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CC-16-1807BUILDING PERMIT APPLICATION 0 IN, BUILDING rYELECTRIC Miami Shores Village Jr�,a.�:J�e" "M JUN 1901�6 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Master Permit No.0.0 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING j MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 7 7� rnNTRArTnR [)PAXAnNrC JOB ADDRESS: 06 ah4 Aw, �>G , 'i 830 rvE City: Miami Shores ��\\ County: Miami Dade Zip: Folio/Parcel#: I -I - 3206 V 3 22�1> Is the Building Historically Designated: Yes NO K Occupancy Type: Load: Construction Type: Flood Zone: BFE`. FFE: OWNER: Name (Fee Simple Titlehold er): K\O V 154l0 f'' Lem+&/ I 1 (-- Phone#: Address: )-k0 SUM. M -Vv�) }\ 9k--` 'Gv� 't - -; 00 City: 1��� � � ��C�tk\ State: ii Zip: -1 Tenant/LesseettNaame: ^ 1 " ff-I.sTic ©v V kk 1 C Phone#: 3DS Email: `t��IfM7�-'V VV\ TL-Vv\^ CONTRACTOR: Company Name: A/ w .% D 2/��� Phone#: �' T / 0 Address-�, /V w y City: nn �C State: Zip: .3 Z Qualifier Name: L/J452F ct4Phone#: 0S iDJ T State Certification or Registration #: �z 1,(o I S- (a 3 Certificate of Competency #: _ DESIGNER: Architect/Engineer: -ckjr- 0 S 7 t� L Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 61co Square/Linear Footage of Work: 2pL7 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition A n ` - 6'Descrip`tion oof-Work• Specify color of color thru tile: Submittal Fee $ 2-W ` 0 Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 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 for the first inspection which occurs seven (7) days after the building permit is issued. In the inspection will not be approved and a reinspection fee will be charged. A Signature 4 4 4 Signature r--4 OWNER or AGENT CON The foregoing instrument was acknowledged before me this day f 20 L�� by who is personally known to ------------------ me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: r I VIA 0L notice, the The foregoing instruluint was acknowledged before me this day of n 20 b by i4& who is personally known to me or who has produced L QY- b L as identification and who did take an oath. NOTARY PUBLIC: Print: $�� A� Notary Public, State of Florida Commission# FF 208563 My comm. expires Mar.11, 20t9 Seal: Seal: a�i y' ORR MIMOUN '� MY COMMISSION MI N Y N 064212 .i. EXPIRES: December 14, 2017 Bonded ThN Notary Public Undervniters ar ec,rrca **************************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)