EL-18-3614Miami Shores Village RECEIVED
d Building Department JUN 1." 201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 , 1 ,
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20�l
BUILDING CANCELMaster Permit No. 1 L-1Z - k V -3614
PERMIT APPLICATION •,��. LED Sub Permit No, _. 4
❑BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP
Q CONTRACTOR DRAWINGS
� JOB ADDRESS: 1 W _\ S� 54
City: Miami Shores County: Miami Dade Zip: 2111 S 0
Folio/Parcel#: 1 k— 310 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type:
I i"
OWNER: Name (Fee Simple Titleholder):
Flood Zone: EFE: FFE:
_= rn t.4- Q r LL C
Phone#: —120 -29-7 -S 33g
Address: !j-;,L. 7 I- 1
City: M L o'c P �_ State: Q in
c l c, Zip: C
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: 1 V\ Q�C O P cirl Phone#: QS
Address: o
City: 0-/ti^� State: Zip: I I //?
Qualifier Name: V1� to r "t r n (k^ 1 k Z// Phone#: 9 S y- (4I 0 "—O34 y
State Certification or Registration #: r '��0 J S 2 b Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
City:
ne#:
Zip:
Value of Work for this Permit: $ C1 0 J Square/Linear Footage of Work:
Type of Work: 0 Addition.., ❑ Alteration NewRepair/Replace:r� +, m 0-'Demolition
9 !; Description of Work �
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $ _
CCF $ CO/CC $
DBPR $ Notary
Double Fee $
Bond $
(Revised02/24/2014)
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 � •ii , � .,
q
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 Signa re
OWNER or AGENT CONTRACTOR
The f reping instrument was acknowledged before me this
day of L 20 ` by
t,C r` GOX G1.who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
CARLO8 E CERRATO
Sign: MY COMMISSION # FF907262
•�
Print: i4t 398153 , FbAds mca.com
Seal:
F-11
The foregoing instrument was acknowledged before me this
Or day of I 20 C S by
M a r`4 Q ho is p onal ly known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
**************s**s*s***rssss*r***s•****r*�*****r***************:**
APPROVED BYt, ,J CAI Y Plans Examiner
Structural Review
MARtA SIJ&W RUIZ-GONZALEZ
MY COUL41SSION 0 Q007879
_ ( EXPIRES: July 4, 2=
Zoning
l
i
Clerk
(Revised02/24/2014)