REV-19-2831 (2)�v�0\o Miami Shores Village PEcZTN'VTED
%C^P`1 Building Department NO 12 6 4u'19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY.
INSPECTION LINE PHONE NUMBER: (305) 762-4949)
BUILDING
PERMIT APPLICATION
❑BUILDING ELECTRIC ROOFING
F C 20 I17'�a
Master Permit No.�C�
Sub Permit No. F-L —
REVISION ❑ EXTENSIOM—'�E]RENEWA �l l ✓ ��� �l
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 0 k,(y fs'�y
City: Miami Shores County: Miami Dade Zip: %'i �J
Folio/Parcel#: J1 S-Lp" olt to Is the Building Historically Designated: Yes NO
Occupancy Type: _ Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_ �AQt ��jh '�14011RS LLC Phone#:_
Addres
s
:
oo LAI._�c.11�,.2o�l�t-
City: PQ M� �+L.�. '+�o.,-y— State: V- _ Zip: oy
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _I"
Address: nov— g e—r_ i A
n
hone#: (,-7%) 3 - br 6'z-
City: OOY64m 1U aL ] �State: Zi 33i473
Qualifier Name: Qfl �n L!L Phone#:
State Certification or Registration #: !f bb x 1 'n Certificate of Competency #: IV
DESIGNER: Architect/Engineer:
Address:
Phone#:
Zip:
Value of Work for this Permit: $ �O n Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New % ❑ Repair/Replace ❑ Demo`li�tioi
Description of Work: _"j �x 0 U f �'� � �.t q hjd �'�/j% 0 .54 1 �J
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Permit Fee $
Radon Fee $
Training/Education Fee $
City: State
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Structural Reviews $ 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
E.
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.
Signature
0 rAGENT
The foregoing instrument was acknowledged before me this
� day of 64�,Q,2 J�,., 20 15 by
�%—,'Td�4, who is personally known to
me or who has produced L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: c� �1.
Print: 1f "1%
Seal:
Signature
AN -TRACTOR
The foregoing instrument was acknowledged before me this
day of awryc%cY)'bI✓(; 2015 , by
RYA-wi , Al� who is personally known to
me or who has produced 'b L as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
O.0'�.,, ROSALIN ALZAMORA
State of Florida -Notary Public
Commission # GG 242544
August 25, 2022
APPROVED BY e alans Examiner
i�
Structural Review
FRITZ MAT"URIN
MY COMMISSION # G ��� 80
g}CPIRES:1une 10,
***********************
Zoning
Clerk
(Revised02/24/2014)