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WS-18-2482BUILDING PERMIT APPLICATION 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 Master Permit No. Sub Permit No. J\ SE 19 2018 LBY ewc] ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q CONTRACTOR DRAWINGS JOB ADDRESS: 3-yy� j I 1 1�^ � City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Gt C; 0 v GCi. Q Phone#: g �-! - Z-RU - 3 f'9 7 Address: 1 00 C2 :rf, Lk fto 111)G1l 17+, City: 0 161110i1 State: jn i :X' ngl r^ I Zip: b 33 b 2 Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: 3MC O-9105ACCO C-e1 OLGIO �nC Phone#: 90S 293C2 I � Address: 1*)Q SURD 2-(b (p (Q_ City: `�( State: �Zip: Qualifier Name: 30h)o nc, OWL_V2 Phone#: State Certification or Registration #: 5 q q 4 ©q f Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State Value of Work for this Permit: $� Square/Linear Footage of Work: _ Zip: Type of Work: ❑ Addition ❑ Alteration //��ff ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Sh 17�s / 0 Ufa ' )S Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ . DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ (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 $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 pnd a reinspection fee will be charged. % n Signatu ER & AGENT Sign The foregoing instrumeiht was acknowledged before me this The foregoing instrunjient was acknowledged before me this j� �3 day of 20l V by t 3 day of J bq 6 el'20 l �� by b(law ( who is ersonally know to who is ersonally know to me or who has produced as me or who has produced as identification and who did taWan oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) �AANAt ri'-JJIN MY COMMISSIr.N4 # H 135W *,Je'C�'F XPIKES: b`d6 tarch 31 OV identification and who did take acroath. NOTARY PUBLIC: Sign: Print: M a Seal: y.;NARIAE• BEMTr-7 MY COMMISSION # fl 'j4583i hatch rch 3 : qi s EXPIRE P aic wn,- Bonded Thnrtdotary _ .._.... ;. y „ F Plans Examiner Zoning , Structural Review Clerk