REV-19-2459Miami Shores Village UBY:
EE,
Building Department ;9
10050 N.E.2nd Avenue, Miami Shores, Florida 331381
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FFBC20
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BUILDING cy Master Permit No. p
PERMIT APPLICATION �l�I -IO�I I -�4S9 Sub Permit No.�- I �n 3-
❑BUILDING MrLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
,`
CONTRACTOR DRAWINGS
JOB ADDRESS: 60 1 GRot9AJD cdAJ(f v L) rS e
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 " ✓ 2,6e 6 1-7 - 2146 Is the Building Historically Designated: Yes NO
Occupancy Type:!Se r Load: Construction Type: (f 156. Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): C A P L6 S F. L E rn n S Phone#: M-.39�)' --30-29
Address: Koo ] 6,AAND Concourse c�jz •
City: M ] AYn ) SN632GS State: T= L, Zip: 3 1 3
Tenant/Lessee Name: ow n e rZ O CC, y JD 1 e JO Phone#:
Email:
CONTRACTOR: Company Name:
Address: 9i t 5
r?k L _ 1, [i bP-
City: 1 b ki. State: 1, zip: 33 I cJ 4
Qualifier Name: Phone#: :06 -19 o'98 y0
State Certification or Registration M Certificate of Competency #: L i L' f76C70
DESIGNER:Arcchitect/Engineer: Yice- r) T'e C.0 Phone#3Q_�' 30s-:5631
Address: C& l 4� M W City: I)O%ii L State: Zip: 33J 74P
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition
Description of Work: As 6 U 1 LT C LE'GT Y- i G)A L_ Fd Q
Specify color of color'tku tile:: w i"
Submittal Fee Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
CCF $1" . . . . ' . 0O/CC-$.n V _ ..:,
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 43 • oz)
(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 refection fee will be charged.
e..".
AGENT
The forgoing instrumentA acknowledged before me this
_ day of 20 by
Z RG05 LC-"5 who is personally known to
me or who has produced
Signatu
CONTRACTOR
The f Weing instrumeenntnwas acknowledged before me this
day of 20 19 by
MW60o is 2tLwna4known to
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB NOTARY PUB
4f�:
Sign: Sign:
Print: L) S ! l7d 5 Print: ✓�S �v 5
Seal: ; ���+:�y;•., LUISESPINOSA Seal: +;t!?i':.t}•, LUISESPINOSA
Commission # GG 290679 fi; Commission # GG 290679
:•.'r,;r Expires January 13, 2023 t;,:P Expires January 13, 2023
8orbed TMu Troy Feln Insurance 800 S85 701A .°►!1,; Bonded Thru Troy Fein Insurance 8004W7010
APPROVED BY��}'(� G%�/ Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)