REV-20-850Miami Shores Village R-ECEIVED
Building Department A R 2 9 2Q20
100SO N-E.2nd Avenue, Miami Shores, Florida 33138 BY:
jA�,
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
Master Permit No. 444dP4;,�;��
Sub Permit No?-125✓ "o�26 `ty�
�EVISION
❑ EXTENSION ❑RENEWAL
�LUMBING [:]MECHANICAL ❑ PUBUC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Q 7 Z, A) i✓ 2. 4 Jc afi ll— -?a J —
City: Miami Shores —_ County:_ _Miami Dade_
Foiio/Parcel#: l 3'2,b toQ l3 d,�J O Is the Building Historically Designated: Yes NO
Occupancy Type: load: Construction Type: Flood Zone: -- 8FE: FFE:
LLC-
OWNER: Name (Fee Simple Titleholder): 6P&jQIty3 �G 2 A -at Phone#: BO7- �
Address: _7-t5, p _ IJ cJ _I G� Ce-
City: 1111acar( L,A —State: � _ Zip:
Tenant/Lessee Name: Phone#: _
Email: j�,1��. Q t�.t�z 9r ��O� t �1 vl . 0,P r -,
CONTRACTOR: Company Name:U�It�i Phoned: "NeAo �13}
— --
Address:
City: State: Zip:
Qualifier Name: f'tti il. /� Qr�� 1 t i Phone#: n9so
State Certification or Reglsftration #: _ l��2LAO && Certificat f Competency M
DESIGNER: Archltect/Engineer. _ "- �! J ZAIK"w -4 . /��n , Phone#
Address:�gL—to �:� V o 1K 90-dCIty: '_ j ,- jv, State:'L_ Zip: 7baLl _
Value of Work for this Permit: $ Square/Linear footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: 0.) ^ j �114_ # X_ _ — _
Specify color of color thru tile:
Submittal Fee $
Scanning Fee S
Technology Foe S—
Strueturai Reviews S_
(RevisedO2/24/2014)
❑ Demolition
Permit Fee $ CCF $ — CO/CC $
Radon Fee $ DBPR $ Notary $
— Trainins/Educatian Fee $ _ _ _ Double Fee $
Bond $
TOTAL FEE NOW DUE $3
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 o 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 i spection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
Inspection w/l�noi be approved and a reinspecrion fee will be charged.
.I
Signature �_ _ Signature_ —
OWNER or AGENT CONTRACTOR
The foregoing i strume/nt was acknowledged before me this The foregoing instrument was acknowledged before me this
day f`(_Li 20 _ by �✓� day of 20'Z..C� , by
�T.trvFi t'�� � tS who is p sonally known to !-Jj" _, o is person n to
me or who has produced as hhas produced — _ as
Identification and who did take an oath. i fication and who did take an oath.
NOTARY PUBLIC: N TARY PUBUQ
Sign: _ _ Sign._ BARBARA CARMONA
— —%� t•t Notary Public- 4tate`ot_E10
Prfnt:._J"!'! l _ _ _ Y (,�®,Z_ Print: _' = Commission # FF 949354
.� COMMISSION # GG2910 �"'�`° — S2020
eal: Seal: _ ��' a" Bonded through Natic 4 Notary Assn. T
y = EXPIRES: Janusm'y 15, 2on
Bonded In Aaron Notary
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APPROVED BY Plans Examiner _ —_ Zoning
Structural Review Clerk
(Revisedo2/24/2014)