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REV-18-3762 (2)BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC viiami Shores Village RECEIVED Building Department DEC 26 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (� I . ;r. isua) i95-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F C 2W1 -) Master Permit No. Sub Permit No. �� 6 ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOF CONTRACTOR DRAWINGS AB ADDRESS: i 1 1 0 0 L o O �K__�� City: Miami Shores County: Miami Dade zip: Folio/Parcel#: 11 " 31 o I — G Z 3 — o3 ?O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C (+(Z1 SZ IR1J I_A*,� s5(_ Phone#: 307 _% Z — `31 Address: I -�5 1XA) to (D City: IA BAWL I S I't•1T26-,5, State: `1- Zip: 331 w Tenant/Lessee Name: e#: CONTRACTOR: Company laame� LWC• I d,� c� HDilu r-PrioneM Adaress q )50 �cy =HV� City: ")01M'+ 'M� AC /State: F � O ►� ` � Zip: � 012 Qualifier Name: � 0Se CQ I1Pe- 141OnSn Phone#: State Certification or Registration #: G C 0 S t US-5 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ 6 City: State Square/Linear Footage of Work: Zip: Type of Work: L—I Addition ❑�IAI_teration ❑lNew ❑ Repair/Replace ❑ Demolition `5 Description of Work: CG U�lm Con nC GTor de-6i l AHU rG(UCo,4t o Specify color of color. liki 616 Submittal Fee $ ...,Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ Q TOTAL FEE NOW DUE � / C4. co (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 Zip, Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation na. commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatin.g 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 ana 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 .vhose 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 Signature OWNE NT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of DG/0 620 by �( day of 0C(0�)- 20 �g by � C i } 2%t5 i Prt-1 �.�{L_, who is personally known to J Cl� FC�IR5 Prt­0'5*� who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: fe-q—.0 Sign: L-s Print:v Ve-P_ e -?. Print: -I -PC- Seal: ,•4PA-`r':,y ,••• BETSY D. PEREZ �+. Notary Public - State of Florida • : ; • Commission # FF 1823BO %y,,:•' My Comm. Expires Apr 3, 2019 ,.***** **�frFO��`yak**J�eddYrar9kllslioeN#Jabare#'*� *** APPROVED BY /F- 1 4 (Revised02/24/2014) Seal: "v''"'.,I• BETSY D. PEREZ Notary Public - State of Florida . • "e Commission # FF 182380 ,ad+ My Comm. Expires Apr 3, 2019 Plans Examiner Structural Review as Zoning Cien,