EL-18-3334Miami Shores Village
Building Department
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 c�i -2
BUILDING �j16I.LED
Master Permit No.
PERMIT APPLI TION Sub PermitNo.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 " `l/ Sf I1 2(j1i $�Or� 3 3 112
City: Miami Shores County: MiamrDade Zin:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: (1
OWNER: Name (Fee Simple Titleholder): ALVA� UA UE: �`A M Phone#: 3D1 302 -9"5- —
r 1 Address: l < Al (, q P" SfWT-
City: 11 14M I^ State: F L Zip: 331120
Tenant/Lessee Name: Phone#: 'D1 )Z 3 S qT
Email: Ub VM�F2�`tfir+i �Mg,e (�/►�,
CONTRACTOR: Company Name: I)or l Cat` me Phone#: _ %96 41 q 7-13-5
Address: 1 0 0 S w J O 4 C--k 7 8 C 2-6-11Z
City: Miaw,% State: P l Zip: `-33171 G
Qualifier Name: r1,1(ArQ5 VA err ay\ (A QZ Phone#: '7 rg LI I q ?-I
State Certification or Registration #: Ec 1'; 0% G d 80 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 600 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑
Description of Work: VI-g. e f
Specify color of color
tt hru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
New
Zip:
❑ Demolition
LK �9 I
/070e Od CCF $ CO/CC $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
Notary $
Double Fee $
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
Zip
State 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 fai that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is s bj to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not h(e appr ved and a reinspection fee will be charged.
Signature
or
CONTRACTOR
The foregoing instrument was ack w dged before me this The foregoing instrument was acknowledged before me this
30 day of d CfD%p r 20 ! &` by Ada day of o cnbor 20 l � by
A IVafO a ley la `l l who i sonally known to Ancife5 d of ooK 13 who is personally known to
me or who has produced �Y 1 JP(' I j ('.12 f 6e as me or who has produced DYi Yef I i C:e n5e' as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: /
Print:
� M.
MALUVRAUU
JAM
Seal: Notary Public • Slate of Florldo
,y owe ComNsslon #F GG 000021 I
�'`' My Cofm..Exore; Oot 2), ZW
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
Notary Public • State of Florida
Comc-mission * GG 008421
My COOT. Expires Oct 23, 2020
****ss******ss**s*ss*s*s***sss*ssss***ss*s***********sss*****sssssss**sss*******sss*****s***ss***ss*s**sssss
APPROVED BYPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)