PLC-18-3665BUILDING
Miami 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
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BY:
FBC 20 I�T
Master Permit No. �-c!
1411A
PERMIT APPLICATION
� Sub Permit No.
LED
❑BUILDING ❑ ELECTRIC ❑ ROOFING
0 REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [--]PUBLIC WORKS
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 15 t9 Q E LoS- 5
UylYi I — Z,
City: Miami Shores County:
Miami Dade Zia:
Folio/Parcel#: 1 l - Z Z 30 - 05 3 — OSOD
Is the Building Historically Designated: Yes NO "
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name Simple Titlehol`der):_ ��y
` r p� �
y ��S C7 Phone#:-404 - 3�-A-114
I(Fee
p
Address: , "_) L K) ���1�^
City: M' � Q,�..� � S `l \UY-(-S State:
1 ,{ C
C' \ (A & Ck Zip:
Tenant/Lessee Name: - NA I
Phone#: 7�
^E (� \' / 1�
Email: �Q(1�1���(�\`l;SlyVA9 VIiv�Oy.
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CONTRACTOR: Company Name: F V 1) Se I V i ck P) VI
to i ng Phone#:gsi ?1 2 -7 8S 2
Address: y bg q OIQ11I9 d (I V -C
City: 00y i t State: F(
Zip: ? 3 3 1
Qualifier Name: 10, k N\6d Ad e
Phone#: 9s" N a 9 0
State Certification or Registration #: C FC l 1/ 3 179 9
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#: `
Address:
City: State: Zip:
Value of Work for this Permit: $ Z o Oy
Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑(N'e�w ❑ Demolition
❑�
,„-❑
Description of Work: �•f`�%fl��[� �E � l I, y I ee
/Repair/Replace
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T LO, SW�'r Gj Li IIIF 6*06k +b
7 1+ &W U-6« IILv� � vtieF� 5t74
i
Specify color -of color tiiru t►le: ._ �" < k�
.�140 • i i it 4
_rd
Submittal Fee $' '�' ` Permit -If
Fee $`
CCF $ CO/CC $
yyy�y"ny:yY..Yrr�W^M,�y.ysdr--.a�+�r
Scanning Fee• $" Radon Fee $
DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $
Bond $
/ �7
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company'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 attackrent. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ' h; a c rs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be a ro d nd a reinspection fee will be charged.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
ll 'J'' day of I/O(j- n h--*- 20 / �- by
DC1t' 1 P S Q who is personally known to
me or who has produced as
The foregoing instrument was acknowledged before me this
day of b T C- , 20 !y , by
/� Joeyk- who is personally known to
me or who has produced
identification and who did take an oath. identification and who did take an oath.
as
NOTARY PUBLIC: NOTARY PUBLIC:
r ,
Sign: Sign: nn
Prin . L Print:
Seal: :: ;.`: Commission # FF 917472 Seal:
Expires September 21, 2019 DIAZROMERO..e
`'2 ;a as aea Thu Trey F* k .ar.0amssro+e s.: ;.: W COIr MMON # GO 2t�2659
EXPIRES: SePMW 26, 2022
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APPROVED BYy ���� Al? Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)