PL-18-1348Miami Shores Village
RECEIVED
Building Department MAY 17 2018
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 204�'
BUILDING CANCEL�.ED Master Permit No.�"1
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
[PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
1 CONTRACTOR DRAWINGS
JOB ADDRESS: Iy`o`� NG ��ST
City: Miami Shores County: Miami Dade Zia_334_36
Folio/Parcel#: I ( - 3ZO S _ 02-7-0,0'25 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /"/F 4f'i ` w/en< �i�'1.5D� Phone#: Wk r� 12 23
Address: r 1ZS Alm�', E�KI-N_Cho/� 60'y c�
City: h ,-� i 1/10✓es State: Zip: i3y
Tenant/Lessee Name: Phone#:
Email
CONTRACTOR: Company Name: r} A_Qyo r1 r �`-�T-� S_jp Phone#: �w T a o f 6
Address: � )a 2-2- (SLo 3S C± J'�1
City: M(� �Cl Y�� ✓ State: n, Zip: �3 3
Qualifier Name: C 1 b �'^ T Phone#:
State Certification or Registration #: J A' 0 vl 210
ficate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $$SOO Square/Linear Footage of Work: t) 00
Type of Work: ❑ Addition ❑ Alteration ❑ New X Repair/Replace ❑ Demolition
Description of Work:
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Y
Specify color. of --pl6e..thru WIL
Submittal Fee $ Permit Fee $ 300 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ T. Notary $
Technology Fee $ Training/Education Fee $
Structural Reviews S
(Revised02/24/2014)
Double Fee $
Bond $ EM • Q
TOTAL FEE NOW DUE $ 2 S O
� (Sc) e--iO
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) A AA
Mortgage Lender's Address
Zip
City State r , 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
promise in good faith that a copy of the notice of commencement and construction lien i
whose property is subject to attachment. Also, a certified copy of the recorded notice of o,
for the first inspection which occurs seven (7) days after the building permit is issu
inspection will no approved and a re' ection fee will be charged.
Signatur Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
lS day of M 12018 by
�y VlSWrlio is personally known to
�'(� C9nC. 1 P Y
me or who has produced (!) as
identification and who did take an oath.
NOTARY PUBLIC:
'ue exceeding $2500, the applicant must
brochure will be delivered to the person
,encement must be posted at the job site
the absence of such posted notice, the
CONTRACTOR
The foregoing instrument was acknowledged before me this
�S day of M0.N 20 IS by
John 'Tv who is personally known to
me or who has produced' In as
identification and who did take an oath.
NOTARY PUBLIC:
,
Sign: L
Sign:
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Print:��'�
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Print:
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Seal: *
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My COMMISSION # FF 0161Seal:
EXPIRES: November 5, 2018
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1ERES J.amok"
i FF 92610
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gotdihru8udg�lNotxyS
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My COMMISSION
EXPIRES: November 8, 2010
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APPROVED BY.
% �i
Plans Examiner
Zoning
Structural Review
Clerk
(Revised02/24/2014)