REV-19-949BUILDING
PERMIT APPLICATION
Miami Shores Village - ,J
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY.
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
�,eV_j _19 FBC 20
Master Permit No.
Sub Permit No. L-
❑BUILDING_ ELECTRIC ❑ ROOFING _0 REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
C, C� CONTRACTOR DRAWINGS
JOB ADDRESS: << b L" � 1 2
Citv: Miami Shores Countv: Miami Dade ZiD: 3 3 t
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#:
Address: X-m dcr-CuD
City: ( /
Tenant/Lessee Name:
State: Zip: 1'�F
Phone#:
Email: jI
CONTRACTOR::: Company Name: 1-L � _U-P C `"" �C� �' CJ -S , Phone#: I�-�
Address: i� r a Y°�4 c � oar"\ #E 3E O 786- 1g4, Z' l7S 60
City: State: Zip: 33 S S
Qualifier Name: V` �'iC 2�. Phone#:
State Certification or Registration #: -jz C I O O S ' 2 ( Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ (PS O 'D ° ti Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New '. ❑ Repair/Replace ❑ Demolition
Description of Work: {'� �' �� 01, �o l� � � �s � T��
r) V% ,C & �s w� �rr G,. cue ` � �A u� Oa���.d Q
Specify color of oI thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ Lf� TOTAL FEE NOW DUE $ / 1 0QT
)
(Revised02/24/2014)
9,
Bonding Company's Name (if applicable)
Bonding Company's Address --
Do
Mortgage lenders Name (if applicable)
Mortgage Lenders Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 nnli 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 o condition to the issuance of a budding permit with an estimated value exceeding $2500, the applicant must
promise in goad faM drat a aw of the notice of t and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a cerd)W 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 wsN not be approved and a reirapection fee will be charged.
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of �r 1 .20 14 • by
101MA V t/J !l%da— . who is personal kn to
me or who has produced �— as
identification and who did take an oath.
NOTARY PUBLIC
Sign:44 a, -�--
A°A20
Print: t t'Q L�L L C;pe2-
seal: 111=LIGM
�; IKO�Y8�11fF?l�12�
EXPM& ,Iwo 20. 2M9
wwwrr.�rwnPweur..r•
APPROVED BY
CONTRACTOR
The foregoi g'instrument was acknowledged before me this
day of . 20 / 1 J by
on y �d� G . who is personally known to
me or who has produced �i;��d� v as
Identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
4 1 ;66 Plans Examiner
VIVIAN GIOADANO
Canftw 1 GG 114912
MY CO"-E,Nt1 Jun 14, 2021
Zoning
tllevW021242014
5truch" Review
dark