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FW-19-2618C IVEI� Miami Shores Village No 012019 BuildingDepartment p 7BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 20 CASABC �- 9-��� CELLED BUILDING Master Permit NI PERMIT APPLICATION Sub Permit No. ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS dI JOB ADDRESS: -J9 m c— AoM g) r � S�c�� l�(arnv Sha �S t 2 a City: Miami Shores County: Miami Dade Zip: / � ^, D. Folio/Parcel#: ' l4 -00 `Q4�- 4 `►S Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: X BFE: FFE: U OWNER: Name (Fee Simple TitIehoIder):(DCa LOCO ___DgAA6rni iLe h Address: �4 PE AOI:)� Z�'e4 11 W i eder FICLI.4(- - AS City: Mzdf' S -C(s II Sh`LA`(State: EL Zip: `ItOr1--)(+ e Tenant/Lessee Name: Phone#: i 4:� 00 r)ADa A 1 Email: cLe_ De . e C--D otm?c - d CONTRACTOR: Company Name: AIDjil`e �fJR Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: 1 City: +'� State:��, Zip: Value of Work for this Permit: $ 4Do} , Square/Linear Footage of Work: 1 / V Type of Work: ❑ Addition ❑ Alteration ❑ New C�q Repair/Replace ❑-/D�emolitio1n ( _ Description of Work: �ena,�r C�-I n1 J"ai(a Sy"i,t P�" 6C(rA_ Ce- rpoP�c� �- n S�nrP�-Cc&n } 6a. C.,Ih( e'en ce hPcE� o�ra +"n Specify color of color thru tile: Submittal Fee $ I Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $. Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ _ Notary $. Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ I 9 r• qO (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 approve inspection fee will be charged. Signature Signature ER or A66" CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this \� day of I J to\1 120 by day of 20, by Ac --664 9DS'4MMwho is personally known to , who is personally known to me or o ms pros a as identi cation and ho di take an oat .,\N 16 NOT Y PUBLI�: _ • �aUO ?5 Sien. ),k 0 v * Mr. me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: � ---- ;!ailed Print: Seal: ��/'elI'...n•'o�.`\\\\� Seal: / � STATE �� as APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)