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EL-19-955Miami Shores Village RFCFiVZC Building Department APR 0.:�.a 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (— Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Cob FBC 20I BUILDING Master Permit No. (L r1c -yi — 17 28 PERMIT APPLICATION Sub Permit No. 'G 1 -nu-1 Q -� ss ❑ BUILDING 02"E"LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [::]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS DRAWINGS JOB ADDRESS: � , © tq t- � l C -A City: Miami Shores County: Miami Dade Zip: 3 3 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 4+1 tlS J::�fn_Q n;CG Phone#: Address: City: VAL'afn '� Sltiprr-_:S State: L, Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: cZ��" (��y T C Y,'n�`Og �� Phone#: Address: L� -,, -'re- City: 11_A� 1 04y__k._k State: � 1 Zip: S Qualifier Name: A4E1_X*-k Co�P-C-L Phone#: State Certification or Registration #: 613 c3cxD 9-1- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ P5 3 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace Description of Work: 042" V), 2-- Specify colorof color thru tile: Submittal Fee $_ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ 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 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 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 reinspection fee will be charged. n — Zff-Signature Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of ZS 20 `S by -NACxhS S• K'Q. M,-- a.P , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: ti Sign: � Q Print: Sa''IAItDRIEOAo Seal Commisslon # FF499220 Expires September 9, 2020 Bonded Thru Tmy Fain lawme, The foregoing instrument was acknowledged before me this day of %15 20 lot by jn%, C!�,bVQ.I Q who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: �. _ omm ss on Seal: fa' Expires September 9,2020 90nded Thru?roy Fain lnwnma e00-385 T019 as ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)