REV-19-247Miami Shores Village
Building Department Rr-r`IVED
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 FEB 0 4 2019
INSPECTION LINE PHONE NUMBER: (305) 762-4949 0 � _,,1
d__1
BUILDING
PER T APPLICATION
UILDING ❑ ELECTRIC ❑ ROOFING
FBC 201�
Master Permit No. l-4 - ZuZ Z
Sub Permit No._
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
(' �j J /,t� CONTRACTOR DRAWINGS
JOB ADDRESS: I;k / " w ` z9a57
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Ctl „-i S� (1!"J H ` N�- Phone#:
Address: 1 IJ N W (c?O z1
City: �I�i'i 1 ��_ ���� State:
Tenant/Lessee Name:
Email:
p: 5315D
- -I-IS - 3oga
CONTRACTOR: Company Name: • f I 1 ��1! D 1,a, 1W 1� Phone#: �`-�� T `Q
1"INCb�
Address: 3� W �At,\
City: Lb� State: Zip: 3 3 0 l.�2
Qualifier Name:y 'D 55�_ FC_LIPG k1_10 1a.So Phone#:
State Certification or Registration M 15 I G 2 SS Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition Ejj Alteration 04j.
❑ New ❑ Repair/Replace
Description of Work: _ 1jew qQS 0moone- -lpn k , New Gc
vi-frnen f
Zip:
❑ Demolition
Specify color of color,thru tile:
Submittal Fee $ Permit Fee $ CCF $ , CO/CC $
Scanning Fee .$ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
Training/Education Fee $
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 prop?rty 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.
Signature Signature _—
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged20 before me this
day of 012 CeM IWOAU �
, � by
•hilisrtan 1n �+c� (ho is personally known to
mer rr who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: �'2�fZJeZ
Seal: BETSY D. PEREZ
zip %Notary Public • State of Florida
Commission # FF 182380
=?,&F My Comm. Expires Apr 3, 2019
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APPROVED BY
The foregoing instrum t was acknowledged before me this
daybf—_ 21-{� 20 by
D52 F. PAO lt�)o who is personally known to
me or who has produced MST 4 ZL (o1 1 %) Q as
identification and who did take an oath.
NOTARY PUBLIC:
CS
Sign:
Print: (2ze+,- C4
Seal:
Plans Examiner
Structural Review
BETSY D. PEREZ
Notary Public - State of Florida
?• •= Commission # FF 182380
_;,�,r� ��� My Comm. Expires Apr 3, 2019
* '�RlfiF+'" * * BdkMdKlMOdgh NAlIg9M'NelarlaA em s r * * * * * s * * s *
Zoning
Clerk
(Revised02/24/2014)