RC-15-990Miami Shores
Village
�V i l l a e CFTk2r0V15
_,�_:
�O� BuildingDepartment AP2
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 B�Y_�
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20(�) C�
BUILDING Master Permit No.�r
PERMIT APPLICATION CARELLED sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�-7 CONTRACTOR DRAWINGS
JOB ADDRESS: / 9 N/ 6_ 7 p 3 4 -
City: Miami Shores County: Miami Dade Zip: .331 3 K
Folio/Parcel#: // 3 ZO6 01 y 179 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): V f AAa Cl# lU Z- Phone#:
Address: 7D 1 N Q 3 57'
City: M / am, O,-P_S State: r:L. Zip: 3 3 / 3 4"
Tenant/Lessee Name: Phone#:
Email
c
CONTRACTOR: Company Name:gi� �21,ijj CO-yi 57elu e.T: e, Phone#:
Address: 13y ti LJ '7S S 1
City: 41 , r4 A-1 i State: r L— Zip: 3 3 / S o
Qualifier Name: Phone#:
State Certification or Registration #:
Certificate of Competency #:
DESIGNER: Architect/Engineer: r6fifi)' ho 60&97-'P//VA Phone#: 3OS 6/2- $ S
Address: o'i56 Caf�,I817,r0. aA)✓eI, City: 6r4ble5 State:-2FL
Zip: 33L3
Value of Work for this Permit: $ �T'), GO V Square/Linear Footage of Work:
Type of Work: EHAddition /Q Alteration I --]New ❑ Repair/Replace ❑ Demolition
Description of Work: A16W LAinv Dty /S oem aQ ]�LA=— �2C42_M 1 r vk)--
Specify color of color thru tile:_"
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
CO/CC $ _
Notary $,
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
(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
a
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 o attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection lvhich occyXs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a provedlnd 0 reinspection fee will be charged.
Signatu
or AGENT
The foregoing instrument was acknowledged before me this
V(D day of AITV-) L 20� by
VIL.MA who
liiss�personally known to
me or who has produced-VL-'00T&- u.ON4�<— as
identification and who did take an oath.
NOTARY PUBLIC:
Sign
Signature 0—.
CONTRACTOR
The foregoing instrument was acknowledged before me this
�7 Oro day ofL 20 1 LJ by
t`1��N1(�Iy9N�17, who is personally known to
me or who has produced f l'�2111 �C as
identification and who did take an oath.
NOTAR;PUBLIC:
Sign:
Print: Print:
Notary Public State of Florida
Seal: ` Sindia Alvarez Seal: Notary Public State of Florida
My Commission FF 156750 Sindia Alvarez
OF pd' Expires 09/03/2018 My Commission FF 156750
Expires 09/0312018
la
APPROVED BY 7 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)