REV-19-2349Miami 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
BUILDING
PERMIT APPLICATION
SBUI�NG ❑ ELECTRIC ❑ ROOFING
�cEzvED
OCT oa 2019
BY:
FBC 20C+
Master Permit No. U f " 07'l _I -15LAQ i1
Sub Permit No. ple-4-10 �i' a3`t�
M REVISION ❑ EXTENSION ❑RENEWAL
I —
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
rn p��(SiCONTRACTOR DRAWINGS
�%
JOB ADDRESS: (Z / t// 1 E qq P—A.+7
City: Miami Shores County: Miami Dade Zip: Sg 3
Folio/Parcel#: 1 1-.32v5 - 00y - ()I y 0 Is the Building Historically Designated: Yes NO_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee
�Simple Titleholder): �Q,I( o�y(s�er Phone#: 306- �'1,3r-72? I
Address: 14 �(! NE qa 5-fl-ee t
City: M,I a m _S h wts State: Fl" Zip:
Tenant/Lessee Name: Phone#:
Email: /� n �,, /
CONTRACTOR: Company Name:�1V &0 l� 9QL � LLC/ Phone#:' �lfj' -71% 7 00�j
Address: 1 'f u o M u\) 1 lns�e c.
City: 91 LI.IM 1 State: ITZ(/ Zip: 2
Qualifier Name: H i r o 5i` L) r e h u m o Phone#:
State Certification or Registration #: C G C I S Z. 0 S 19 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Add
City: State:
Value of Work for this Permit: $-4�Sy�, Square/Linear Footage of Work:
Type of Work: ❑ Addition L_° I Alteration ❑ New ❑ Repair/Replace
Description of Work: R r- v i r i o n fo 4` ern i f
/'IoJea� poo� 6 FeL�
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Zip:
❑ Demolition
Permit Fee $ CCF $ CO/CC $
Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Double Fee $
Bond $
(Revised02/24/2014)
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
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.
l `
Signature �-V
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of "LUJ — , 201�, by
who is personallyknown to
me or who has produced
vhoLAMEa"65 oath.
COMMISSION # GG 178019
EXPIRES: March 2, 2022
Print:
Seal:
Signature:�-- 1/..,
C NTRACTOR
The foregoing instrument was acknowledged before me this
day of e v .20 � by
�0—,-kj &90LA,1 9,6who is personally� to
as me or who has produced
identifica
NOTARY JWL MY COMMISSION # GG 178019
s..� EXPIRES' arc 2022
Print:
Seal:
as
APPROVED BY (� �� Plans Examiner b Zoning
Structural Review Clerk
(Revised02/24/2014)