CC-16-3251`
IVE
Miami Shores Village
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Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
514'
FBc Zo14
BUILDING
Master Permit No. W 6 — �5 2-51
PERMIT APPLICATION
I '
- � v � _,+ , i J J Sub Permit No.
BUILDING
❑ ELECTRIC
'
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING
❑ MECHANICAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: lcl
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��A.1-L) M L9Vi A %V
City: Miami
Shores
2
County: • Miami Dade Zip: � 1349
S
Folio/Parcel#: '
22 "
~ i% 5 o 6 Is the Building Historically Designated: Yes NO �
Occupancy Type:
Load:
Construction Type: 4� W l) Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): I C'VC V{ Ol.. N)4V I'KIC. Phone#: �q' )Tj Cj Z
Address: 3/5a
City: :5 A W A A% A. State: Cis, Zip: 710
Tenant/Lessee Name: i�kA Phone#:
Email: L U S M
CONTRACTOR: Company Name: �.) C��Z 6V N ZA L-C— Z Phone#: -:30 rj
Address: 405 WE, `VA— —sr--
City: N l>�� M— State: Zip: i3 3 l G 1
Qualifier Name: ..tC25E !f D N ,2AL-ZZ Phone#: &25; Sci1
State Certification or Registration #: Cj.4C Certificate of Competency #:
DESIGNER: Architect/Engineer: _�� � D U Z�1.E2 Phone#: 3 0 "; SQ I 10
Address: 41 Vj 10e I `¢ %-2ma zz City: tate: f4 Zip: 3 3 t C
Value of Work for this Permit: $ 44- G Co Qt Square/Linear Footage of Work: ± 15(!SQ
Type of Work: ❑ Addition ❑ Alteration ❑ New Z Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ 200 Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
CO/CC $
Notary $ 15
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
1
MISS1
`ff
I , 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 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.
Signature Signature401X
WNER or AGENT CONTRACTOR
The foregoing instrum^e�nt was acknowledged before me this
iy-,-rh dayof
i PVWC601Y , 20 IL by
M�Y'TF M InN LUDh G who is personally known to
me or who has produced D OWY �1 (1S'E, as
identification nd who did take
NOTARY BLIC: I
Print:
Seal: �01. I YANADYPRIETO
'= MY COMMISSION # FF 214031
'.. :.:
x• a= EXPIRES: March 25, 2019
Bonded Thru Notary Public Underwriters
The foregoing instrumient was acknowledged before me this
� �� day of J�1OV-VMID-Qr 20 t by
My, Gon7-Glle2 who is personally known to
me or who has produced +W V 1(4 YIS-t as
identification and who did to
NOTARY
Sign:
Print:
Seal:
******************************************************************
APPROVED BY Plans Examiner
P, q Structural Review
(Revised02/24/2014)
+aim YMADY PRI7
MY COMMISSION # FF 214031
a•, EXPIRES: March 25. 2019
Bonded Thru Notary Public Urdervaiters
1(-7 Zoning
Clerk