REV-3-18-823 .��- ia i res illa �
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10(350 N.E.2nd Avenue, Miami Shores, Florida 3313� � � � �����
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��vse���r��������r��n�E NUn�aE�:�sQ�)7ca���� �'� °� � �.� �� "l
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�BC 2Q�����
Bu��.���� Master Permit No.� �
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�T �.' T' Sub Permit Rlo. � . - - �..�
�au�L��rv� � ���e-rR�c � �c�oF�rv� � R�visio�v � �x�-E�s�o� ❑R���wa�
PLU(V1�ING � MECHANICAL ❑PU�LIC WORKS � CH�NGE aF (� CANCELLATIQN � SHOP
CO(�TRACTOFt DRAW(NGS
JO�ADDRESS: ��`� �� �� �'�
City: NEiami Shores Countv: Miami Dade Zip:
FoliojRarcel#: Es fihe�uilding HisforicalEy Designated:Yes NO
Occupancy Type: �oad: Construc�i�n Type: Flood Zane: �FE: FFE:
�
OWP(ER:Name(FeeSimpl�Titl�holder}: � ������ �a�"���< ������� Phane#:
Address: ��~��� �'� �� �� �
city: ��c����� ��c���., state: �"1�, ���� ���p .��� �.��
TenantJ�essee Nam�: Rhone#:
Email:
CONTRACTQR:Campany Name: � �� ��"�Y�§���1 , � � `��,��t`��' Phone#:
Address ���� � ��� �
City: �H Statee e,. _ _.� Zip,._._ ���°�� �
Qualifier Name. ����� �� �t"��;�� Phone#:
State Certificatian or Re�istration#: ��,,�������� Certificate of Campetency#:
DESEGNER:Rrchitectf Engine�r: Phone#:
Address: City: State: Zip:
Value of Work for Lhis Permit:$ le �� Square/I.inear Foota�e of W�rk:
Type c�f W�rk: � Addition �Iteration [� New ❑ ftepair/Replace ❑ DemoliEian
Description of Work: � �.���Ye��i!�� ��`�`�= _
� ��f��S ���.����<-, �'� C � � f1�'t �����t
�
i �
Spe�%fy co/or of��lt�r thru trle:
sU�m�t�a��ee� Per�,�t F�e$ ;��� ceF� eo/cc�
Scanroing Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Trainingf Education Fee$ �ouble Fee$
Structural Reviews$ Band$ � ��� �
TQTAL FEE Nf?W QUE$ � �
(Reviseaozfznlzai4}
Banding Company`s�Vame{if applieable)
Bonding Company's Address _
City State Zip
Mortgage Lender's Name(if applicable}
Mort�age�ender's Address
City Stat� Zip
Applicatian is hereby made to obtain a permit to do the�ork and installations as indicated. i certify that no wark or installation has
commenced prior to the issuance af a permit and that all work will be perforrned to meet the standards af all laws regulating
eonstruction in this jurisdiction. I understand that � separ�te permit must be secured for ELECTR(C, FLUMBkNG, SftsNS, PQOLS,
FtJRNACES, BC?ILERS, HEATERS,TANKS,AER CQNQITIORIERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that al! work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TQ OWNER� YOUR FAILURE Ta RECQRD A NOT[CE OF CQMNIEN�EMEIVT MAY
RESULT !N YOUR PAYING TWICE Ft)R IMRROVEMEtVTS TQ YQUR PRt3PER . IF YOU IiVTEND
TCJ OBT°AIN FINA►NCING, CC?NSU�T WITH YC)UR LENDEft OR AN A ORNEY �EFQRE RECQRDING
Y�UR NQTtCE OF �QMIVtENCEMENT.°'
Natice to Applicant: As a conditian to the issuance of a building permit with an estimated vatue exeeeding$25Q0, the applicant rtauSt
promise in goad faith tir�t a capy of tne notice of eommencement and canstruction lien !aw braci�ure wilt be delivered to the person
whose property is subject to attochment. A/so, a certifred eopy of the recorded notice of commencement rrrust be�aosted at the jab site
fc�r the first insp�etion w h accurs seven (7) days after the burlding permit ts issued. (n the absenee af such posted natice, fhe
inspection wilt not be a pr ved and a reinspettian fee witf be charged.
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Si�nature Signature "°"`���`` ��`" �'�
� �,�- r�ENT�� CORITRACTt3R
The foregoing instrument was acknowledged before me this The fore�oing instrument was acknawledged before me this
_.. day of {'C� 20 �� , by �� day of C� �`�.�t _ ,2Q �� , bY
�i�s�;i�� ��1��'�.��_ ,who is personally known to '���� ���;����� .who is persanaEly known to
1
me ar who has produced as me or who has prod�aced as
identificatian and who di ke an . identificatian and who did ta �n aaTh. ""A�
NOTARY PU�tIC: N4TAEtY PUE�LIC: �� t
+, �
X �i`
SI�Yt: $l�tt;
Print: �ta� � ' � ' � d� Print; �a3 � � � � ,j
Seal: ``,�'�'`��'.�`��'�, �� � 9 � 377� Seal: YU€ti61 ���5{}�pg
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APRROVED�Y � � ��� Plans Examiner Zoning
�
Siruetural Review Clerk
(aev�seaozlzataoi�)