PL-17-2367Miami Shores Village OCT o41
017
Building Department 14-"
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (30S) 762-4949
FBC 20
BUILDING CANCELLED
Master Permit No. �- ��14- 618
PERMIT APPLICATION Sub Permit No.l —I Z � �
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
mPLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 10,r S�
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: I/ z 2 f� / 01540,24) 10 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 8`'fQ 2�_4 A.)1J ,_C,- I& SOA# 9A)616tPhone#:
Address: 3s i(%4g�'
City: �A.J4 dA
Tenant/Lessee Name:
Email
State:�Zip:
Phone#:
CONTRACTOR: Company Name: Ae'�(' �1 ('� �-�_ *y 1 Ce4 (.1C. Phone#:
Address: %. 4 Z-3 S w pL
City: AX4 State:L. Zip:
Qualifier Name: - Phone#:�lea,(?J2
State Certification or Registration #: CSC % 2 Z€3G Certificate of Competency #:
DESIGNER: Architect/Engineer: ` Phone#:
Address:
State: Zip:
Value of Work for this Permit: $ O —0 C� Square/Linear Footage of Work:
Type of Work: ❑ Addition' ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
❑ Demolition
Pr ono-t�-- 151 /rl �c e�vJ I.GG�c�
♦ /� v_
"1 4 .} .. SY'�;°°. S�Fn+J ♦ tt; x� " R
Specify color;of color�thru. tile:
Submittal Fee $ -Permit Fee $�� ��7 CCF $ CO/CC $
Scanning Fee $
Radon Fee $ Z ' 4OC3
Technology Fee $ Training/Education Fee $
Structural Reviews $
DBPR $ .0 , ?•� Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ I o
(Revised02/24/2014)
Bonding Coinipany's`Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zi
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(. RIF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YQUf `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 6timated value exceeding $25'00, 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 approvedand a reinspection fee will be charged.
Signature \ Signature
OWNER o ,XGGENT CONTRACTOR
' The foregoing instrument was acknowledged befor a this The foregoing instrument was acknowledged before me this
day of 20 by day of e� 20 by
' who is personal) known to ��"C[�S!'D1��Q ;his personally k6pwn to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: Jorge Ortigosa
Notary Public St. du of Florida
FF 952774 - Exp 02.07.2020
identification and who.did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal:
MY COMMISSION 0 FF921130
EXPIRES November 27.2019
APPROVED BY (�'�Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)