REV-19-2651 (2)Miami Shores Village ENTERED
building Department NOV oe 201
\\\ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 HY'i
INSPECTION LINE PHONE NUMBER: (305) 762-4949 L�
FBC 201�
BUILDING Master Permit No. C C V 06 _[C1-19115
PERMIT APPLICATION Sub Permit No. A V/ tih _?VI
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [—]SHOP
)��,e. C CONTRACTOR DRAWINGS
JOB ADDRESS: 1 IVL� /
City: Miami Shores �� r ID County: Miami Dade Zip:
Folio/Parcel#:_`2 7 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Z Phone#:
Address: ! ��
City: A4, , C �� State: Zip: l
Tenant/Lessee Name: Phone#:
Email: ,
CONTRACTOR: Company Name: l! Phone#: 3057335
Alddress: V
W 2-0 �Z.
City: digmt
f) -•T ((7C _ State: FL Zip: 33��f �
Lo Qualifier Name: &Q`f Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: Ta Zl� City: , , State: Zip:
Value of Work for this Permit: $ ! SOO Square/Linear•Foota$ Q{'Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New air/Replace El Demolition
Description of Work: Re/ai , C�� f,4n t Cafe��'� ._ �' /' /U ��•
Specify col r of-colorthru tile:
Submittal Fee $J • Permit Fee $' CA CCF $ i • ZO CO/CC $
Scanning Fee $ R�don,Fee.$•,.• •`�2- Co— DBPR $ 2 ' C� Notary $
Technology Fee $ 2. • 5y w Training/Education Fee $ O yy Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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
WE
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
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 and 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
whose 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. /n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
/ RP day of (n�f A , 20 1 by
r.( W L, �eC who is personally known to
V IDmJent
as pr u d L as
idand who di take an oatF�������ylp�1���///j/
NB IC: �4o0014 SiPrn: C��v1q v1_ `t� 6 �� �:
.L o. ,_. Nam _�.��: v
:�kj i-•• r&mac UnAa�•• �O` �\
The foregoing instrumennt+was acknowledged before me this
Iq` day of—t- S4Z. A- • 20 19 by
who is personally known to
me or who has produced V7L_ � I . as
identification and who did take an oath.
Seal: V " �i���//�o(�� ft)�i;�,` �� Seal: MgRISIEIDYS SANTA]Florfda
llotary Public • State of Commission N GG 202Bonded throush National Nota
APPROVED BY ® %� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)