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REV-19-2971 (2)Miami Shores Village ENTERED ig Building Department �� 1I `' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20►`1 BUILDING ► Master Permit No.gjc — PERMIT APPLIC 1 �'F VA2 Sub Permit No. ❑BUILDING ❑ ELECTRIC fINGION EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ag3o �) C- 2h" City: Miami Shores County: County: Miami Dade Zip: Folio/Parcel#: 11 320h " ©13" 2zLif Is the Building Historically Designated: Yes NO Occupancy Type: Load: Constructions Type: Flood Zone: BF FFE: OWNER: Name (Fee SimQle Ti lehol r): MIA.),r, v**f-5 c�� ��hone#: `I � Address: avb " � x _ ___ City: "1.*�a Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Address: City: 41 W in i t ll Qualifier Name: LO State: �% C�ny�R�ccC1a+��sst� State Certification or Registration #: I-, k-IL- 1A I byi Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Address: __! City: State: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑+New ❑ Repair/Replace p Description of Work: �l I91o.7 43t 33 )4 1 Zip: ❑ Demolition Specify color of gq5 thru tile: Submittal Fee $ 41<0 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $_ Structural Reviews $ Training/Education Fee $ 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'$2500, the applicant must promise in good faith that a copy of the notice of commencement and "construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 4*A --- 0(r iVjv�` J 1 Signature Signature Ji OWNER or AGE CO TRACTOR - The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged bef ' me this nday of 20 , by �� day of 7 ",( ' 1 1Q, by xPl who is personally known to who is rsona c vu o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: Print: n p, 1 NOTARY PUBLIC: Print: Seal: s;.�P� - ORITMIMOUN Seal: MY COMMISSION # GG 162406 Al EXPIRES: December 14, 2021 '•'Foy f °P' Bonded Thru Notary Pubic UndenNrbr$ ******************** ***** APPROVED BY -��--� �a �c� Plans Examiner Structural Review �a�a�nuulllei�� ��QP •�Q�PES � //�� CO a in co *************************************** Zoning Clerk (Revisedo2/24/2014) Miami shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#:(P ( (y' 23� DATE: Z Contractor ❑ Owner ❑ Architect (Name) Picked up 2 sets of plans and (other) Address: From the building department on this date in order to have corrections done to plans And/or get County stamps, I understand that the plans need to be brought back to Miami Shores VillageAuiI- rtr Dep ent to continue pe.r itting process. Signature: IN (IG ATURE) PERMIT CLERK INITIAL u RESUBMITTED DATE: PERMIT CLERK INITIAL: — (�k