PL-20-122BUILDING
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (30S) 7S649n
INSPECTION UNE PHONE NUMBER: (305) 762-4949
JA 17 2020,
BY:
FBC 201� l .
Master Permit NoE-C-`-
PERMIT APPLICATION C t, YU111
Sub Permit No.�L - 0( - �0 � �
BUILDING ELECTRIC ROOFING ER EXTENSION RENEWAL
[%fPLUMBING ❑ MECHANICAL [3 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
JOB ADDRESS: l2? I N G
DRAWINGS
City: Miami Shores County: Miami -Dade Zio: 3 313 1
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type,:, Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): L-e-eon ��D� d b" Phone#: 30 ' �� �'1 - 3 (/
P
Address: 12 7 1 ty
clty: Ni arh '� S`korc S State: 1 —zip: 3 31
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Address: _ \00--) -Z IUC.(J
city:
•
zip: 331?�a,_
Qualifier Name: ''PoLjn -ol 5co4 Phone#:3o5=E3Y3
State Certification or Registration #: 00Bc? Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City State _Zip:
Value of Work for this Permit: $ 3, QZo , Ui Square/Linear Footage of Work:
Type of Work: ❑ Addition [!f Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: kocD koLm s cam, L M k 15 " y
-jp
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ co/cc $
Scanning Fee $
Technology Fee $,
Structural Reviews $
(Revisedo2/24/2014)
Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL. FEE NOW DUE S
Bonding Company's Name (If applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State I 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 on estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the persorl
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'relnspectlan fee wie�h rged.
Signature S
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
G040n , who is personally known to
me or who has produced
Identification and who did take an oath.
NOTARY P
6 Sign:
Print: —�� �Y`Q �� • C?��'i U
OWt Pue,, PAMElA J. CASQURIA
Seal: +� '....,� * MY COMMISSION # FF 961989
NE�oe EXPIRES: May 9, 2020
jf;
F�OOFF F''lO��., Bwded TTvu Budget Notary Services
#i#iit#i#i
as
The foregoing instrument was acknowledged before me this
rR "1 day of 71A "t , 20 �� , by
'EJUDOW'd yQtitnE whoIsWx&oa&IlyAagwnto
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: l�W's' ►�� w�y�y
Print:
CRISTINA ARIAS
Seal: P= Notary Public - State of Florida
• Commission N FF 934455
a F`�Aos My Comm. Expires Mar 2. 2020
80ded through National Notary Assn
APPROVED BY Plans Examiner
Structural Review
Zoning
Clerk
(it"Ised02/24/2014)