PL-19-14710
Miami Shores Village
Building Department *9-6
101050 N.E.2nd Avenue, Miami Shores, Florida 33138 r
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 - 0'1
FBC 201 �
BUILDING Master Permit No. V., r- - 57-1 �1�t-?- ,
PERMIT APPLICATION Sub Permit No. PL- (3(-- - I rf- i- 1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSIONRENEWAL
�<PLUiVIBiNG ❑ MECHANICAL ❑PUBLIC WORKS C] CHANGE OF 0 CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
/ 7i ?' /�/'E
o (�-�^
6 3 J
City:
Miami Shores
County: Miami Dade Zip: 3
l 3O
Folio/Parcel#:
_Is the Building Historically Designated: Yes ____
NO I/
Occupancy Type:
_ Load:
Construction Type: _ Flood Zone: _ BFE: ___
FFE:
OWNER: Name (Fee Simple Titleholder):
Addres5. MZ-5
91§�- S.fir
one#: N`{ — %D
t=ity:lN�'� y�S State: Y(i Zip: 5313�
Tenant/Lessee Name:
r _ Phone#:
Email:
CONTRACTOR: Company Narn :
Ataclress: ZUl ��7
city:
Qualifier Name: .�
State Certification or Rekistration #:
CCU
W,O" --,./ ?�a
State:
/io'Z qd ,:3 ,3 Certificate of Competency #:
#:
P
DESIGNER: Architect/Engineer: � Phone#:
4A. Address: _ City: Ala State: Zip:
Value of Work for this Permit: $ v Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ /Allltteration / ❑ New ❑ Repair/Replace ❑ Den;r_>lition/
Description of Work:
Specify color of color thru tile:
Submittal Fee $W Permit Fee $
Scanning Fee $ _ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF S
DBPR $
CO/CC $
Notary
Double Fee $ .
Bond $
TOTAL FEE NOW DUE $ _
f evised02/14/2014)
. . W
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.JF1
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 rein spectionfee will be charged.
Signature__— Sign45 ure E or ANENT CONTRACTOR
The foregoing instrument was acknowledged before me this
. �2011 day of _ 20 1q. - by
udrjn A&hweo who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_ C
Print:
The foregoing instrument was acknowledged before me this
day 0 20 by
grXp w is personally know to
me or who has produced :!���as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: ,Ry PLI" IRMA M PACCIONE Seal:
o Commission # GG 157056
Expires December 15,2021
�iFOF Ma Bonded T?n Bulet Nonm $"
APPROVED BY <Z= A21 Plans Examiner
Zoning
Structural Review
(Revised02/24/2014!
Clerk