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RF-19-2689 (3)BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC Miami Shores Village RECEIVED Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: A • 0 6 2020 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 1� Master Permit No. 'P-o--01-(9- 2z--7 Sub Permit No.�7�� OOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS A CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 61 /\` E V -�) r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L v LL-�-,GV\ 19od rx 9 u e z Phone#:7aO6 — 2:�( — / �74.1 Address: /�� EF ST M ► Gl City: k/\/\ F1 AM �k6 t 4-2' State: C' Zip: 3 3 / 3 Tenant/Lessee Name: /^� Phone#: Email: �Yyl ii l \,V� r6G\.,\zron�'k V1G C6W1 CONTRACTOR: Company Name: I `0c" 2 4 D Phone#:0, J 4l �3 `� CIO Address: � 14 1 10 (SS. Ad `d City: irn'I T State: Zip: 5 : Kc Qualifier Name: E(A 43� n a IC Jce� Q Phone#: State Certification or Registration #: (,(Y 12 © 3 2 � Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 3 7 0 d Square/Linear Footage of Work: 200 v Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: (` 6 V\ A� Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ ` � TOTAL FEE NOW DUE $ 1 1 o ' (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 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 dccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will rapt be approved and a reinspection fee will be charged. Signatu OWNEaorAGENT The foregoing instrument was acknowledged before me this 19 of C 20 1 by i 0e who is personally known to me or who has produced as identificatio nd NOTARY UBLIC fledQ MARIA C. UBAU Commission # GG353698 ' •vim My Comm. Expires Jul 14, 2023 Sign: Print: r Signature i ,n. FC 2:Y►c AWRACTOR The foregoing instrument was acknowledged before me this r 9 day ojf�b2G 20 t 9 by —j' QJ!Q44 0 (—Ed&Q— who is personally known to me or who has produced NOTARY Sign:_ Print: Seal: Seal: as Notzry Public - SiaEs of Florida I ARIA C. UBAU Commission # GG353698 My Comm. Expires Jul 14, 2023 t(111� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)