REV-19-2969 (2)tray. ENTFEZED
�a,�w A-j 5ALMiami Shores Village pEr 18 2 ;
w 1 BY:
�� Building Department _
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
Y INSPECTION LINE PHONE NUMBER: (305) 762-4949 IA
FBC ,2ry01I1"�j,•
BUILDING Master Permit No. '�LC-�i -l 0 " 237(
PERMIT APPLICATION Sub Permit No. i;l1Zy -12- Imo( -7 9 I
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I &0 N V 1 l S'-
City: Miami Shores ^? County: Miami Dade Zip:
Folio/Parcel#: j - �2o6 —oi J ` 293 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWr
Addr
City:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Na
Address( W;5_
ne#:
M C-.-.oA 1. i i'�- �o' Phone#:1�
..s__ a w dril
City: ly UXIM ' n 1(Q'%Vi
Qualifier Name: WA1J TW
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $_
Type of Work: ❑ Addition
Description of Work:
//i� �
Vr j txt
C
Alteration ❑
Dh Vok 5E
Phone
rtificate of Competency #:
ne#:
City:
Square/Linear Footage of Work:
w '❑ Repair/Replace
b I %1
gay
Zip:
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ •CCF $ CO/CC $ '
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ W
(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 and a reinspection fee will be charged. /1 h
Signature ` Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
1�1 day of 20 1, by
A.-V4-r I&A YE o who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
The foregoing instrument was acknowledged before`me this T
day of U/'IZ_C1411-1 20 by
_0kJ (S l "10\312Co I ,''who is EnaEno to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: OMT MIMOU4 Seal:
MY COMMISSION # GGs 162406 c t N. • o=
EXPIRES: DeCembe(14. 2021 • r�i �c ��'7` ,�
... TM Nptaty Pubic UtdeTr�le�s �� �� • \�
' SOP P, 80(1d8�% f,.+"'e '• C� ��-
************** *2AVi
APPROVED BY Plans Examiner Zoning
Structural Review
Clerk
(Revised02/24/2014)