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MCC-19-2322 (2)Miami 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 ❑BUILDING ❑ ELECTRIC ❑ ROOFING RECEIVED oC + vil l.Y FBC 201-" Master Permit No. CC - © 3 —19 `6s!s Sub Permit No. MCC- ) 0- lg- a31-20-z ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING § MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS G�7� 1 Z� N _n �/� y!Q'X ► V-C JOBADDRESS: City: Miami Shores County: Miami Dade Zip: 3--� (' , Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Zone: BFE: Construction Typpee:�1 FFE: 1Flood �_. _t OWNER: Name (Fee Simple Titleholder):('4 -1 �J (Ja Pho e#:� Address: ocl L �J 0- `- %"� A)T-- City: 't ';AA !`-.e� State: Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: Address: l0 '-LjCA'.' ne#: k City: State: ��JOIL �� Zip:�y Qualifier Name: 5%V\�� !± `!'�'j�- Phone#: -- 7 A(0 31;� State Certification or Registration #:c�AG Certificate of Competency #: DESIGNER: Architect/Engineer: 1.`A-._h...+'9..aM�s:.�'\...'�� •L9YeC; a./C.k.n.�'.1Y� ne#: State: Zip: •Value,of Work for this "Permit: • na Square/Linear Footage of Work: ,Type, of Work: ❑ Addition ► ❑ Alteration ❑ New ❑ Repair/Replace :�e.e.ire•�e::.a.�.^,-�.+ewa'r.tr'�K".ar-p•tY"'1.._= �. . • � {� Description of Work: El Demolition Specify color of color thr 1 N tile: Y Submittal Fee $ �,n�� Permit Fee $ 1W CCF $ �. CO/CC Scanning Fee $ �• W Radon Fee $ '�I. Do DBPR $ vc. Qh Notary $ Technology Fee $ P-S0 Training/Education Fee $ b- (D' Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ �n • �� (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 attachm nt. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection hich occur even (7J days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap roved and einspection fee will be charged. Signature Signature 0 ER or AGE T NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before rre this 'Z- day of 20 `g by 2 day of �—\ 1 20 lS by o is personally known Ism C 14 ('<. who is personally known me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take NOTARY PUBLIC: Sign:_ Print: c- Seal: , i►*YO�. JAVIER PEREZ ?�Ak Notary Public • State of Florida Commission . FF 958026 My Comm. Expires Feb 7, 2020 APPROVED BY NOTARY PUBLIC: Print: Seal: FERNANDO ARIAS JR Notary Public — State of Florida Commission # GG 179009 Ily Comm. Expires May 19, 2022 Hon- through National Notary Assn. 'PI ns Examiner Zoning Structural Review Clerk (Revised02/24/2014)