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EL-18-1355BUILDING PERMIT APPLIC TION ❑BUILDING LECTRIC 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: (305) 762-4949 -" Y 1,.8 12018 G7H FBC 20 n r11 Master Permit No. EL( V r 135S Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS:©— %7'r- -�— / -2 City: Miami Shores County: Miami Dade Zio: Folio/Parcel#: b —1 (C) Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholde Ad City: Construction Type: Flood Zone: _ State: BFE: FFE: 4: c/S1 y-'-> /y5 9 g _Zip: 3 % O �)- V Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: 654A2'—' Phone#: ,/ 3 ^ Ll -2l y— -�,16 / Address: 3U %l ti/ai, k4lltl 2 s,� City: 0+/Z ate: )� Zip: Qualifier Name: Phone#: State Certification or Registration #: % j 6y 9•1 %y Certificate of Competency #: %= G 13 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: 1 Value of Work for this Permit: $ ar2 dill?} Square/Linear Footage of Work: �! /) Type of Work: ❑ Addition Alteration It n 0 New ❑ R,epair/Replace ❑ Demolition Description of ork: .0 - ) l� L Specify color of color thru tile: Submittal Fee $ Permit Fee $ %,gym• nb CCF $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 6 (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 $1500, 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 insaection will not be aooroved and a reinsoection fee will be choraed. �ry t 1-. Signature I OWNER or AGENT The foregoing instrument was acknowledged before me this 13 day of �C�rL`j 20 /,? , by / K UO d 7J t? ce who is personally known to me or who has producedd as identification and who did take an oath. NOTARY PUBLIC: Sign: !� Print_ Seal:�a1<'"""'"'•a CAROLINE GOOD t+ Notary Public - State of Florida i' Commission #F FF 230087 My Comm. Expires May 12, 2019 * * * * * * * rlMak>D * **oe11CYt1�tMFeilptWreR9rMNfdUaF�A4Rrt APPROVED BY Signaturex. / CONTRACTOR The foregoing instrument was acknowledged before me this I %b day of �� 120 ( & by 'CAI G � D who is personally known to me or who has produced�� '�fys as identification and who did take an oath. NOTA UBLIC: Sign. Print: Seal: ''ti'w�'.., . •. � .. _ - � , =o40 oo*k Notary PubliC State of Florida Sindia Alvarez y My Commission FF 156750 f ur pd Expires 09/03/2018 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)