RC-19-1623Miami Shores Village R-ECZIVPD
L 16 2019
1 Building Department
` 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
YYY Tel: (305) 795-2204 Fax: (305) 756-8972 2f
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�
BUILDING Master Permit No.-EC-04`1 623
PERMIT APPLICATION 4: r '; �; Sub Permit No.
�,I"l4l
BUILDING ❑ ELECTRIC ROOFING ❑ REVISION EXTENSION RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [-]CANCELLATION ❑ SHOP
-')� ,, 1 Fyn CONTRACTOR DRAWINGS
-
JOB ADDRESS: - 6 0 00 �{ qy T
City: Miami Shores County: Miami Dade zip: 33
Folio/Parcel#: I I �) 10 l 033 00 4-0 Is the Building Historically Designated: Yes NO !�
Occupancy Type: Q ES Load: Construction Type: CO Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): DS (A Lbp om EZ Phone#: qlef �'— Z 0 Z `Oqb l
Address: l)Uj qq STiZEr::T
City: I I i S 1+0&25 State: Zip: .3 3 (�y
Tenant/Lessee Name:
Email: MI(v,33 .LCLoub'e-&NA
1-1
CONTRACTOR: Company Name:
Address:
City:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer: _
Address:
State:
Phone#:
Phone#:
Zip:
Phone#:
Certificate of Competency #:
City:
Phone#:
Value of Work for this Permit: $ 1 7 00• i10 Square/Linear Footage of Work: _
Type of Work: ❑ Addition ❑ Alteration ❑ Repair/Replace
Description of Work: �e! su2E (1 L 5TU CCQ l4 N ) Y n4I Ni 1
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
e: Zip: _
2-000
❑ Demolition
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Structural Reviews $
(Revised02/24/2014)
Bond $
TOTAL FEE NOW DUE $
Binding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
Zip
Zi
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 an:9:
reins --"-'fee will be charged.
Signature Signature
OWNER or GENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 by
lip ho is personally known to
me or who has produced���
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Pri s1 N,j�l 4� A�CJV.p Q��
Seal: SINNA ALVAREZ
MY CCMh41SSI0N # GG 2382"'3
'Z.: EXPIRES: September 3, 2022
Bonded Thru Notary Public Underwriters
********************* axe
APPROVED BY
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:
as
***************************************************
Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk