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REV-19-681Miami Shores Village R" " -'VED Building Department APR 01 .-Jig 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 I /` INSPECTION LINE PHONE NUMBER: (30S) 762-4949 p FBC 201--T BUILDING Master Permit N& r7T1—`dam PERMIT APPLICATION Sub Permit No. -,4e+ ❑BUILDING (ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP G% CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip: '--,>3 S-39 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Flood Zone: BFE: FFE: i \,Cons`truction.T/ypee:^ - OWNER: Name (Fee Simple Titleholder): 1�5 IF NWT S-� Phone#: -71L, ' q- 61-2-B Address: A-IZ0�n, t3 � ��►-1�II City: 5 l �1� State: p: 3-2,� -C Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: � �f'hQr�Q �J (Gr-7-��C Phone#: 7�� �Y % " 7 4 Address: % S % 4 9 City: State: Ile, � � (Z Zip: / Qualifier Name: PA2& Phone#: State Certification or Registration #: �=✓3 .3 z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ El P(..� Alteration [2New t' "R'e Air Re ace Pa / . � ❑ Demolition Description of Work: ` "t• Specify color of color thru tile: Submittal Fee $ Permit Fee $ 1 oti GK, CCF $ (�'�'i� CO/CC $ Scanning Fee $ 3 DO Radon Fee $ -2- . (r) DB�PRR $ 7 . (� Notary $ Technology Fee $ 2 • J Training/Education Fee $ 0 r` D Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 11 © VJ� (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 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 OFCOMMENCEMENT 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# and a reinspection fee will be charged. R orAGENT The foregoing instrument was acl nowledged before me this da''y//of, 20 by ��l�s b`�1-�►� � , who i�nown to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 4 Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of ' �L 20 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ` .�cY or : �y: Sign: Prin *; s .. Prin Seal: y,; ; fFF Ille 2 :ors Seal GELSYS M SARGEN70N 1� •,��� QQr '• Notary public - State oIFIc0da � �•• �• F��� N COmmissiOn#GG091120 k' MY Comm. Expires Apr I I, 2021 Bonded through NationalNotary +A�P** s**x»ws»»»»»»»»»w APPROVED BY �i �1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)