EL-18-1682Miami Shores Village RECEIVED
Building Department JUN 20 1018
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 20V--i-
BUILDING CANCELLED Master Permit No.E r bo
PERMIT APPLICATION Sub Permit No.
F-IBUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 2b S we 01( S1'
City: Miami Shores /j County: Miami Dade Zip:
Folio/Parcel#: 1 • 3� o • � i� 3��0 Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 301' e f (2-01EYL71- W i WA MSan Phone#: '-305 boa R qb:� S
Address: '1 Z 3 .S til C olb S%'
City: i"n k 4,n I sOrb sty State: --p L Zip: 3 3/-38
Tenant/Lessee Name: Phone#:
Email: j7.+ r5egj, r. UUI41AZOAM tQ 6644 L • QM
CONTRACTOR: Company Name: S FbE - I G +( U) R-P Phone#: 3, an 31
Address: 3 S- � 129 f �� r1F 3 �i/
City: � 1 AIM i State: L Zip: 33 �910
Qualifier Name: 4EW Axt/b0 iz• PE1145L Phone#: (odd 313
State Certification or Registration #: I ?)Oo 2, I 0 Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ �2 Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: P"V A �DEF IV\ -A<M y At- rtR-A-AK PEA. FW 7104 04 T--6 iL
17-01Uri�c I?C C'aTri'r5 uc-
Specify color of color thru tile:,
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $ CO/CC $
Radon Fee $ y 4 S DBPR $ 6 ' 6� Notary $
Training/Education Fee $
Double Fee $
Bond $ / r C'
TOTAL FEE NOW DUE $ �+ 3 S T�
(Revised02/24/2014)
I
r,
Al Franco r
Ibex ex Project Manager
V /� Franco[Dibextechcorp.com
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Ibex tech core.
00000 IZ=3SS SW ic'9 Court, Suite- a
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www.ibpxtPchcorp.com
EC1�002786
Bonding Company's Name (if applicable)
Bondyig•Comvoany'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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap ra,,,ens
ctio fee will be charged.
SignaturSignature
o 4
CONTRACTOR
The foregoing instrument was ackl owl dged before me this The foregoing instrument was acknowledged before me this
It day of -7 0 lu'T 20 ) Y U
by 19 day of �r4'9 120 78 by
Q0JI517r W I (-1I *7Y(gM who is personally known to ltlk~ a ;+ _ who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign: 1 �,�,
Print: � `C �
NOTARY PUBLIC:
i�aSign:
Print: A -
Seal: Seal: ti;v'n''•., MICHELLLERENA
,.• �;RY v�;'•• MICHEL LLERENA '+° Nota a 5n,
. ry Public - State of Flaldallotary Public - State of Florida • Commission k GG 145599
CommissionM GG 145599 , r r. ? My Comm. Expires Sep 24,20g1
+ My Comm. Expires Sep 24, 202114�•
************�ia*ryAus*
APPROVED BY
B Plans Examiner
Zoning
(Revised02/24/2014)
Structural Review
Clerk