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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: (31)3) 762,4949
❑BUILDING ❑ ELECTRIC ❑ ROOFING
RECEIVED
MAR 15 1019
FBC 20 I�
Master Permit No. ?%C `• /S • n • MS
Sub Permit No.�2 Y � �
REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: C\L C> tJ� ` 1 O�Ty ,M . V—T
City: Miami Shores County Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 1`� 4 f�la�, , u,Q.�Vi�� Phone#:
Address: A-tZa w�, m�ey �jkp
City: �A16¢.kI ItAke,ik State: Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: _,Akgr.>r—Lp Cpa dTuoz—n p,,L tou .phone#: %04•S?i�• ZD84r
Address: OSq k•C 10b W `7 !�. ---A- • *'LpD
City: 0=py% l o xAk State: FL. Zip: 7}�`e��j
.a
Qualifier Name:
hone#:
State Certification or Registration*: G G.G • D(oD $ l�� Certificate of Competency #:
DESIGNER: Architect/Engineer: sekil Aal►� Phone#: �Oh•igi•�� 2�
Address: ALoa A.e. City: State: Zip: _*—1
Value of Work for this Permit: 'LD/v D 0 , O O
$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration El New 1, 4n t p r%RepFsce El Demolition
Description of Work:
'Cze•�t\ hto ILL
Specify color of color thru tile: • • s ;
Submittal Fee $ '"" Permi&ec $ , 6a) , 00 CCF $ � t�'' CO/CC $
Scanning Fee $8 ( , a3 Radon Fee $ S CIO DBPR $ ' Q Notary $
Technology Fee $ I S , 60 Training/Education Fee $ _ Q Double Fee $
Structural Reviews $ 4S ' (::� Bond $
TOTAL FEE NOW DUE $ %% • CiD
(Revised02/24/2014)
Bonding Company's Name (if applicable) t-1 A.
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City 11
- State
q
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."
F
Notice to Applicant: As a condition to the issuance of a building permit with O'estimated value exceeding $2500, the'applicont must
promise in good faith that a copy of the notice of commencement and,construction lien Idw 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 ac rs seven (7) days after the building permit is issued In he absence of such posted notice, the
inspection will not be approved a a reinspection fee will be charged.
iatureSignature
or AGENT
The foregoing instrument was acknowledged before me this
141)— day of t 11dr'G�, ? 20 k� by
4,4 S JS who is personally known to
me'orwho has produced • ' as
identification and who did take an oath. '
NOTARY PUBLIC:
V CONTRACTOR
The foregoing instrument was acknowledged before me this
1 z .
If day of N%•42CAI • 20 /q by
194IZk CA&Ar4X , who is personally known to
me or who hasproduced as
identification and who did take an oath.
NOTARY PUBLIC:
i
Sign: w3,�. 9 s Sign:
Print: : " '•%0 :*s Print: /Z_ ,�iyOc/ 9r4c,1, 6OFF
ElF'2 -
Seal: Z-` 1mv 'i,—T Randy Sanchez
�7 Seal:
Sy7j. ••• tN .•q��,T NOTARY PUBLIC
��i, ••••.••• F��'�� ac -+STATE OF FLORIDA
/C fit III Comm# GG202873
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APPROVED BY Plans Examiner J �� Zoning
Structural Review Clerk
(Revised02/24/2014)