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REV-16-242 (2)f I I ❑ BUILDING ❑ ELECTRIC Afti Shores Village g Department Ave nue, Miami Shores, Florida 33138 33138: (305) 795-2204 Fax: (305) 756-8972 CTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING RECEIVED JAN 2,8 2 16 BY: FBC 20 t Master Permit No. Sub Permit No. REVISION ❑ EXTENSION DRENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP c CONTRACTOR DRAWINGS JOB ADDRESS: 3 Q �� J �� L V) City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Z 06 0 « 9-7 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: �/ ( Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L " &it r C Phone#: 3©S q.% i 3'A 7 Address: 1 -130 o LC ftr/ .. ,c City: V "`t 4� )� `���� State: 1 , Zip: -'s3i1y 0 Tenant/Lessee Name: Phone#: Email:(. CONTRACTOR: ompany Name: 1 `� ( CC f 1 `� Phone#:1 Address: City: State: 1 1 Zip: �C,Z(01-'l Qualifier Name: i Phone#: State Certification or Registration #: CAW3 l �- j Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ' V 1�y�� L`'�' iUcL)S l Specify color of color: .' t/ Submittal Fee $ Permit Fee' $ V ki CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ T (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 on 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 re' ee will be charged. Signat a ' OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this Y day of n LW,M 20 ( by Johil wh is p rsonally known t me or who baf-p-Nduced as The foregoing instrument was acknowledged before me this day of anm 20 by Ql U a C k v o. p sonally known o me or who has produced as identifi tion and ho did take an oath. identification and who did take an oath. NOTA Y PUBLI NOTARY P B IC: 1 Sign Sign: Prin l i'Ji)'l_Q_S Print: l lSli Seal: y,,w LORE MOOMES Seal: MY COMMISSION #EE18160 COMES EXPIRES: MAR 21, 2016 aim Bonded through 18t SO InSUM S: 2016 Bonded thro 1st SteEe Inns ************ * ***************** APPROVED BY /9 Plans Examiner Zoning Structural Revi w Clerk (Revised02/24/2014)