DEMO-19-1102Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (30S) 795-2204 Fax: (30S) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
RECEIVED
MAY 15 2t p°e
FBC 20 ['1 �
BUILDING Master Permit No. 12ti—a�-(--1
PERMIT APPLICATION Sub Permit NoDFL*--Zg- 1q-1 1OZ
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
r
❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
U 6th `7"2,4/
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: t 1 ' .31 O) a 0-1 O Is the Building Historically Designated: Yes NO L_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): & 0 " -�h�,2 $�YY�Pil�S �' pone#: Ja (�5 '(q-70 a29 C�5
Address: b Ly 21 k\C-e-
City: p6..knr.P-4+0 1?)a�:( State: Zip: 33 157
Tenant/Lessee Name: Phone#:
Email: J`0—nle�i'Y-"CL i '&Yi
CONTRACTOR: Company Name: . ftire-Or`t
Address: ?J3-TC> /1 le-q sT44M---t
City: C[zcy y-r Ggove State:
Qualifier Name:
CV v► &AMj Phone#: :�ZM. 391. OL8fe
_Zip: 33133
ne#:' ��-321•o�r6
State Certification or Registration #: CGC-(5 Z yX31 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
n e#:
City: State: Zip:
Value of Work for this Permit: $ T�o 0 . U c% Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ���molition
Description of Work: -� ^0 -�X �S 1`i V( A f 1 I� -tom , ( r - ✓ &ryL-4 P-"e-
an si d�R' "D a .q- . C or\v2 r-f � 4R. x .... �-�� A (ic .
0
Specify color of color thru tile:
Submittal Fee $ J�� Permiffee $ _
Scanning Fee $ Radon Fee $ _
Technology Fee $
Structural Reviews $
Training/Education Fee $
DBPR $ Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable) ilk
Bonding Company's Address NIA-_
City"� N11 .4- State II�IQ- Zip I�
Mortgage;Lender's Name (if applicable)
Mortgage Lender's Address IVI&
City N State NA- Zip 14-
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 $1500, 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.
k ll�r
Signature �^^ *Signature
OWNER or AGENT "'*` r NTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
L LA day of A A 61 20 1 by I ld day of o b I 20 by
(TC,Yi t -e who is personally known to
me or who has produced t c;nc y2) 1 1 �q C�s
identification and who did take an oath.
NOTARY PUBLIC:
Sig .
Print:
N\ f,�12
Seal:
?i�Po`
c ':
^•
SULAINENIEVES
Notary Public - State of Florida
• :
Commission # GG 180483
My Comm. Expires Jac 29.2022
•••'F°F�' '•
BonaeC :hro,fgh Na�c, Nz:ara Ass^.
**********
APPROVED BY
US(((( who is personally known to
me or who has produced 1223(a 65R. 89 411 Oas
identification and who did take an oath.
NOTARY PUBLIC:
Print:
SULAINE NIEVES
Seal: ?'; r �` ' Notary Public - State of Florida
. ; Commission # GG 180483
••.'••','�c...; a,�.• My Comm. Expires Jan 29.2022
,,,,,, BonCeC:nroaghNa�ona NcaryAssn.
Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)