seal: SINDIA ALVAREZ MY COMMISSION # GG 238273 o`. EXPIRES: September 3, 2022 '••poi it?P' WftdW TIvu I of ffl , PUMIC Undemrit S ns Examiner Structural Review Zoning Clerk (Revised02/24/2014)