RC-17-2496j
Miami Shores Village
Building Department
`' �D
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
SEP 12 20
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
— —I
FBC 20
BUILDING
Master Permit No. 7-1 Ib
PERMIT APPLICATION
Sub Permit No.
❑BUILDING ❑ ELECTRIC
❑ ROOFING ❑ REVISION ❑ EXTENSION
❑RENEWAL
❑PLUMBING ❑ MECHANICAL
[]PUBLICWORKS ❑ CHANGE OF CANCELLATION
❑ SHOP
CONTRACTOR
DRAWINGS
U
JOB ADDRESS: I D(05 - 4E IOy 'F --
City: Miami Shores
County: Miami Dade Zip:
3 3 13B
Folio/Parcel#: I I - Z Z32 - 0 Z$ - 0540 Is the Building Historically Designated: Yes
NO k
Occupancy Type: 9 Load:
Construction Type: G Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholder):
JV KW fff-N'Nu D0 '-I V f-9 Pphone#:
Address: 10(b5C) NF— 10'Th
FL
City: M I W I s1iol2ciS
State: FL Zip:
3 b
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name: 1414)(- Pf,:� -S I&," N 9u I L1 / Phone#: 15 �1 ' Z�J� - l UO
Address: 151 5 I &Vie Z-1(�W S F 4 ((3
City: SOOTY: WFiSf MKWW -� State: r—L Zip: 3 333 `
Qualifier Name: C'Cf?,IZE(Zn* Phone#: CIS LA • ZU
State Certification or Registration #: C'I`X+ `33 (Z'� , Certificate of Competency #: _
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace ❑ Demolition
CUY\C-( ll k+ 0,V)
Specify color of color thru tile:,
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
CO/CC $ _
Notary $,
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
i . 1
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 approved and a reinspection fee will be charged. b
Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of , 20 by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
Signature
CONTRACTOR
The foregoing instruL—;
t was acknowledged before come this
�% 20 �� by
0 � day of
is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
NESTOR CARDENAS
Notary Public - State of Florida
Commission 9 GG 142782
"q
My Comm. Expires Sep 13, 2021
..
scededthrou;hNaticnaINcnryAssn.
Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)