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REV-12-21-3365 m i i r s iII ����. � �, �$���1 ��� N� i I i n rt r�t 10050 N.E.2nd Av�nu�,Miami Shares,Flarid�33138 ,� �rei:(sos}7��-zao�Fax:(�o�}7s�-a��z ,���� t ..N ��...a� ��_a_w.�.� IWSFECTIQN l.IWE PHQPIE HtE1M8£R;(3�5)762-4"9A� ,� �L � 1�A��L6'rF B"�9 98il6 E71d ���t�....���E .,....�:'1. �4�.,.,�.. ���gF� p�np� /� ��p�� .�p.� �fi 4 �'�#� � . . . � �� ... . ' ����R+["[���M �tl,�.�t '�TM 5 C^ �� � ,.� ��uiLn��� ������� ❑ Roo��N� REVISION � E�c-r��swo� �RENEWAL ❑��u����� � r��cN��� � ��u��.�c�r���s ❑ e�A��� c�� ❑ �cE��a�wc�� ❑ s��� co������r�� ���wt��s �oa����Ess. ��,.� `� � CitY' Miarni Shores C�unty• Miami Dade Zi}�� ����� , Follo/Rarcel#:��p � ���-"�.� � Is the Buildin�Hfstoric�lEy Dasi�nat�d,Y�s NU Qecup�r�cy Type: La�d: Constructiorr Type: Flood Zc�ne: �FE: FFE: �WNER;Name(F�e Simple Titleholder);� ���, � �� ("'� �,C� Fhone#.�t�`°�.-� ' � ��� Address:��i"�� City: _ _�_1� State: ��. Zip: °��� TenantjLessee Nam�; Phone#k: Email: �t, '� � o ��RlT CTQR:Company lV�me. ° s�C. ti Ph�n�#: Addeesse �� t C[fiy: ' St�t�: �`� 2ip: ���`�°� 4ualifi�r Nam�,�a��.s t��a� �r�t���"�'"��a`�� Phone#: Stat�C�rtifiicati�n or Re�istrati�n#. t�`�' �� � � Certificate of�ompetency#: UESi�NER;ArchitectJEn�ineer: Phone#: Ac#dr�ss: �ity: State: Zip: V�#ue ofi Work for this Permita$ � Square/L€near Fo�tag��af Work: 'Type of Wa�rk: ❑ Addition ❑ Alteratian New [� Repair/Replace ❑ Demolition D�seript�on of Wark: e����c� t� �� �.. � ��.,, � � �� � � � �- � � � �� 9��.-i`t �� Sp�c%fy ca{r�r�of calor�t�ru ti1e: su��e��ca'Fee� ��rr��F�e S ceF, co/cc S Scannin�Fee$ RadQn F�e$ DBPR$ �uotary� '�echnaalogy Fee$ TrainingfEdueatiqn Fee$ ub6e F�e� Straetural Revleays$ �ond$ sc���,�FE��ow�u���`�' � (RevisedO2J2A/2o14} � E�t�ndin��ompany's IVame(1f�pplic�bl�) 6onding�ompany`s,Address City St�te 2�p Mort���e Lend�r's Name(if applicabP�) PYcart�a��l.ender`s,�ddress �ity State Zip Applic�tion is hereby made ta e�btain a p�rmit tca dc�the w�rk�nd ir�stall�tions�s indicated. 1 c�rtify that no w�rk or inst�llafii�n has eommenced pciar to th� issuanc� of a permit and t�at �II wcrrk will be perform�d to m��t the st�nd�rds of all I�ws r��ulatin� constru�tion in this jurisdictic�n. I und�rstand th�t a separate permit rnust b� seeured fcar ELECTRI�, PLUMB(N�, SIGNS, PQQLS, FllRNACES,BQl�ERS,NEATERS,TANKS,AIR CC?NGITi�NERS,ETC..... �WNER'5,4FFI�AVIT: l Gerti€y that ail the foregc�in� i�farm�ti�r� is aecur�te and thaT a!1 vdark wilR b� dcane in c�mpliance with all appficabl�faws re�ul�ting�or�struction and zonin�. ` ARNIIV� Tt� �1tVNER. Y�UR F�►1�URE TC? RE��R[} A N�TIGE �F �Q ENCEMENT NIAY RESl�1.T' IN Yt�UR PAYINta ICE Ft?R IMRRUVEMEN�'S TO YqUR PRC}PEI� . IF Yt?U INTEND TQ A�TAI#� FlNANGIN�� ���I�U�T WITH Yi�UR LENDER C)R A!V ATFt�R�UEI' �E��RE RE�QR�II�G ��tJR IV�TICE QF CE�MMENCE ENT'.,, 1Vat�fee to A�r�alicant: As a cc�ndition tca the issucrnc��c+f a bur'{ding�aermit w#fh ara estimc�ted v�/u�excee�irrg$25L1Q, the applicant trtust promi.s�in go��fcrith th�t a cc�iay of th�natice vf commenc�rrtent and c�r�strueti�rz ften /aw brcacbur�e wr'fE b�de/iuer�ed t� t�he persan whos��ar��aerty is su6jeci to attachment. Also,a c�rCi�ed copy of the reccarded notlee of carnmencement rnust be�a�st�d at the Jab site ��r clte�rst inspectiora wrhlch aceurs sc�ven (7) days trfter th� buFlding permlr is issu�d. ln rhe c�bsence �f.�uch pc�sred notiee, the inspeett�n wilt nc�C be appeoved and a refns�ect�ion fe�w�ll b�eh�eged. ,.���� ___-�-�� .�,�� � ����r� ��° , .����`�,`��..�` �� � �� �..... Si�naEure Si�nature � � C..-�---�-`~""� C?WNER or ACEf�T CC3NTRACT�R The far���oin�instruarsent was ackn�wfed�ed b�fore me this The foregaing rnstrument�r�s acknowl�dged b�f�r�me this �- � day af � �� ,2Q � 6y ��`w day af ���,�_°� 20 ��.� by C �`�2�e�� who is p rsona(ly knouvn fie� �`��,:t� ,,�,.� ���;` �_ ��"�;,_��> ,u,rha is personalfy known to rr�e c�r wt�e 6�as produced as rne c�r wh�h�s pradue�d a� id�nti�catiren�nd�ho dic�take an ��h. id��tifieation and who did tak�an oath. Nt1TAR PUBt.I ^ {� NOTARY Pl1BLEC. ���l��,PF� ��ei�� �1�� ut,11c-`����1���°`�p15 Slgn: �'°�s� ., ;a�x�r! ;����an,r�`�������i�S�' Sign: �.r• „��.�.. w. '' tri� �ptt ��� ,��:� f.4 ty'�Y Z� � ia ,w,��.m� tiv �i�:nn�r�.t a �;,z1... �(IPlL: �'n'.�� M+� ti9� �C[t�L: � � ���m,,w� � S��'. _... .�i� . . . J�f�F. 4 �`:, .<,<}k . '�� �.. � � � tli � _ , t .�$ � 1 ����� jl � �i.. ., . > ,. � A.`..i.Aa.lS��3..v §.. ,,. .. i,�;SEb2tilW `;d AY Tr.h bo;F � ,i `w �***����**�**����*��*�*����3�*���*�**�**�����*��*��*�*���4�����*****���**��'���***���*�'+��*���3�*��������*�*�*��� � i� ^ ~1 APPRt�VED BY �: �'� 1�� �'- � Rlans Examin�r �ofling Structural R�view Glerk (Revisedoat24/2o1�}