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REV-4-17-1121 � i hor s illa u i I d i r� a rt e r�� �` �� � ����. � ���,Y� :� � �.� � 10050 N.E.2nd Av�nue, Miami Shores, Florida 33138 Te�:(3os>���-2204 Fa�x:(�os}�s�-���a ItVSPECTION LtNE PHONE NUMBER�(��S)T62-4944 F � �11LD1 Master P�rmit No. � �� �� �`E �T ���'� �I Sub P�rmit Nt�. � �� �� � � UILDING � ELECTRIC ❑ RC}OFING � REVISIQN (� EXTENSI�N �RENEWAL �PE�UMB(NG � MECHA�IICAL �PUBLIC WORKS �] �FIANGE UF � CANCELLATIt�N � SHC}P CQNTRAC�"OR DRAWINGS ao�ao���ss; ��"�-� `� ���� �� `�-�€��� CitY: Miami Shores Countv: Miami��[?ade Zip• ��.����� �°`�°��;�; FotiojRarcel#: [s the�uilding Histarica(fy l�esignated.Yes N� � C}ccupancy Type: Laad: Construction Type: Flood Zane: BFE: FFE: QWNER: Name(Fe�Simple Ti�iehold�r}: �,������i� ��__������ �����hon�#�: Address: ���� �� ��`� _� c�t�: � ���� s����: ����,��� z��: �``���'� Tenant/less�e Name: Phone#: Email: c�NT��c�o�.c��,pa�,y�a��: �� ��.�� ��.`�#���� �������`� �n�n��: ����, �� 1 `��°� Address: � � � � �� City: �?��� State: '� ��``�.#'� Zip: ������ Quaiifier Name: Phone#:������������ State Certification or Registration#: ��� �.���� Certificate of Competeney#: I3EStGP1ER:ArchifiectJEngineer: Phone#. Address: �� � City: State: Zip: r � Value of Work for this Permit:$ �� _ Squar�/Linear Foota�e af 1fVark� Type of Work: Additic�n ❑ A,Iteration [� New [� RepairJReplace � Demolition Descriptictn of Work: •��� � ��"r� ��� r �{" �r�, �°�"�� .� '� ���� �� ����� � � Specifjr cQlr�r af c�1ar thru tile: suam'ttaE Fee$ Permit Fee$ ccF$ '�o/cc$ Scanning Fee$ Radon Fee$ DBPR$ Natary$ Technolagy Fee$ TCBIfEiC1��ECIUCBt'tCAtl FeE,� Double Fee$ Struetural Reviews$ �ond$ TOTAL FEE NOW DUE$ (Revised02(24{2014} Bonding Company's Name(if appEicable� Bonding Company's Address _ City State Zip Mortgage Lender's Name{if applieable) Mortgage Lender's Address City State Zip �ppfication is hereby made to ol�tain a permit ta d�the work and instalEations as indicated. I eertify that n�w�rk or installation has cc�mmerrced prior ta the issuance of a peemit and that aEl work will be performed to meet �he standards of all laws regulating canstruetion in this jurisdictian. I understand that a separate permit must be sec�red for EIECTRIC, PLUMBING, SIGNS, POQI.S, FUftN�CES, �C}ILERS, NE�TERS,TANKS,AIR�QNDlT(GNERS, ETC..... OWNER'S AFFIOAVIT: I certify that all the foreg�aing information is accurate and that all work will be done in compEiance with all applieable laws regulating construction and zaning. "WARNING TO OWNER: Y�UR FAIGURE TO RECQRD A NOTICE OF �aMMENCEMEIVT MAY RESULT IN YOUR PAYING I�E F�R [MPRQVEMERITS TQ YQUR PRORER . IF YQU tNTE�ID TC} ABTAIN FINANCING, CONSULT WITH YQUR LENDER OR AN ATTtJRNEY �EF{)RE REC�R,QING YatJR NC}1'tCE C}F COMMENCEMENT." Notice ta ApplicanT: As a canditipn to the issuance caf a bui/ding permit with an estimated valu�exceeding$25C?C� the applicant must promise in good faith that a eopy of the notice of commencement and construetian (ien taw brochure wilt be delivered to the person whose prop�rty is subject tv attachment. ,4tso,a certified e�py c�f the recorded notfce of c�mmeneement must be peasted at rhe jQb site for the first inspecriQn which oceurs seven (7J days after the building permit is issued. In the absenee of such posted notic�, the inspection will not be appro r�n�u reinspeetion fee wilf be charged. --— �_ � � j' �.�, Signature Si�nature � �� .�-��� '�: C?WN�R � ENT ��'� CO R r The foregoing instrument was acknowledged befor�me this The farego�ng in r,es°�ment was acknowledged before me this day of �. C� 20 � � , bY ! day of ,2Q � � , by e� ��t �,wh�is personally known ta �° � �� . whc�is personally known ta me or who has produced as me c�r who has produe�d as identifieatiean and who did t k.�an oath, �,��"" identification and who did ta a�oath, � � NOTARY PUB`EC: j � � NOTARY FU�LIC: ; �'' t� �` ' � � , v� � Sign: Sign; Print: ��3s^�e, � .«�. Print: ���� Seal: ���;��lP`G°>� Y ' P� �61�Obo� Seal. ����'�'�'��� `Y P� Vili�I�b�S ��, �� r� �On � 377� � ��°R � 3?�� �� �� , ��5,20�9 �� �� �t �5�24�9 � � �� ..,. °�� on ���` r� �hcu *���*������#*� a$��„���*� ��*� �*�� �**�*�*�***�*��*��**���� �:�*� ����*��******�*���*�����* � APPRt�VED BY Plans Examiner Zanin� StructuraE Reui�w CEerk {Reviseao2lz�J�o�a) � � y����� � � � �-��� ���.� '� I 1 , ��..�� , � � �, �� � �� , �� � a 14Q50 PIeE.2nd Avenue,I4�iarr�i Sha�res, Flarida 33�.38 �� � � T�1:(3�4?5}795-22f}4 Fax:(3�5�756-f3972 � ` �`�' �� rn����cc�c��L�t�E�t��n��o�t� ���:t��s�� � � �� � � � . ���� � � � � �t'Pr�C fit �< �"_�� ��� E1 �� � � SUb P+�r it t3. - �� � ��� � ll�fLl?iI�C ����� � � ' �: � � ilf�f� E?CTE�ISIt�Iy RENElfttsqL E ���� �.`�������� �� ����� C� �I ����.�����n �. � � � ���� � � .� � ���ur���r�� �� t� � '�u .� �� � ��� ����� ��� �a� ���������rEc�� � s��� ����..������ ��� �� ����,,� T�a��-�� ���,w�r��s � 1i3�A�rflJ�ESS: � �"�����'������� Cit : [ui ' ` ��� � � � � � �i�mi�ade �i : �" . v �,�, F�lic�/Pa�r�l#. � � ��� �ild[rt�HEstc�ricalt�O��si�nat�d.Y�s t�f��_�� �ccuparrey Type;° �� �"�� � Fl��d zcar,e: �o��� aFE; FFE: � � � ��� � t�1l�NE��Name(F ����' ��;�.5� � �`��, � ����� ti... . � ti � , �4ddr�ss: ,s.� �' City: �o�� � �E�; ���"°��' T�en�ntJLess��t�ame: Fhcan�t�; �rr�ail: � � �C�P�'FR��`t�Fte��rr�p�►,y��r��; �',�i�.� `�,��,�����`3 � �-���7�°`�'���������Iz � Addr�ss: ���� �~`�"` �� �'�� e�� � j , �,� City; �`��?.��`�. 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