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BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
1 L3
FBC 201- 04-L'
Master Permit No. CC 05� /9 // QP12
Sub Permit No. Rev- ID-1 °I o 4oV
1W REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: T 7d o & e2NA Ay6
City: Miami Shores County: Miami Dade Zip: 33 (39
Folio/Parcel#: , �i ��� (� I Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): `t Artbf— L4Kme#: �d.� / 7 1
Address: 19,50 /(ft A4<7-
City: OMA WI LL,4k,AS State: F/ Zip: 973 0/1,,
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: &AVP2-- '1P 9,t-QP f1 eg-r Phone#:
Address: /��.�,I""'S<_0AA�jk1 6 s%
City: Mi �`I i ��c State: k" i0 rt Zip: 3 ° 01
Qualifier Name: ALITI
one#:
State Certification or Registration #: DS 7cI 33 V Certificate of Competency #: DESIGNER:Archiittect/Engineer: //�5Trp+�'U' 42A6A:;.ALLA Phone#: Clamay 5.l 01
Address: U�� (AJ l� 12MI" City: PlaN ct�oyV State:—fb Zip: 33
Value of WoWfor this'Pei f6it:`$ 5- '"4nP Square/Linear Footage pf,Work: 1
Type of Work: ❑ Addition Alteration ❑New ❑Repair/Replace ElDemolition f
Description of'Work: (�� L/ ►4A Q/ (s� ' �z (.o G C �/ac izyzJ 5
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $y • 66 CO/CC $
50
Scanning Fee $ 2 GO Radon Fee $ DBPR $ 2 1 0C) Notary $
Technology Fee $ Z • Training/Education Fee $ o Double Fee $
Structural Reviews $ Bond $ �G
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)
I
Mortgage Lender's Address
City
State
Zip
W
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 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 approveAand a rein.5pection fee will be charged.
Signatu
R or AGENT
The foregoing instrum nt as acknowledged before me this
-� day of 0 20 _% Q by
CsotUs/►ti1& who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PU 1 ; . °��. CAR C: : n.NANDEZ
SWX Y PL--d. State of Florida
Comrries;or• a GG 909254
orrti M, C711'rr'. Lx]Irl'S ALg 29, 2023
Sig _ / Boncec tnr:,.vr s. „r., %•1,.,11 A—
P
Signature /:��
CONTRACTOR
The foregoing instrument was acknowledged before me this
1 day of 0 C , 20 (3 by
r✓bAQ"rIN 6mi'l-►-V4 who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY
.y .
CAR! OS P;RNANDEZ
Notary PL,- : State or Florida
pr o;
.'ov
Con•rr.issror ❑ GG 909254
N4"'
My Comm.:x;;ucs A•..g 29. 2023
Bondec through %a;,:ra rotary Assn.
Sign
P
Seal: Seal:
R r A.-AAZ
as
APPROVED BY ` Y Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)