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DS-18-1183Miami Shores Village IRECFTVFD 11fv�. Building Department VYo3ZW8 �w 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 �. FBC 20 k45 BUILDING Master Permit No. � ( 03 r ) f & 3 PERMIT APPLICATION Sub Permit No. -O-( 6 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP p / q CONTRACTOR DRAWINGS tV JOB ADDRESS: Iq E 13,,' g } City: Miami Shores County: Miami Dade Zip: 33) 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple gTitleholder): / �G�!�C7 WA N-er Phone#: 3 `17Z01 0Y07 Address: 17 A%E 13--0f 6� City: M-'4/►1 ; .SGo/is State: F/ Zip: 33 13 3' Tenant/Lessee Name: Phone#: Email: C tiQr, I es 1wa I Ter Q 4 f,"4: I. r ,ni CONTRACTOR: Company Name: So UA A hi Asr..t• P iHL ZPL Phone#: `� 0' 8a0 Address: City: AP FL Zip:i— Qualifier Name: H-4K4 Phone#: State Certification or Registration #: e6c m Q/ rr Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: N � Value of Work for this Permit: $ Square/Linear Footage of Work: 6GD.5 S Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 114'tt_a ,pwJAt- t,�r�•�kwd-f �i Specify.color of color thru tile: - Submittal Fee $ CK�� Permit Fee $ !� `� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ ODBPR $ W Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $9C _bp?) -- �- = TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address r L. 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 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 tk,&7, OWNER or AGENT The foregoing instrument was acknowledged before me this I day of 1474 V 20 (8' by CA Ar la 6' 6" 1 t'2 r• , who is personally known to me or who has produced FL do-,,C-S A Ylti SC as identification and who did take an oath. NOTARY PU Print: Seal: Signature CONTRACTOR The foregoing instrumen as acknowledged before me this d'ay of a 20 ��, by who is personally known to me or who has produced 4,4AYt- as identification and who did take an oath. NOTARY PUBLIC Sign:_ Print: August 20, 2021 1 Seal: WfMREY CHAN WIVIMISSION # GG136185 EXPIRES August 20, 2021 APPROVED BYk4j� Plans Examiner S Zoning Structural Review Clerk (Revised02/24/2014)