REV-4-18-999 i i r s i�l� e
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IOQSQ N.E.2nd Avenue, Miami Shares, Florida 33138
� � � �rei:t�os}�ss-2zoa�aX:(3os}���-ss�a
� I(VSPECTIOPJ�tNE PHQNE NUMBER:(3d5}76Z-4949
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F e ��
�L E Mast�r P�rm�t N�. �� �� . "
(� �� � Sub Permit N� �� � ��� ��"� � �".�`�
�B11lLD{NG � ELECTRIC � ROQFING � REVESIQN � EXTENSION �RENEWAL
�P�UMBING MECHANICAL ❑Pt1BLIC WORKS [� CNAfVGE OF � CANCELLATIQN � SNQP
CQ(VTRACTOR DRAWING5
�os Aao��ss: ��2�-�� ��- � `��
CitY: Miami Shores Counfiv: Miami Qade Zip� ���'��� "�-��
Faii�jParcel#F. Is the Buildir�g Historically Designated:Yes NQ �'°`��
Oecupancy Type: �oad: Constructian 7ype: Flood Zone: BFE: FFE:
QWNER: Name(Fee Simple Titlehalder}:_�� ��t� � ��C�����9 �� � � Phone#:
a
Address: ��-�� �' �� ��
City: �����.� ���.�.3=;`�� State: ��,.- �ip: �?����
Tenantf Lessee Name: Phane#:
EmaiL
c�r����crc�R:c��,�a�,Y�a�,e: ����-� � �':������. �nan��: �� ��°� ��"�3�
Address: ���� � �� � ��
Gty: � �{�t�'1°`t� StaCe= ��- Zip: ��� ��
4ualifier Name: ��ii1�a°�'"� ��'��i��� Pt�one#: ��
State Certificatian or Registration#: �,.�� ��� `��� � Certificate of Campetency#:
DESIGNER:Architect/Engine�r: Phone#:
11ddr�ss: City: State: Zip:
VaEue of Wor�C far thEs Permit:$ y4' � Squaref Cinear Foatage of Work:
Typ�of Vtfork: � �,ddi�ion ❑ Alteration ❑ New ❑ Repair/Re (ace
p ❑ Demolition
Description of Work: ��1 ���� �;_ ���r� �� ��,����.3� � z f� " `
� � P
�.r�� '� �����`�'`�P'� '£ a
�s
5pecify�o/or e�f c�lor thru tite:
�. .,.
Subrrtittal Fee$ Permit Fee$ �� � �"" CCF$ COjCC$
Scanning Fee$ R�don Fe�$ D�PR$ Notary$
Technalagy Fee$ Training/Educati�n Fee$ Double Fee$
Structural Reviews$ �ond$ � °
TQTAL FEE IUOW DUE$ � '��9 &
�.
(Revisedazfzn/zaza}
Banding Company's Name(if applicable}
�onding Company's Address _
City State Zip
Mortgage�ender's tUame(if applieablej
[Utart�age Lender's Address
City State 2ip
,4pplication is hereby made to obtain a {�ermit to do the wark and instal(ations as indicated. I eereify that no work or installation has
commer�ced prior ta the issuance of a permit and that all wc�rk will be performed to meet tP�e standards af all laws regulating
construction in this jurisdiction. I und�rst�nd that a separate permit must be secured for ELECTRIC, PLUMBING, SRGNS, FOOLS,
FUftN,4CES, �QfLEftS, HEATERS,TA(�KS,AIR CONDiTEQ�iERS, ETC....,
OWNER'S AFFtDAVtT: I certify that a(I the foregoing infarmation is aecurate and that al( work will be dane in eompliance with all
applicable laws regulating canstruction and zoning.
"WARNING TO OWNER: YOUR FAI�.URE TQ RECOR� ,4 MQTICE OF �OMMENCEMENT MAY
RESULT 1N YQUR PAYING TWICE F{aR lMPR�VEMENTS TQ VQUR PRQPER . IF Y�U INTEND
Tt) t)BTAIM FINANCING, CONSt1LT VVITH YUUR LENDER �R AN ATTURNEY BEFORE RECORDING
YQUR RIQTICE QF CQMMENCEMENT."
IVotrce to Applicant: As a condition to the issuance of� building permrt with pn estrmated value exceeding$25(1{1, the a�pticanf must
promise in good faith that a copy of the notice of commencement and eonstructian lien (aw brochure witl be delivered to the person
whose praperty is su�aject ta attachmenc. Also, a certified copy af the recorded notice of cammeneement must be posted at ihe jab site
for the first inspection wh' occurs seven (7J doys after the building permit is issued. !n the czbsence of such posted notice, the
inspection wrll not be ap ro ed and a reinspection fee witt be charged. ����
� �I
I
w.._ , . _�,--�_
Si�nature - � Signature'� ��
0 k2 or AGENT � CO A � R
The foregoing instrument was acknowledged before me this The foregaing instrument v,#�s acknowledged before me this
��� day of ��ss` '� 2Q_.. �� , bY �.� � ��' day af ��G:�E t� 2CJ �� , by
�
� i�� �4� cc�� ,who is persanally known to � �a�r'� ��� �� �C� ,wha is per�onally known to
me or who has produced as me ar who has pr�dueed as
identifieatian and who d' ake an o identification and vuh�did ta an oath.
�
,
NQTARY PUBUC: � NOTARY PUBLIC:
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Sign: Si�n:
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Prie�t: 03� � �' 1d . � � �c� � Print: ��� � � � � �- � '� ` � �,��
Seal: ��,����� � �Uit�S6�6C����bQ5 Seal: ��������`��.� YElR1�I � V�t��Q�QS
��. � �,Si�n � �77� ��' � �',�-, C�rn�i�#�� � 17i
�� �� �� � �t 15,2��9 �� �.� ��y�g �,t F�gq
��8�`(�F1��i1��'� G�# . �61S1L3�4t4e 41t67� '^�,�{p» � ��e aY�� �.�' �� F���48&�
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APPRQVED BY �lans Examin�r Zonin�
Structural R�view Clerk
(Reu�seao2lz�lzola�