REV-20-851BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC ❑ ROOFING
Miami Shores Village
Building Department
100SO N.E.2nd Avenue, Miami Shores, Florida 33138
RECEIVED
A 2 9 2020
BY:
Tel: (305) 79S-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
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Z0 ' Zoo
Master Permit No. e4 =L ;- '--ram,•', Q
Sub Permit Nov
Ef-REVISION
[] EXTENSION RENEWAL
GZ(PLUMBING ❑ MECHANICAL
[:]PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
DRAWINGS
CONT(LlNI-
106 ADDRESS: Q,7 23 hi
r—qACTOR
? tJE 72 --
City.-..._ Miami Shores
County_Miami Dade
Follo/Parceft t 1 I, 'Z.b &0 1224
r2 10 A the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER. Name (Fee Simple Titleholder):
LL.C_
Cokf Mn ��3 Nam ._ 2 A-015 Phone#.
Address: -7 k"5 C) jo 0j (¢ _. _.._......_... _ _..
City:
State:
Tenant/Lessee Name:
Phone#:_
Email:
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CONTRACTOR: Company Name: _
itJ til� _ _ Phone#: kk eP
Address: -jl-1o0,_ Sl
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City: _ — i��_PA4 .._
State:
Qualifier Name: _ tom,
Phone#- —1VE%o ?1n�l- QA
State Certificatlon or Regi Lion #: C/ %4ZQA0 FS \ Certifi tf f Competency #:
DESIGNER: Architect/Engineer.
e J�� /_}fain . _ Phone#i 4 (e I k'
Address: leg Gib 0 0rLqwJ a 1
R
_-Qa� A� Clty: a ✓ State\lt- _ Zip: AdZ�,_
Value of Work for this Permit: $.,__._,....__
___ Square/Linear Footage of Work:
TYPe of Work:, ❑ Addition ❑ Alteration ❑ New
Description of Work: :(7+(/, st 1 pj,.) —' j] V-r.% 3 2,.--
Specify color of color thru file:
❑ Repair/Replace ❑ Demolition
Submittal Fee S __ Permit Fee $ CCP S CO/CC $ --- ,._ ---
Scanning Fee $ Radon Fee $ _ DBPR $ Notary $
Technology Fee $ .-. ` Training/Educatlon Fee S - Double Fee $
Structural Reviews $_ ..._ __-- _.. _ Bond $ _
TOTAL FEE NOW DUE $
lReulsed02/24/2014)
Bonding Companys Name (if applicable)
Bonding Company's Address
M
State
Mortgage Lenders Name (if applicable)
Mortgage Lenders 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 b condition to the issuance of a building permit with an estimated value exceeding $2SW, the applicant must
promise In good faith t at a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is bJ ct to ottachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspe_t whkh occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will note e�pproved and a reinspection fee will be charged.
Signature
CONTRACTOR
The foregoing Instrument was acknowledged before me this
'S O_ day of 1.AP V-e—L-�- 20 �, by
4.1
s persona y
o has produced as
id cation and who did take an oath.
L N ARYpUBLIC:
A.-6t-,ke V'Fmqu� : ,•a�'"„ss
BARBARA CARMONASign:'F._ Sign; U:t= Notary Public - State of Florida
••~ +� - • • e mrtfssion IF FF-949354
Print: �I I �/� ? Y 15 "
Print: My Comm. Expires May 7 2020
Seal: M.i�l b� Seal. �`•�" edthrough National NogryAssn.
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�� r �� IN
PW
APPROVED BY ���.�Ll Plans Examiner Zoning
OWNER or AGENT
The foregoing
�-- day of
me or who has produced
was acknowledged before me this
RL(_ 20 rZO by
who is personally known to
Identification and who did take an oath.
NOTARY PUBLIC:
(Revlsedo2/24/2014)
as
Structural Review Clerk